Headache in pregnancy.

Conventional wisdom teaches that chronic headaches typically improve and often abate during pregnancy, leading many clinicians to take a wait-and-see approach of delaying treatment in hopes of seeing spontaneous improvement. Although headaches do improve in later pregnancy for up to 50% of chronic headache sufferers, headaches persist and may even worsen for the remainder. Clinicians must recognize that treating headache during pregnancy is important in order to limit excessive use of over-the-counter pain remedies, dehydration, and pain- related disability. Safe and effective medication and nonmedication treatment options are available for the pregnant headache sufferer, including both acute care and preventive therapies. Care of the pregnant headache patient should begin before she is known to be pregnant, when the fertile female is initially established as a patient. Preconception planning should include modification of medication regimes to include medications safe for use during early pregnancy, when the woman may not yet realize she is pregnant, and effective nonmedication therapies, such as relaxation, biofeedback, and lifestyle modification.