How do I manage a patient who is 14 weeks pregnant and suffering from headaches

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 ¹.
• 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 ²,³.
• 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 ¹.
• 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 ¹.
• Review any current migraine medications for safety in pregnancy and adjust as needed, with specialist input if migraine characteristics change or worsen ¹.
• 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) ²,³.
• 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 ²,³.
• Consider early referral to secondary care if blood pressure rises persistently or if headache characteristics change, to exclude secondary causes and initiate appropriate management ¹,².