ABSTRACT
The majority of headaches in pregnancy are benign, but fear of a serious intracranial cause may lead pregnant women to present for review. The pain of headaches is thought to arise in a widespread network of sensory fibres which surround intracranial blood vessels. Headache may result from direct stimulation of these fibres causing pain or secondary to the inflammatory effects of vasoactive neuropeptides released after stimulation of the sensory fibres. The woman should be questioned to elicit any neurological symptoms associated with the headache, such as numbness, tingling, loss of or alteration in sensation or movement, and systemic disturbance such as fever, anorexia, and skin rashes. After pre-eclampsia, cerebral thrombosis, a vascular anomaly, and intracranial bleeding are the most likely serious diagnostic possibilities requiring exclusion in women presenting with a significant, new onset headache in pregnancy. Migraine is usually a severe, unilateral throbbing headache aggravated by activity with associated nausea, vomiting, photophobia, phonophobia and sometimes, but not always, an aura.
