When Should a Pregnant Woman Worry About a Headache?A few days ago, I read a comment on one of the pregnancy websites that forced me dig to up my old password in an attempt to contact her. She had been given misinformation that might have killed her.

She was forty weeks pregnant, complained about a headache and felt “something wasn’t right.” Unfortunately, her obstetrician wasn’t working and she spoke with his on-call colleague who told her that her blood pressure of 145/87 was “okay and not to worry.” Oh, did she receive incorrect information and to add insult to injury, she also received incorrect information from fellow pregnant moms on the website. This patient was a disaster waiting to happen because she could very well have had pre-eclampsia.

Physicians and midwives don’t intentionally set out to hurt patients but they inevitably do when they miss a diagnosis. The on-call physician did not have the patient’s prenatal chart or maybe he just wasn’t thinking. The complaint of a headache in a pregnant woman in her third trimester (and sometimes second as well) is a warning sign that the blood pressure might be elevated. A blood pressure value of 145/87 is not normal in a pregnant woman who is in her third trimester and needs to be further evaluated.  The “new” definition of pre-eclampsia is someone who has a blood pressure of 140/90 or greater whereas the “old” definition was an increase in the systolic (top number) of 30-mmHg or an increase of 15-mmHg of the diastolic (bottom) number. The reader’s blood pressure of 145/87 was not normal using either definition.  She should have been immediately sent to the hospital for further evaluation. Better safe than sorry.

Pre-eclampsia is sneaky and many healthcare providers miss that diagnosis because they are waiting for the classic signs to occur such as a headache, blurry vision, a blood pressure of 150/100, swollen ankles and protein in the urine.  Quite frankly, by the time a patient exhibits all of these signs, she is at risk for having a stroke. A smart provider will make the diagnosis before a patient reaches this critical junction.

Pregnant moms, never ignore a headache, especially when you are in the third trimester.  Remember, a healthy pregnancy doesn’t just happen. It takes a smart mom who knows what to do.