What Causes Postpartum Headaches and How Are They Treated?

Some causes of a primary headache in the postpartum period include:

• personal or family history of migraines
• shifting hormone levels
• weight loss related to hormone level drop
• stress
• lack of sleep
• dehydration
• other environmental factors

Some secondary postpartum headaches can be caused by:

• preeclampsia
• use of regional anesthesia
• cortical vein thrombosis
• some medications
• caffeine withdrawal
• meningitis

Breastfeeding doesn’t contribute to postpartum headaches directly but you may have a headache while breastfeeding for a few different reasons:

• Your hormones may fluctuate while breastfeeding, leading to a headache.
• You may be physically or emotionally drained by the demands of breastfeeding, resulting in a headache.
• Lack of sleep or dehydration could be causing a tension or migraine headache.

You should talk with your doctor if you have frequent or severe headaches while breastfeeding.

The type of postpartum headache you have can vary. Some are more common than others. One study reported that in their sample group of 95 women with postpartum headache:

• nearly half had a tension or migraine headache
• 24 percent had a headache related to preeclampsia
• 16 percent had a headache caused by regional anesthesia

Primary headaches

Tension

It’s not uncommon to experience a tension headache. Generally, these headaches are mild. Your head may ache on both sides in a band around your head. The headache could last 30 minutes or linger for up to a week. Tension headache can be caused by stress as well as environmental factors, such as lack of sleep or dehydration.

Migraine

Migraines are severe, throbbing headaches that often occur on one side of your head. They can also include symptoms like nausea, vomiting, and sensitivity to lights and sounds. They can leave you unable to function for hours or even days.

The American Migraine Association states that 1 in 4 women will have a migraine within the first two weeks after childbirth. This may be due to the dropping hormones that occur in the days following childbirth. You may also be more susceptible to a migraine because of the around-the-clock care your baby requires.

Like tension headaches, environmental factors can trigger a migraine.

Secondary headaches

Secondary postpartum headaches occur because of another medical condition. Two of the most common causes are preeclampsia or regional anesthesia.

Preeclampsia

Preeclampsia is a very serious condition that can occur before or after childbirth. It’s when you have high blood pressure and possibly protein in your urine. It can lead to seizures, a coma, or, left untreated, death.

Headaches caused by preeclampsia can be severe and may:

• pulse
• worsen with physical activity
• occur on both sides of your head

You may also have:

• high blood pressure or protein in your urine
• vision changes
• upper abdominal pain
• decreased need to urinate
• shortness of breath

Preeclampsia is a medical emergency. Contact your doctor immediately if you suspect preeclampsia.

Postdural puncture headache

The use of regional anesthesia during childbirth carries some potential side effects. One of these is a postdural puncture headache.

Postdural puncture headache can occur if you receive an epidural or spinal that accidentally punctures your dura prior to delivery. This can lead to a severe headache with the first 72 hours following the procedure, particularly when you stand or sit upright. You may also experience other symptoms such as:

• neck stiffness
• nausea and vomiting
• vision and hearing changes

A doctor must supervise the treatment for this condition. Most cases can be resolved with more conservative treatment approaches within 24 to 48 hours. Conservative treatment may include:

• rest
• drinking more water
• caffeine

It may be necessary to treat the condition with a more invasive treatment, such as an epidural blood patch.

While headaches are a relatively common occurrence, you should take note of the symptoms of a postpartum headache. Contact your doctor immediately if your headaches:

• are severe
• peak in intensity after a short period of time
• are accompanied by other concerning symptoms like fever, neck stiffness, nausea or vomiting, visual changes, or cognitive problems
• change over time or when you move into a different position
• wake you up from sleep
• occur after physical activity

Your doctor will discuss your symptoms as well as conduct an exam. You may need additional tests and procedures to diagnose a secondary headache.

Treatment of a headache depends on the type.

Treating primary headaches

Tension and migraine headaches can be treated with over-the-counter nonsteroidal anti-inflammatories, such as naproxen (Aleve) and ibuprofen (Advil). Most of these are safe to take while breastfeeding, with the exception of aspirin.

Contact your doctor if you are taking another type of medication for headaches and want to determine whether it’s compatible with breastfeeding.

Treating secondary headaches

Secondary headaches should always be treated by your doctor and may involve a more intense treatment than primary headaches. You should discuss the risks of treatments for secondary headaches if you’re breastfeeding.

Taking care of yourself is an important way to prevent tension and migraine headaches. This can be easier said than done in the early days of caring for a newborn.

Here are a few tips for preventing the occurrence of primary headaches:

• Get enough rest. Try to take naps when your baby naps and ask your partner or a friend to watch over the baby between feedings.
• Drink plenty of fluid. Tote around a large water bottle or make sure you have a glass of water by your side.
• Eat healthy foods regularly. Stock your refrigerator and pantry with nutritious foods that are convenient to prepare and eat.
• Try to relax to reduce stress. Take an easy walk, read a book, or chat with a friend to alleviate stress.

There are many causes of postpartum headaches. Despite the cause, postpartum headaches should go away within 6 or so weeks of delivering your baby.

Most often, postpartum headaches are tension or migraine headaches, which you can treat at home or with the help of your doctor. More severe secondary headaches should be seen by your doctor immediately and may require a higher level of treatment to prevent more serious symptoms from occurring.