The 411 on why headaches are so common in pregnancy, and what you can do about them.

By Danielle Braff

Having a baby can give you a headache—literally. Hormonal changes, lack of sleep, caffeine withdrawal, dehydration, and stress can all add up to a massive pain in the brain during your pregnancy and immediately postpartum. In fact, about 80% of women will experience some sort of headache during their childbearing years, says Ilona Goldfarb, M.D., an ob/gyn at Mass General Hospital in Boston and an instructor at Harvard Medical School.

Think you’re going to be lucky because you’ve never had a headache before? Think again. As many as 15% of women who have never experienced a migraine will get one during their first trimesters. You can thank your hormones for that little treat: Estrogen levels go crazy during the first dozen weeks or so, and because there are estrogen receptors in the brain, they fluctuate and send a signal of pain to your head, Goldfarb says.

Once you’re over the first-trimester hump, hormonal levels start to even out—but the headaches may continue. Tension headaches are super common throughout pregnancy and during the first two months postpartum for many reasons, Goldfarb says.

If you can’t find a comfy sleeping position and don’t get a good night’s sleep, or baby is waking you up at the crack of dawn, you may have a tension headache. General stress or dehydration can also be behind these headaches. (We know, even though you’re aware you should be drinking water, sometimes the very idea of keeping down liquids makes you queasy!). It’s important to eat small, frequent meals, too, because low blood sugar can trigger tension headaches.

During your third trimester, there's yet another headache that can come on, this time accompanied by nausea and fever. This one’s more serious and may be a sign of preeclampsia, a condition that’s potentially very dangerous for you and your baby, Goldfarb says.

But don’t stress out—that'll just lead to another headache! Instead, take our quiz to figure out what type of pain you may be experiencing—and learn how to zap it even when you’re pregnant or breastfeeding.

Mother of one Danielle Braff says her current pains in the head come mostly from staring at her computer screen. Her articles have appeared in numerous publications, including Health, SELF, and Kiwi.

Med-free Methods
The American Pregnancy Association (americanpregnancy.org) recommends these natural remedies for a headache:

• Place cold compress or ice pack at the base of your neck.
• Take a warm shower or bath.
• Rest in a dark room and practice deep breathing.
• Ask your partner to massage your neck and shoulders.

Headache Help
Being pregnant can make your head hurt, but it doesn’t have to. Circle your answers to figure out the cause behind the pain, plus how to get past it.

You are:
A. In your first trimester or postpartum period
B. In your second trimester
C. In your third trimester

On a scale of 1 to 10, your headache is:
A. Somewhere between a 7 and a 9. You can’t think clearly. You see spots and feel like throwing up or lying in bed all day.
B. 5. The pain goes across your head; it feels like you’ve got a baseball cap on too tightly. It also reaches down to your neck.
C. 10. In addition to your headache, you’re nauseous and even have a fever.

Before the headache arrived:
A. You saw flashing lights or bright lights and felt numbness in random parts of your body.
B. You were stressed and tired and grouchy, like from a lack of caffeine.
C. Your heart was racing and your face and hands were swollen.

Scoring

Mostly A's You have a migraine. Estrogen levels fluctuate during your first trimester and up to two months postpartum, so you’re right in the zone for these severe headaches. About 60% of women in their childbearing years link migraines to hormonal changes, says Susan Hutchinson, M.D., director of the Orange County Migraine and Headache Center.

Pregnant women can safely take acetaminophen (aka Tylenol), but it may not be enough. If your migraine is accompanied by nausea, ask your ob/gyn to prescribe Zofran or Reglan. Breastfeeding moms can take Tylenol, Excedrin, or migraine medicines such as Imitrex without worrying about dumping their milk. With migraine-specific drugs such as Amerge, Maxalt, or Relpax, you’ll have to “pump and dump” to protect the baby, Hutchinson says. Acupuncture and biofeedback treatments can also work to naturally lessen migraine frequency and intensity.

Mostly B's It’s a tension headache. Lack of sleep, stress, dehydration, and even bad posture can make your head feel like it has a rubber band wrapped around it. You can get this kind of headache at any time during pregnancy or postpartum. Fortunately, it’s not debilitating and can usually be cured with Tylenol.

Tension headaches can also be caused by caffeine withdrawal, so slow down your caffeine intake gradually, dropping one serving daily, Hutchinson says. If tension headaches return regularly, make sure you’re getting 8 hours of sleep nightly, drinking about 64 ounces of water daily, and minimizing your use of artificial sweeteners. Pay attention to your posture, too.

Mostly C's You may have preeclampsia, a pregnancy complication usually occurring late in the second trimester or at any time in the third trimester. The headache is accompanied by elevated blood pressure, swelling, and protein in your urine, something the hospital can test. Call your ob/gyn right away. If the preeclampsia is severe, you may have to deliver your baby early.