November 5, 2019

By Kimberly Langdon, M.D., OB/GYN

Like headaches in general, postpartum headaches may be from a variety of causes. Sometimes the causes are not directly related to the postpartum phase like, for example, tension (stress) and migraines that existed pre-pregnancy. Sometimes they are directly related, like a spinal headache that results from an epidural or spinal block, and sometimes changes during postpartum can amplify the causes, like low glucose, weight loss, medications, caffeine withdrawal, and fatigue. Despite the fact that many of these headaches are no cause for concern, postpartum headaches are sometimes a sign of something more serious.

What triggers postpartum headaches?

There are wide fluctuations in both hormones and blood volume postpartum, which can both trigger headaches. All that excess fluid that was gained during the pregnancy needs to be eliminated in the urine, and this starts about one to two days postpartum. The best thing to do is to continue to drink beverages because maintaining adequate fluid in the bloodstream helps prevent headaches and might even relieve one.

Related: Got cankles? How to reduce leg swelling after childbirth

The estrogen and progesterone levels drop suddenly which can also trigger headaches although the mechanism is not well understood. Excessively low or high estrogen and rapid decreases can all lead to headaches primarily of the vascular nature—like migraines.
Migraine headaches often return during the first-week postpartum, and lactation may affect the frequency and severity of the headaches depending on whether the person is susceptible or triggered by low estrogen found during lactation..

How common are postpartum headaches?

Postpartum headaches occur in about 34% of women, usually between days 3 to 6. Postpartum headaches are usually less severe than typical migraines. They tend to be on both sides rather than one side, prolonged and associated with visual changes, sensitivity to light, nausea, and decreased appetite.

What can you do about them?

To treat postpartum headaches, over-the-counter pain relievers are typically recommended. While some of these medications are not safe for use during pregnancy, they can be used postpartum while breastfeeding. The following medications are safe:

• Ibuprofen (Advil)
• Acetaminophen (Tylenol)
• Naproxyn (Aleve)
• Aspirin (low-dose, short-term use)
• Caffeine (in moderation, up to 500mg or about 5 cups of coffee per day)

If your headaches or migraines are severe, your doctor may also prescribe one of the following medications:

• Meperidine
• Codeine
• Morphine
• 5-HT1 = serotonin receptor subtype 1

Beta-blockers can be used postpartum to prevent future migraines. A good schedule of sleep (unlikely for new moms), adequate fluid intake, and avoiding hypoglycemic episodes (when your blood sugar levels drop) are the easiest ways to avoid headaches. One way to keep your blood sugar levels consistent is to have small snacks like nuts, fruits, and veggies throughout the day.

When to be concerned?

Despite how common and often harmless headaches are postpartum, they can occasionally be a sign of something more serious. One of the obstetrician’s worst patient phone calls starts with, “I have a headache, and I just delivered a baby.” The biggest worry is postpartum preeclampsia or toxemia. In the case of preeclampsia, the situation is more grave since they can lead to seizures if the condition is unmonitored or untreated.

Related: Childbirth complications and warning signs

Preeclampsia is a poorly understood condition affecting pregnant (and in rare cases postpartum) women that causes kidney dysfunction, high blood pressure, protein in the urine, dehydration, and other potentially other more serious events. Headaches, swelling in the hands, feet or face, high blood pressure, and visual changes are the hallmarks of the condition. Generally, the risk of serious complications are rare, but the treatment consists of magnesium infusions and delivery if the mother is pregnant and full term.

There are more serious causes for headaches such as meningitis, stroke from clots or hemorrhage, seizures, and brain tumors. If your headache is severe such that it scores 6 or higher on a 1 to 10-point scale, or you have other unexplained symptoms, talk to your healthcare provider.

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