Headache experience and management concerns in pregnant and early postpartum women: a cross-sectional survey in routine obstetric care in Japan

Abstract Background Headache during pregnancy and the postpartum period may interfere with daily life, while concerns about symptoms, medication safety, and access to care may complicate management. Evidence from women attending routine obstetric care in Japan is limited. We examined headache experience, functional impact, management behaviors, specific headache-related concerns, and migraine screener positivity among pregnant and early postpartum participants. Methods This single-center cross-sectional survey included 242 Japanese women attending prenatal or one-month postpartum checkups at a general hospital in Japan (128 pregnant and 114 early postpartum participants). A self-administered questionnaire assessed headache experience, a history of functionally impairing headache, headache-related concerns, management methods, specific concerns, and four migraine screening items. Outcomes were summarized using a stepwise analytic approach, and group comparisons using Fisher’s exact test were exploratory. Results Headache experience was reported by 153/242 participants (63.2%). Among these participants, 69/153 (45.1%) reported a history of headache severe enough to interfere with household activities or work. Among those reporting a history of functionally impairing headache, 39/69 (56.5%) reported headache-related concerns in the stepwise analysis. A history of functionally impairing headache was reported by 42/80 pregnant participants (52.5%) and 27/73 early postpartum participants (37.0%), while headache-related concerns were reported by 28/42 (66.7%) and 11/27 (40.7%), respectively. Migraine screener positivity was identified in 49/240 participants (20.4%). Migraine screener-positive participants more frequently reported headache experience than screener-negative participants (48/49 [98.0%] vs. 103/191 [53.9%]) and, among those with headache experience, a history of functionally impairing headache (33/48 [68.8%] vs. 36/103 [35.0%]; both p < 0.001). Rest-based strategies and over-the-counter medication were common. Specific concerns included headache worsening, fetal or infant effects of medication, medication availability, headache cause, and where to seek care. Conclusions Among women attending routine obstetric care in Japan, headache was common, and many participants reported a history of functionally impairing headache together with specific management concerns. Migraine screener positivity was associated with a higher prevalence of headache experience and a history of functionally impairing headache. Prenatal and one-month postpartum encounters provide opportunities to assess headache burden, address medication-related concerns, and clarify consultation pathways before regular obstetric contact becomes less frequent.