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Headache in Pregnancy
Checklist
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Last updated 3/20/2026
Headache Description
When did the headache start?
What are the pain characteristics of the headache?
What is the severity of the headache, from a scale of 0 to 10 (0=no pain, 10= worst pain of life)
How quickly to peak headache intensity?
Peak intensity note
What is the location of the headache?
Headache Frequency and Duration
How many days per week does the patient experience any form of headache? Headache duration?
How many days per week does the patient have a very severe headache? Headache duration?
If the headache is daily, how long has it been this way? (new daily persistent headache)
In the past 3 months has the patient missed days of work or other activities due to a severe headache?
In the past 3 months has the patient required visits to urgent care/ED for acute treatment? If so, what medications were most effective?
Pattern or precipitants identified?
Are there aggravating factors?
Are there relieving factors?
Features Associated with Common Benign Headaches
Migraine
Tension
Trigeminal autonomic cephalgias
Headache History
Prior diagnosis of primary headache (migraine, tension, cluster, etc.)
If history of primary headache, how well controlled was headache prior to pregnancy? What was treatment regimen with regard to OTC and prescribed abortive/preventative agents?
Pearl
Treatments
Acute Interventions tried (per American College of Obstetricians and Gynecologist recommendations for use during pregnancy)
Acute interventions note
Pearl
Non-pharmacologic interventions tried (biofeedback, acupuncture, massage, compresses)
Preventative treatments tried
Preventative treatments note
Screen for Secondary Headaches
SNOOP (Systemic signs, Neurologic signs, Onset>50, Onset-Thunderclap, Positional components)
Peripartum
Additional screening questions
Additional Screening Questions
Pearl
Secondary headache screen
Onset-thunderclap (reaching maximal intensity within 1 minute: (increased risk for secondary headache)
Precipitated by coughing/sneezing/straining (elevated ICP)
Headache worse with recumbency (elevated ICP)
Recent fall/head or neck trauma/exertion/chiropractic neck manipulation (SAH, cerebral dissection, CSF leak, post-concussive)
Epidural anesthesia or spinal anesthesia followed by headache worse when standing and improved with supine (CSF leak/post-dural puncture headache)
History of AD polycystic kidney disease (aneurysm)
History of connective tissue disease? (aneurysm, spontaneous CSF leak)
Family history of first degree relatives with brain aneurysm
Associated tinnitus/hearing loss/aural fullness (spontaneous CSF leak)
Weight gain/blurry vision/transient vision loss/pulsatile tinnitus (Idiopathic intracranial hypertension)
New neck pain (vertebral dissection, meningitis, cervicogenic)
Recent use of cocaine/amphetamine/LSD/marijuana/ecstasy (toxic vasculopathy, RCVS)
Recent sinusitis/otitis (meningitis, abscess)
Imaging
Prior brain and/or vessel (arterial, venous) imaging
Pearl
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Headache in Pregnancy | NeuroNav