Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Management of a 14-week pregnant patient with frequent, all-day headaches and mostly normal blood pressure but occasional slight elevations:
- Perform a thorough clinical assessment including a full neurological examination, blood pressure monitoring, and urinalysis to exclude secondary causes such as pre-eclampsia or other serious conditions. Any abnormalities require urgent secondary care assessment NICE CKS.
- Since the patient is at 14 weeks gestation, new onset hypertension before 20 weeks is less likely to be gestational hypertension but should still be monitored closely NICE CKS,NICE NG133.
- Advise the patient to keep a headache diary to identify possible triggers such as lack of sleep, missed meals, or dehydration, and encourage non-pharmacological measures like trigger avoidance, relaxation techniques, and cognitive behavioural therapy before considering drug treatment NICE CKS.
- For headache management, paracetamol is the first-line treatment for acute migraine in pregnancy. If ineffective, consider ibuprofen only before 20 weeks gestation or a triptan, weighing benefits and risks carefully NICE CKS.
- Review any current migraine medications for safety in pregnancy and adjust as needed, with specialist input if migraine characteristics change or worsen NICE CKS.
- Monitor blood pressure regularly at antenatal visits and advise the patient to seek immediate medical review if symptoms of pre-eclampsia develop (e.g., severe headache, visual changes, vomiting) NICE CKS,NICE NG133.
- Given occasional slight elevations in blood pressure but mostly normal readings, continue close monitoring without immediate antihypertensive treatment unless blood pressure consistently exceeds 140/90 mmHg or other signs of pre-eclampsia appear NICE CKS,NICE NG133.
- Consider early referral to secondary care if blood pressure rises persistently or if headache characteristics change, to exclude secondary causes and initiate appropriate management NICE CKS,NICE CKS.