Treatment of Headaches in Pregnancy We all want to avoid potential medication side effects. Non-medication treatments are the best option, and it would be well worth your time to investigate all of these options. A Dietary Approach A dietary approach during pregnancy should not include an overly strict elimination diet. Certainly many of the common triggers can be eliminated without harm and may improve the overall health of the diet. In pregnancy, I would focus on the least healthy ones such as cheese, chocolate, eggs, processed meats (nitrates), caffeinated drinks, monosodium glutamate, and aspartame. Common Triggers Common triggers often cause headaches in susceptible people. Just as some food sensitivities manifest as a rash on your skin, migraine sufferers have a reaction in the blood vessels and nerves. Here are the common food triggers, also known as the "Dirty Dozen," in order of importance: • dairy products* • chocolate • eggs • citrus fruits • meat** • wheat (bread, pasta, etc.) • nuts and peanuts • tomatoes • onions • corn • apples • bananas * Includes skim or whole cow’s milk, goat’s milk, cheese, yogurt, etc. ** Includes beef, pork, chicken, turkey, fish, etc. Certain beverages and additives are also among the worst triggers, including alcoholic beverages (especially red wine), caffeinated drinks (coffee, tea, and colas), monosodium glutamate, aspartame (NutraSweet), and nitrites Vegetarian Diet A healthy vegetarian diet eliminates many of the triggers (meats and nitrates, dairy). Additionally, increasing the fiber content and decreasing the fat content of the diet may also help reduce the number of headaches. One study suggested a 50% reduction in the number of headaches in patients switching to a vegetarian diet. Vegetarian diets in pregnancy are very healthy. Vegetarian moms have a lowered risk of pregnancy-induced hypertension, pre-eclampsia, excessive weight gain and gestational diabetes. I would suggest that the fat content of the diet be about 15- 20% of total calories, though that fat should come from natural unprocessed sources like avocado or nuts rather than bottled oils. I also suggest taking a vitamin B12 oral supplement of 100 mcg per day or 1,000 mcg once a week. I generally suggest all pregnant women, whether vegetarian or not, make sure they are getting sufficient folate, about 600 mcg per day from either foods or supplements, vitamin D through sun exposure or supplementation at 400 IU per day and consider supplementation with DHA (an omega 3 fatty acid) of 200 mg per day. See my web page discussion about DHA. For more information on vegetarian diets in pregnancy I suggest reading this book, click on the link to order or you can order it from Amazon: Your Vegetarian Pregnancy: A Month-by-Month Guide to Health and Nutrition By Holly Roberts, D.O., F.A.C.O.G. Fulfilling every nutritional guideline recommended by the American College of Obstetrics and Gynecology, this book is the first authoritative guide to maintaining a healthy plant-based diet before, during, and after the birth of your child. Here is a short web page: Vegetarian Diets in Pregnancy I have other web pages about a vegetarian diet at Moving Towards a Plant Based Diet Consider Modifying the Elimination Diet. Just don’t make the diet quite so strict. Foods that Fight Pain. by Dr. Neal Barnard. If you are considering this, make sure you talk to me or a nutritionist first. Reduced Sodium Diet Excessive weight gain and water retention during pregnancy may increase the likelihood of headaches, and may cause a condition called Idiopathic Intracranial Hypertension. This condition is very difficult to treat just using pain medications. The headaches are crushing and severe. Though, if you can reduce your sodium intake to 1,000 to 1,500 mg per day and avoid gaining more weight than necessary, it’s possible to completely get rid of these headaches. If you are unable to get the sodium out of your diet, and we have made this diagnosis, sometimes it’s necessary to use a diuretic named Acetalzolamide. See my web page on Low Sodium Diets Medications I like to use Tylenol for acute headache treatment. I use 325 mg tablets. I limit the dosage to three tablets per day. As well, I limit the use of Tylenol to only two days per week. This helps avoid medication overuse (rebound headache). I will sometimes use Magnesium Oxide 400mg tablets once a day for preventative treatment. This may help reduce the number of headaches in a month. It will take several weeks of treatment for this reduction to become apparent. I insist on discussing this supplement with you prior to your starting. It is not appropriate for some people. Do not take supplements or herbal medications during pregnancy without consultation with your physician I avoid the use of Ergots (DHE, Cafergot), the Triptans (Imitrex, Zomig, Maxalt, etc.), Aspirin and the Non-Steroidal Anti-Inflammatories (Naproxen, Motrin). I generally don't use medications with narcotics (Percoet, Vicodin) or barbiturates (Fioricet) for headache if they can be avoided. These last medications, if used more than one time per week, have the potential to cause rebound headache. Concerning preventative medications, I don't use anti-seizure medications (Topamax, Depakote, or Neurontin). I like to avoid the Tricyclic Anti-Depressants if possible (Elavil, Pamelor). In general, I usually try to stop all prescription preventative medications. I ask that my pregnant patients discuss any new headache medication (whether over-the-counter or prescription) with her Obstetrician prior to starting. Other Alternatives MigraCap - a ice chilled face mask Velcro Headband - may be helpful Acupuncture - some report good benefit Mind-Body Therapies - some evidence of benefit Sleep Hygiene - see this web page on effects of improved sleep on reducing headaches Return to Headaches

Treatment of Headaches in Pregnancy

We all want to avoid potential medication side effects. Non-medication treatments are the best option, and it would be well worth your time to investigate all of these options.

A Dietary Approach

A dietary approach during pregnancy should not include an overly strict elimination diet. Certainly many of the common triggers can be eliminated without harm and may improve the overall health of the diet. In pregnancy, I would focus on the least healthy ones such as cheese, chocolate, eggs, processed meats (nitrates), caffeinated drinks, monosodium glutamate, and aspartame.

Common Triggers

Common triggers often cause headaches in susceptible people. Just as some food sensitivities manifest as a rash on your skin, migraine sufferers have a reaction in the blood vessels and nerves. Here are the common food triggers, also known as the "Dirty Dozen," in order of importance:

•dairy products*

•chocolate

•eggs

•citrus fruits

•meat**

•wheat (bread, pasta, etc.)

•nuts and peanuts

•tomatoes

•onions

•corn

•apples

•bananas

* Includes skim or whole cow’s milk, goat’s milk, cheese, yogurt, etc.
** Includes beef, pork, chicken, turkey, fish, etc.

Certain beverages and additives are also among the worst triggers, including alcoholic beverages (especially red wine), caffeinated drinks (coffee, tea, and colas), monosodium glutamate, aspartame (NutraSweet), and nitrites

Vegetarian Diet

A healthy vegetarian diet eliminates many of the triggers (meats and nitrates, dairy). Additionally, increasing the fiber content and decreasing the fat content of the diet may also help reduce the number of headaches. One study suggested a 50% reduction in the number of headaches in patients switching to a vegetarian diet.

Vegetarian diets in pregnancy are very healthy. Vegetarian moms have a lowered risk of pregnancy-induced hypertension, pre-eclampsia, excessive weight gain and gestational diabetes. I would suggest that the fat content of the diet be about 15- 20% of total calories, though that fat should come from natural unprocessed sources like avocado or nuts rather than bottled oils. I also suggest taking a vitamin B12 oral supplement of 100 mcg per day or 1,000 mcg once a week.

I generally suggest all pregnant women, whether vegetarian or not, make sure they are getting sufficient folate, about 600 mcg per day from either foods or supplements, vitamin D through sun exposure or supplementation at 400 IU per day and consider supplementation with DHA (an omega 3 fatty acid) of 200 mg per day. See my web page discussion about DHA.

For more information on vegetarian diets in pregnancy I suggest reading this book, click on the link to order or you can order it from Amazon:

Your Vegetarian Pregnancy: A Month-by-Month Guide to Health and Nutrition
By Holly Roberts, D.O., F.A.C.O.G.

Fulfilling every nutritional guideline recommended by the American College of Obstetrics and Gynecology, this book is the first authoritative guide to maintaining a healthy plant-based diet before, during, and after the birth of your child.

Here is a short web page:

Vegetarian Diets in Pregnancy

I have other web pages about a vegetarian diet at Moving Towards a Plant Based Diet

Consider Modifying the Elimination Diet.

Just don’t make the diet quite so strict. Foods that Fight Pain. by Dr. Neal Barnard.

If you are considering this, make sure you talk to me or a nutritionist first.

Reduced Sodium Diet

Excessive weight gain and water retention during pregnancy may increase the likelihood of headaches, and may cause a condition called Idiopathic Intracranial Hypertension. This condition is very difficult to treat just using pain medications. The headaches are crushing and severe. Though, if you can reduce your sodium intake to 1,000 to 1,500 mg per day and avoid gaining more weight than necessary, it’s possible to completely get rid of these headaches. If you are unable to get the sodium out of your diet, and we have made this diagnosis, sometimes it’s necessary to use a diuretic named Acetalzolamide.

See my web page on Low Sodium Diets

Medications

I like to use Tylenol for acute headache treatment. I use 325 mg tablets. I limit the dosage to three tablets per day. As well, I limit the use of Tylenol to only two days per week. This helps avoid medication overuse (rebound headache).

I will sometimes use Magnesium Oxide 400mg tablets once a day for preventative treatment. This may help reduce the number of headaches in a month. It will take several weeks of treatment for this reduction to become apparent. I insist on discussing this supplement with you prior to your starting. It is not appropriate for some people.

Do not take supplements or herbal medications during pregnancy without consultation with your physician

I avoid the use of Ergots (DHE, Cafergot), the Triptans (Imitrex, Zomig, Maxalt, etc.), Aspirin and the Non-Steroidal Anti-Inflammatories (Naproxen, Motrin). I generally don't use medications with narcotics (Percoet, Vicodin) or barbiturates (Fioricet) for headache if they can be avoided. These last medications, if used more than one time per week, have the potential to cause rebound headache.

Concerning preventative medications, I don't use anti-seizure medications (Topamax, Depakote, or Neurontin). I like to avoid the Tricyclic Anti-Depressants if possible (Elavil, Pamelor). In general, I usually try to stop all prescription preventative medications.

I ask that my pregnant patients discuss any new headache medication (whether over-the-counter or prescription) with her Obstetrician prior to starting.

Other Alternatives

MigraCap - a ice chilled face mask

Velcro Headband - may be helpful

Acupuncture - some report good benefit

Mind-Body Therapies - some evidence of benefit

Sleep Hygiene - see this web page on effects of improved sleep on reducing headaches

Return to Headaches