Headaches are common in pregnancy, especially in the first and third trimesters. They are usually caused by hormonal changes, dehydration, fatigue, or tension. Paracetamol is safe to take during pregnancy; ibuprofen and aspirin should be avoided unless prescribed. Seek urgent medical help if you have a severe headache that does not respond to paracetamol, especially after 20 weeks, as this can be a sign of pre-eclampsia.
Headaches during pregnancy are very common and usually not a cause for concern. The main causes include:
Hormonal changes. Fluctuating oestrogen and progesterone levels in the first trimester can trigger headaches. Many people who are prone to migraines find they improve in the second trimester when hormones stabilise, while others experience them for the first time during pregnancy.
Dehydration. Pregnancy increases your fluid requirements. Not drinking enough water is one of the most common and easily fixable causes of pregnancy headaches. Aim for 6 to 8 glasses of water per day, more in warm weather or after exercise.
Fatigue and poor sleep. Pregnancy fatigue, disrupted sleep, and changing sleep positions can all contribute to tension headaches.
Caffeine withdrawal. If you have recently reduced your caffeine intake for pregnancy, withdrawal headaches are common in the first week or two. These usually resolve as your body adjusts.
Tension and posture. As your body changes shape during pregnancy, your posture shifts. Carrying extra weight, particularly in the third trimester, can cause neck and shoulder tension that leads to headaches.
Low blood sugar. Skipping meals or going too long between eating can cause blood sugar drops that trigger headaches. Small, frequent meals help maintain steady blood sugar levels.
Nasal congestion. Pregnancy hormones can cause the lining of the nose to swell, leading to stuffiness and sinus-type headaches. This is called pregnancy rhinitis.
Paracetamol. Paracetamol is considered safe during pregnancy when taken at the recommended dose (up to 1g, four times daily). It is the first-line painkiller recommended by the NHS. Take the lowest effective dose for the shortest time needed.
Avoid ibuprofen. Non-steroidal anti-inflammatory drugs (NSAIDs) including ibuprofen, naproxen, and aspirin should be avoided during pregnancy unless specifically prescribed by a doctor. Ibuprofen is particularly risky in the third trimester as it can affect the baby''s circulation and reduce amniotic fluid.
Avoid aspirin unless prescribed. Low-dose aspirin (75 to 150mg) is sometimes prescribed to reduce the risk of pre-eclampsia, but this is different from taking standard-dose aspirin as a painkiller.
Rest in a dark room. For migraine-type headaches, lying in a cool, dark room can help. Apply a cold compress to your forehead or the back of your neck.
Stay hydrated. Drink a large glass of water as soon as you feel a headache starting. Dehydration headaches often respond quickly to rehydration.
Regular meals. Eat small, frequent meals to keep blood sugar stable. Complex carbohydrates and protein provide sustained energy.
Gentle massage. Tension headaches can be eased by gentle massage of the temples, neck, and shoulders. Ask your partner or consider a pregnancy-specific massage.
Fresh air and movement. A short walk in fresh air can help with tension headaches. Regular gentle exercise helps prevent recurrence.
While most pregnancy headaches are harmless, some require urgent medical assessment. Contact your maternity unit immediately if you experience:
A severe headache that does not respond to paracetamol, especially after 20 weeks of pregnancy. This is one of the key warning signs of pre-eclampsia.
A headache accompanied by visual disturbances (blurred vision, spots, flashing lights). A headache with sudden swelling of the face, hands, or feet. A headache with pain just below the ribs. A sudden, severe headache that is unlike any you have had before.
Pre-eclampsia is a serious condition that requires prompt treatment. Regular blood pressure checks at your antenatal appointments are one of the main ways it is detected. If you have any of the symptoms above between appointments, do not wait — contact your maternity unit.
If you had migraines before pregnancy, they may improve (particularly in the second and third trimesters) or they may continue. Many migraine medications are not safe during pregnancy. Speak to your GP about which treatments are appropriate. Triptans, for example, are generally avoided during pregnancy due to insufficient safety data.
Keeping a headache diary can help identify triggers. Common triggers include specific foods, stress, bright lights, strong smells, and irregular sleep patterns.
Yes, paracetamol is considered safe during pregnancy when taken at the recommended dose. It is the first-line painkiller recommended by the NHS for pregnant people.
Ibuprofen and other NSAIDs can affect the baby's circulation, reduce amniotic fluid, and may increase the risk of complications, particularly in the third trimester. Always use paracetamol instead.
A severe headache that does not respond to paracetamol, especially after 20 weeks of pregnancy, can be a warning sign of pre-eclampsia. Seek urgent medical advice if this occurs, particularly with visual disturbances or sudden swelling.
It varies. Some people find migraines improve during pregnancy (particularly in the second and third trimesters), while others experience them for the first time. Speak to your GP about safe treatment options.
Yes, dehydration is one of the most common causes of pregnancy headaches. Pregnancy increases your fluid needs, so aim for at least 6 to 8 glasses of water per day.
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