Many pregnant women are troubled by headaches. Early in pregnancy, increased blood circulation and hormonal changes can cause headaches. Other possible causes include stress or anxiety, fatigue, nasal congestion, eyestrain, and tension. If you suddenly eliminated or cut down on caffeine when you learned you were pregnant, this "withdrawal" also can cause headaches for a few days.

If you suffer from migraines, they may stay the same, improve or worsen when you're pregnant. They might be worse in the first trimester, then improve in the second.

■ Prevention and self-care for headaches

One way to avoid getting headaches is to determine what triggers them and avoid those things. Triggers may include cigarette smoke, stuffy rooms, eyestrain and certain foods. Here are some other suggestions for minimizing the pain of headaches:

• Get plenty of sleep each night, and rest during the day when possible.

• Drink plenty of liquids.

• Soothe a sinus headache by applying a warm washcloth to the front and sides of your face, around your nose, eyes and temples. If you feel a tension headache coming on, apply an ice pack or cold compress to your forehead and the back of your neck.

• Massage your neck, shoulders, face and scalp, or ask your partner or a friend to give you a massage.

• Practice relaxation techniques and exercises, such as meditation.

• Get some fresh air. Take a walk outside if possible.

• Minimize the stresses in your life. Although some stresses can't be avoided, you can boost your coping skills. If you're under more stress than you feel you can handle, it might be helpful to talk to a therapist or counselor. Talk to your health care provider about it.

■ When to seek medical help for headaches

Contact your health care provider right away if you're having headaches that are severe, persistent or frequent, or that are accompanied by blurred vision or other vision changes. If you have high blood pressure, it's important to report any headache.

Talk to your health care provider before taking any pain relievers or headache medications, including aspirin or ibuprofen (Advil, Motrin, others), which could cause problems if they're taken during pregnancy. Acetaminophen (Tylenol, others) is a better choice during pregnancy. It appears to be very safe. It's usually the first choice for pain and fever relief during pregnancy.

If you have migraines, talk to your health care provider about how to manage them during pregnancy. Don't take any migraine medications without checking with your health care provider. He or she may tell you to avoid some medications used to treat migraines, including aspirin, pro-pranolol and especially ergotamine-containing medications.

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