Nausea headaches and fatigue

What’s Causing My Chest Pain and Headache?

Chest pain and headache rarely occur together. Most conditions they’re both associated with are also uncommon. A very rare condition called cardiac cephalgialimits blood flow to the heart, which leads to chest pain and a headache. Other possible causes linking the two include:


There is a relationship between the mind and body. When a person experiences depression or extreme, long-lasting feelings of sadness or hopelessness, symptoms of headache and chest pain may occur. People with depression often report physical symptoms such as backaches, headaches, and chest pain, which may or may not be related to somatization.


High blood pressure (hypertension) doesn’t cause any symptoms unless it’s uncontrolled or end stage. However, when blood pressure gets very high, you may have chest pain and a headache.

The idea that high blood pressure causes headaches is controversial. According to the American Heart Association, evidence suggests headaches are usually only a side effect of very high blood pressure. A blood pressure that may cause symptoms could be a systolic pressure (top number) greater than 180 or a diastolic pressure (bottom number) greater than 110. The chest pain in times of very high blood pressure may be related to extra strain on the heart.

Legionnaires’ disease

Another condition that involves chest pain and headache is an infectious disease called Legionnaires’ disease. The bacteria Legionella pneumophila causes the disease. It’s mostly spread when people inhale water droplets contaminated with the L. pneumophila bacteria. Sources of these bacteria include:

  • hot tubs
  • fountains
  • swimming pools
  • physical therapy equipment
  • contaminated water systems

In addition to chest pain and headache, the condition can cause symptoms such as:

  • high fever
  • cough
  • shortness of breath
  • nausea
  • vomiting
  • confusion


Lupus is an autoimmune disease in which the immune system attacks healthy tissues. The heart is a commonly affected organ. Lupus can lead to inflammation in different layers of your heart, which can cause chest pain. If the lupus inflammation also extends to the blood vessels, it can cause headaches. Other symptoms may include:

  • blurred vision
  • appetite loss
  • fever
  • neurologic symptoms
  • skin rash
  • abnormal urine


According to a 2014 study published in the Journal of Emergency Medicine, chest pain can be a symptom of a migraine headache. However, this is rare. Migraine headaches are severe headaches that aren’t related to tension or sinuses. Researchers don’t know what causes chest pain to occur as a migraine side effect. But treatments for migraines will typically help resolve this chest pain.

Subarachnoid hemorrhage

A subarachnoid hemorrhage (SAH) is a serious condition that results when there is bleeding in the subarachnoid space. This is the space between the brain and the thin tissues that cover it. Having a head injury or bleeding disorder, or taking blood thinners, can lead to a subarachnoid hemorrhage. A thunderclap headache is the most common symptom. This type of headache is severe and starts suddenly. Other symptoms can include:

  • chest pain
  • difficulty adjusting to bright lights
  • neck stiffness
  • double vision (diplopia)
  • mood changes

Other causes

  • pneumonia
  • anxiety
  • costochondritis
  • peptic ulcer
  • Chinese restaurant syndrome
  • alcohol withdrawal delirium (AWD)
  • heart attack
  • stroke
  • tuberculosis
  • malignant hypertension (hypertensive emergency)
  • systemic lupus erythematosus (SLE)
  • fibromyalgia
  • sarcoidosis
  • anthrax
  • carbon monoxide poisoning
  • infectious mononucleosis

Unrelated causes

Sometimes a person has chest pain as a symptom of one condition and a headache as a symptom of a separate condition. This could be the case if you have a respiratory infection and are also dehydrated. Even if the two symptoms aren’t directly related, they can be cause for concern, so it’s best to seek medical attention.

Microvascular Angina: Why Women Shouldn’t Ignore Chest Pain and Fatigue

“It’s concerning because the problem can be missed. It doesn’t show up on a traditional angiogram, which can lead to delayed diagnosis if physicians dismiss the chest pain as nothing,” says Erin Michos, M.D., associate director of preventive cardiology at the Ciccarone Center for the Prevention of Heart Disease.

This chest pain in one of the heart’s arteries is more common in women than in men, says Michos.

What Is Microvascular Angina?

Angina is any chest pain that occurs when your heart muscle doesn’t get enough blood to meet its work demand, a condition called ischemia.

The most common source of angina is obstructive coronary disease, which happens when one of the heart’s arteries is blocked. People with this type of angina might feel chest pain during exercise or exertion if not enough blood is supplied to the working heart muscle.

But according to the American Heart Association, up to 50 percent of women with angina symptoms don’t have a blocked artery. In fact, they may not even have chest pain, though they may have other symptoms.

“They may feel severely short of breath. They might feel extreme fatigue, which rest doesn’t make better. They may have pain with exertion in their back, jaw or arm with no chest pain. They might have nausea and indigestion,” says Michos.

These women should be evaluated for microvascular angina. Microvascular angina can occur when the heart’s tiniest arteries are not able to supply enough oxygen-rich blood due to spasm or cellular dysfunction.

It can be difficult to diagnose microvascular angina because an angiogram — a specialized X-ray of the heart — won’t show obstruction or blockages in these tiny arteries, and symptoms like nausea and indigestion mimic other illnesses. Often, your doctor will perform a stress test to monitor the heart’s function during exercise to make a diagnosis.

When the diagnosis is uncertain after a typical stress test, there are advanced tests that can be performed to evaluate for microvascular disease. This includes a special type of stress test using cardiac MRI or a technique performed at the time of an angiogram to test for dysfunction in the heart’s arteries when a usual blockage isn’t found.

Treating Microvascular Angina

Because microvascular angina affects tiny arteries, surgical treatments that can be used on larger arteries are not an option. However, medications can reduce symptoms and improve heart health. Medications prescribed for microvascular angina include:

  • Nitroglycerin, which dilates and relaxes arteries to prevent spasms
  • Beta blockers, which slow heart rate
  • Statins, which can slow the progression of fatty plaque in the arteries
  • Calcium channel blockers, which help relax blood vessels

Preventing Microvascular Angina

Women with microvascular angina have increased rates of stroke, heart attack and heart failure. While treatment can help reduce the risk of these complications, “the best intervention is prevention,” says Michos.

It’s important to know your risk. “Traditional risk factors, like smoking and diabetes, that lead to blockages in the larger arteries are also risk factors for microvascular angina,” adds Michos. High blood pressure, high cholesterol and high body mass index also increase risk.

Lifestyle choices, like a healthy diet and moderate exercise, can address many of these risk factors and lower your chances of getting microvascular angina. It’s also important not to be shy about bringing up chest pain or other symptoms with your doctor.

“Women with chest pain often dismiss it. They think heart disease is a man’s disease, or that it’s indigestion or stress. The biggest thing is to create awareness that angina can happen without obstructive disease and that it’s risky,” Michos says.

From the Respiratory Staff at Corner Medical

Pain, fever, shortness of breath — when are these a temporary bother or something much worse?

By Beth Howard

You wake up one morning with a fever. Or maybe you have a really bad neck ache. How do you know if a symptom is serious or not? “The things that we doctors are most concerned about are new symptoms that develop quickly, rather than things that develop over a long period of time,” says Keith L. Black, M.D., chair of neurosurgery at Cedars-Sinai Medical Center in Los Angeles.

Another warning sign? That uh-oh feeling that tells you something’s not quite right. “You know your body best,” says Len Lichtenfeld, M.D., deputy chief medical officer at the American Cancer Society. “When you see or feel something different or just feel ‘off,’ pay attention; don’t dismiss it.”

Here are nine symptoms and what they might mean.

  1. Sudden Intense Headache

The big worries: If you experience head pain unlike any you’ve had before, especially if it peaks in seconds to minutes in any part of the head, it could signal a ruptured aneurysm, a blood vessel in your brain that suddenly bursts, requiring immediate attention.

In addition, your doctor will want to rule out three other conditions:

  1. Cardiac cephalgia: A rare disorder in which reduced blood supply to the heart manifests as a headache and can also cause chest pain and exhaustion with exertion.
  2. Meningitis: A headache often accompanied by a stiff neck, fever and confusion or other changes in mental status.
  3. Temporal Arteritis: A rare illness in which a person’s immune cells invade the walls of the arteries that carry blood to the head, causing headache, low-grade fever or pain upon speaking or chewing. “The reason temporal arteritis is such a concern is that it can result in the temporary or permanent loss of vision in one or both eyes,” says Brian Grosberg, M.D., codirector of the Montefiore Headache Center in the Bronx, New York. Steroids usually take care of the problem if treatment is prompt.

What else it might be: Shingles can cause pain in the forehead before the notorious skin reaction (shingles is a painful flare-up of the herpes zoster virus that lies dormant in anyone who’s had chicken pox). Contrary to common belief, sudden severe headaches are unlikely to be a sign of a brain tumor. Rather, research shows that two-thirds of patients diagnosed with a brain tumor experienced tension headaches — dull, achy or pressure-like pain — that steadily worsened over a period of weeks to months.

  1. Chest Pain

The big worries: Any intense discomfort, heaviness or pressure — like an elephant sitting on your chest — could spell heart attack. It may be combined with pain radiating down an arm, nausea and vomiting, sweating, and shortness of breath. Women can experience more subtle symptoms, like fatigue, a burning sensation or upper abdominal pain. In any case, call 911. “If it is a heart attack, a delay could cause the heart muscle to be damaged,” says Eric Topol, M.D., a cardiologist at the Scripps Clinic in La Jolla, California. If these symptoms occur only during exertion, it could also be angina, which happens when the heart muscle temporarily doesn’t get enough blood.

Sudden severe chest or upper-back pain (often described as a ripping sensation) can be caused by a tear in the aorta, known as aortic dissection, which requires immediate attention. Fortunately, this life-threatening condition occurs in only about three out of 100,000 people.

What else it might be: “Perhaps 10 to 20 percent of cases of intense chest pain are due not to heart trouble but to gastroesophageal reflux disease ,” says Topol. Rarely, it could also signal esophageal spasm, an abnormal contraction of the muscles in the esophagus, which carries food from the throat to the stomach. Both conditions can be treated with medications, but it’s always wise to go to the ER: “It’s a heart attack or angina until proven otherwise,” Topol says.

  1. Unexplained Weight Loss

The big worries: Losing more than 5 percent of your body weight — without trying — over a period of six months could mean cancer: Weight loss is a symptom in up to 36 percent of cancers in older people. “If you or a family member is suddenly losing weight after trying 400 times before, you have to ask, ‘Why is this time the charm?’ ” says Lichtenfeld.

What else it might be: Endocrine disorders are a common cause of unintentional weight loss. Of those with an endocrine disorder (especially hyperthyroidism, an overactive thyroid), up to 11 percent experience weight loss. The condition also triggers restlessness, sweating, increased appetite and difficulty concentrating.

If your weight loss is accompanied by extreme thirst or hunger, fatigue and frequent urination, it could be a sign of diabetes.

Gastrointestinal conditions like inflammatory bowel disease and celiac disease cause weight loss as well — in addition to symptoms such as diarrhea and abdominal pain.

Depression and other psychiatric conditions could be to blame, too. “Decreased appetite and weight loss are very common symptoms of depression,” says Susan G. Kornstein, M.D., professor of psychiatry and obstetrics/gynecology at Virginia Commonwealth University. “But patients with unexplained weight loss should undergo a workup to rule out general medical causes.”

  1. Unusual Bleeding

The big worries: Ulcers and colon cancer can cause rectal bleeding or black or tarry stools, says Andres Pardo-Agila, M.D., a family medicine physician at the University of Texas Health Science Center at Houston. If you haven’t had a colonoscopy recently, talk to your physician. Vaginal bleeding can be linked to gynecologic cancers. Bloody vomit can result from stomach or esophageal cancer, and people with lung cancer can cough up blood. “Whenever you see blood where it shouldn’t be, see a doctor,” says Lichtenfeld.

What else it might be: Blood in the stool may be due to hemorrhoids, while blood in the urine may be the result of a bladder or kidney infection. Vaginal bleeding long after menopause may be due to the growth of benign polyps or fibroids. Vomiting blood can result from a tear in the blood vessels or an ulcer in the stomach or esophagus. And coughing up blood can happen with noncancerous conditions, like bronchitis, pneumonia or tuberculosis. “There are many common reasons for seeing blood where you don’t expect it, but it still has to be checked out and treated,” Lichtenfeld advises.

  1. High or Persistent Fever

The big worries: Fever is your body’s way of fighting infection. But “fever of 103 degrees and higher warrants a trip to the doctor — period,” says David Bronson, M.D., president of the American College of Physicians. It may indicate a urinary tract infection, pneumonia, endocarditis (inflammation of the lining of the heart chambers and valves) or meningitis, which may require antibiotics to clear up. A persistent low-grade fever — for several weeks — with no obvious cause is characteristic of some infections, including a sinus infection, and some cancers, like lymphoma and leukemia. “Cancer is on the list of things we think about, but it is usually not the first thing,” says Ronan Factora, M.D., a geriatrician at the Cleveland Clinic in Ohio.

What else it might be: Fever can be triggered by a virus, which, depending on your health and other symptoms, may require hospitalization.

  1. Shortness of Breath

The big worries: Sudden shortness of breath can indicate a pulmonary embolism — when a blood clot forms in the body’s deep veins (usually in the legs), travels to the lungs and gets lodged in the lung’s blood vessels. Suspect an embolism if you’ve recently traveled, have undergone surgery or have been immobile, and/or your shortness of breath is accompanied by chest pain and coughing up blood. If you find yourself gasping after climbing two or three stairs or getting tired sooner than you used to, doctors will want to rule out chronic obstructive pulmonary disease (COPD), especially if it’s accompanied by a cough and fatigue and you have a history of smoking. Irregular heart rhythm, congestive heart failure and other types of heart disease are additional possibilities. When organs aren’t getting enough oxygen, breathlessness can result. See a doctor — stat.

What else it might be: Shortness of breath can occur with asthma, bronchitis or pneumonia. You can also experience shortness of breath, sometimes with heart palpitations, if you are under extreme emotional distress or anxiety. Regardless, patients should go to the doctor. “I don’t jump to a psychological issue unless there is nothing else going on,” says Factora. “But we don’t want to miss those few cases where survival is at stake.”

  1. Sudden Confusion

The big worries: If you’re experiencing sudden confusion, personality changes, aggression or an inability to concentrate, it’s important to see a doctor right away. “The mortality rate for severe confusion is pretty high. You have to figure out what’s going on,” says Bronson. In the worst case, a brain tumor or bleeding in the brain could be behind the delirium. If you’re also experiencing slurred speech, difficulty finding the right words, or numbness or weakness in the face, hand or leg, stroke is a strong possibility. “You have a window of about two to three hours to get to the hospital,” says Cedars-Sinai’s Black. Beyond that, brain loss may be irreversible.

What else it might be: Medicines and drug-alcohol interactions can also affect your mental state. Plus, confusion can signal an infection, abnormal blood pressure, low blood sugar or dehydration, each of which should be ruled out by a physician.

  1. Swelling in the Legs

The big worries: An accumulation of fluid (called edema) in the extremities can be caused by a number of conditions, but the one that most concerns doctors is heart failure, when the heart cannot pump as much blood as the body needs. When that happens, blood backs up in the veins, causing fluid to accumulate in the body’s tissues. “Swelling of the legs, especially if it is persistent, should never be ignored,” says Gordon F. Tomaselli, M.D., director of the division of cardiology at the Johns Hopkins University School of Medicine in Baltimore. Heart failure is suspected when both legs are affected and the patient also has shortness of breath, fatigue and chest tightness.

What else it might be: A vein problem known as venous insufficiency can also cause swelling. Normally, valves in the leg veins keep blood flowing back to the heart, but in those with venous insufficiency, these valves are weakened, causing a backup of blood. “If valves are the problem, swelling usually goes away when you lie down,” Tomaselli says. Compression stockings can help. Swelling can also result from hypothyroidism (not enough thyroid hormone).

  1. Sudden or severe abdominal pain

The big worries: Sudden abdominal pain could signal that an aortic aneurysm — a bulge that develops in the aorta, frequently in the abdominal area — has ruptured. “If the aneurysm ruptures, the pain tends to be sudden and severe and typically centralized around the belly button,” says Richard Desi, M.D., a gastroenterologist with Mercy Medical Center in Baltimore. Alternatively, sudden pain can indicate a perforated viscus (a hole in the stomach, intestine or other hollow organ), often due to an ulcer. Intestinal ischemia, which happens when blood flow to the intestines slows or stops, starving tissues of oxygen, can be a culprit, too. “It’s more common in older, sicker patients who have heart failure or atrial fibrillation,” says Brian Putka, M.D., a gastroenterologist with the Cleveland Clinic. Each of these conditions is life threatening, requiring emergency surgery.

What else it might be: Abdominal pain is frequently due to gallstones, which are hard, pebblelike deposits that get lodged in a gallbladder duct, resulting in sharp pain as well as nausea and vomiting. Diverticulitis — inflammation or infection in small pouches of the large intestine — can be another cause of sudden, severe pain, along with changes in bowel habits, fever and nausea. Although irritable bowel syndrome can trigger painful spasms in the colon, the pain tends to come and go over time and may also cause constipation, diarrhea or alternating bouts of both. Appendicitis is a less likely candidate for sudden abdominal pain in those over 50, as the condition is less common with age. When it does occur, however, expect gradually worsening pain in the right-lower quadrant of the abdomen.

Every newborn is a blessing, and every birth is unique. Part of our goal at the Family BirthPlace is to encourage your family members to participate throughout your entire pregnancy. Pregnancy, labor, and delivery are part of a major life change, and the process can be filled with anticipation, questions, and concerns. We’re here to offer pregnancy advice and support along the way.

Here’s what you can expect during each stage of pregnancy, labor, and delivery.

First Trimester (1–14 Weeks)

During the first three months of pregnancy (or the first trimester), your body goes through many changes as it adjusts to your growing baby.

Physical Symptoms:

  • Absence of menstrual period
  • Feeling tired and sleepy
  • Frequent urination
  • Heartburn, indigestion
  • Food aversions and cravings
  • Constipation
  • Nausea with or without vomiting
  • Gas, bloating
  • Breast changes

Emotional Symptoms:

  • Mood swings
  • Weepiness
  • Irritability
  • Misgivings and fear
  • Joy

First Trimester Care and Changes

Vitamin Intake: Taking the vitamins ordered by your doctor is extremely important. The vitamins may cause your stool to be darker, and you may have problems with constipation. If you experience these problems, talk to your doctor. Do not take any medications (including over-the-counter medications) without asking your doctor.

Exercise: Continue your usual physical and household activities. Walking is great exercise that requires no training or equipment. We also suggest swimming in shallow water (that is neither hot nor cold), riding a stationary bike, (at a comfortable speed and tension) and performing exercises especially designed for pregnant women. You should now begin pelvic toning (Kegel exercises) and relaxation exercises daily.

Diet: During the first trimester, you need to consume an extra 300 calories each day.

Sexual Relations: Most experts agree sex and orgasm during a low-risk pregnancy are safe. Sexual relations are important to a marriage or relationship, so here are our recommendations:

  • Emphasize love rather than love making
  • Frequency is less important than quality
  • Stay rested; get your sleep
  • Try new positions if you are uncomfortable

If you have a history of miscarriage or signs of a threatened miscarriage, your doctor may recommend some restrictions.

Common Concerns

Fatigue: Take care of yourself and let others help you. Try to get more sleep and eat a proper diet. Check your work and home environment for poor ventilation, poor lighting, or excessive noise that add to fatigue.

Mood Swings: Avoid sugar, chocolate, and caffeine. Proper diet, rest, sleep and exercise may help.

Morning Sickness: Eat a high-complex-carbohydrate diet; drink plenty of fluids; take your vitamins; and try to avoid the sight, smell, and taste of foods that make you queasy. Try eating crackers 20 minutes before rising in the morning, and get up slowly. Brush your teeth or rinse after each bout of vomiting. Minimize stress and practice relaxation techniques. Sea-Bands (bands worn on the wrist for motion sickness) are available at drug stores and may offer some relief.

Excessive Saliva: Also called ptyalism, an excessive flow of saliva is common and harmless. Frequent brushing and rinsing with a mint-flavored toothpaste or mouthwash and chewing sugarless gum may help.

Frequent Urination: This condition is caused by an increase in body fluid and pressure from your growing uterus. Lean forward when you empty your bladder.

Headaches: Your increasing hormone levels may lead to headaches. Try to relax, seek quiet places, get enough rest, eat regularly, don’t get overheated, and stay away from unventilated areas. Alternately apply hot and cold compresses to the aching area every 30 seconds. And stand tall: slouching and looking down causes headaches.

Breast Changes: Your breasts will enlarge and become very tender due to your increased hormone levels. The areola (dark area around nipple) will darken, and you may notice little bumps, which are tiny glands. The veins become more visible. Increased weight from your enlarged breasts may cause some back discomfort that a well-fitted support bra can help alleviate.

Gas and constipation: Constipation, which is common during pregnancy, can cause gas and bloating, so eat less and more often. You can cut down on constipation by drinking warm liquids in the morning, developing a regular bathroom schedule, drinking more fluids, and eating more fruits and vegetables. It is important to avoid gas-producing foods.

Warning Signs

Warning signs of a potential problem or miscarriage during the first trimester may include mild cramps or spotting. Lie down and rest if this occurs. Spotting is common during pregnancy—especially around the time you would normally expect your period. If pain increases and bleeding is similar to your period, contact your healthcare provider.

If you experience any of the following signs, go to the Level III Emergency and Trauma Center at Saint Francis Medical Center:

  • Heavy vaginal bleeding with cramps or pain in the center or one-side of your lower abdomen
  • Pain that continues for more than a day, even if there is no bleeding
  • Passing clots or grayish-pink material
  • A temperature more than 100 F and no flu symptoms, or a temperature that lasts more than one day

Second Trimester (15–27 Weeks)

During your second trimester of pregnancy, you will feel better and your growing baby will not cause you discomfort. Every three weeks, you should meet with your doctor to test your weight, blood pressure, and urine; measure the height of your uterus; check your baby’s heart rate; and check for signs of swelling.

Your doctor may order special tests (such as a sonogram) to determine the size, age, and growth of your baby. A sonogram is a painless test used to locate the placenta (afterbirth) and is not harmful to your baby. A fetal activity test (FAT) monitors your baby’s heart rate and movements. We will perform your FAT and sonograms at Saint Francis Medical Center.

Physical Symptoms:

  • End of or decrease in nausea and vomiting, and a decrease in urinary frequency
  • Fatigue, constipation, heartburn, indigestion, and gas
  • Breast enlargement, though they will be less tender
  • Slight whitish vaginal discharge
  • Occasional lightheadedness, dizziness, nasal congestion, nosebleeds, bleeding gums, increase in appetite, mild swelling of ankles and feet, swelling of the hands and face, varicose veins, and hemorrhoids
  • Fetal movement, backache, skin pigmentation changes, and increased pulse rate
  • Dropping things

Emotional Symptoms:

  • Mood swings (less severe)
  • Joy and/or fear as you become more aware of your pregnancy
  • Frustration and boredom
  • Forgetfulness or having problems concentrating

Second Trimester Care and Changes

Exercise: Exercise is still important, but do not exhaust yourself. Walking is one of the best choices, so take a daily walk at a comfortable rate if weather permits. Keep up your Kegel exercises as well as pelvic rocking. Maintain correct posture.

Diet: Eat smaller but more frequent meals. Fresh fruits and vegetables should help you maintain regular bowel movements. Increase your fluids.

Breathlessness: This is due to an increased level of hormones in your body. As your pregnancy advances, your uterus pushes up against your diaphragm.

Forgetfulness: Forgetting an appointment, losing things and having problems concentrating are normal and temporary. Recognize these problems as a normal part of pregnancy and try to reduce your stress. Keep a good sense of humor—and checklists.

Hair Dyes and Perms: It is best to avoid hair dyes and/or perms during your pregnancy. If you are concerned about gray hair, try a pure vegetable coloring.

Nasal Stuffiness: Nasal stuffiness often occurs with pregnancy. If pollen affects you, drink more fluids and stay indoors with a filtered air conditioner. Avoid animals and dust. Nosebleeds may occur. Try applying Vaseline in each nostril, squeeze your nose for a few seconds, and apply a cold cloth. Use a vaporizer or humidifier.

Vaginal Discharge: A thick, milky, mild-smelling discharge is normal throughout pregnancy. Do not douche unless prescribed by your doctor. If the discharge is yellowish, greenish, or thick and cheesy; has a foul odor; or is accompanied by burning, itching or soreness, you likely have an infection. Notify your doctor for treatment. Good hygiene habits, a good diet, and avoiding refined sugar can hasten your recovery.

Fetal Movement: Fetal movement indicates your baby is healthy and active. The first time your baby moves can be very exciting and usually occurs between 14 and 22 weeks. By 23 or 24 weeks of pregnancy, fetal movement is well established. Your doctor will ask you about your baby’s activity at your appointments. As your pregnancy progresses, try to be very aware of your baby’s movements.

Appearance: You will obviously look pregnant and may find loose clothing or maternity clothes are more comfortable.

Advice: Everyone has advice for an expecting mother, including your mother, mother-in-law, family, and friends. Your doctor, childbirth educator, and nurse are your best resources.

Fatigue: Your body is working harder. Slow things down but do not stop. Make sure to monitor your activities and exercise. Try sleeping on your left side with a pillow between your legs. A good night of sleep and an afternoon nap are the best medicine for fatigue.

Backache: Your growing uterus is placing more pressure on your lower back, so good body mechanics are important—and watch your weight gain. Also, do not wear high heel shoes and avoid heavy lifting. Try to relax, and have your partner massage your back.

Sore feet: As your pregnancy advances, your feet may become slightly larger. Wear comfortable shoes with low heels. Foot massages will also help.

Travel: Check with your doctor before making plans, and make sure to carry a copy of your obstetrical history if you travel. Don’t sit for a long time. Eat a good diet and drink plenty of fluids. If you must travel outside the country, drink bottled water and avoid uncooked foods.

Dental Problems: Your gums may be swollen and bleed. Floss and brush regularly, and attend to any other dental problems.

Itchy Abdomen: Pregnant bellies become itchier as the months progress. Try not to scratch. Ask your doctor to prescribe a lotion that may help.

Overheating: During pregnancy your metabolic rate is higher, so you feel warmer. Bathe often, use a good antiperspirant, and dress in layers so you can remove some clothing if you feel warm.

Premature labor: Premature labor is when labor starts before week 36 of your pregnancy. If premature labor is not stopped, it will result in the birth of a baby who is too small and may have difficulty breathing. There are many factors that can increase the risk of premature labor:

  • Smoking: Stop now.
  • Alcohol and Drugs: Avoid completely. Do not take any medications, including over-the-counter medicines, without the approval of your doctor.
  • Infection: Reduce your risk of infection by staying away from crowds. Don’t hold your urine, as it may increase your risk of infection.
  • Incompetent Cervix: This is when the cervix opens prematurely. If undiagnosed, it can lead to a late miscarriage or early labor. If diagnosed, you can avoid premature labor by having your cervix sutured closed around week 14.
  • Heavy Physical Work: Premature labor may be caused by heavy work and standing too long. Avoid these activities.
  • Poor Diet and Poor Weight Gain: Women who do not eat well and do not have an adequate weight gain are at risk for premature labor.
  • Previous Premature Labor: If you have a history of premature delivery, abstain from sex during the last two to three months of pregnancy. If you think you are having premature labor, contact your doctor immediately. After 20 weeks of pregnancy, all emergency care is provided at the Saint Francis Family BirthPlace. Go there immediately.

Premature Rupture of Membranes: When the bag of water surrounding your baby breaks or starts to leak before 37 weeks, it is referred to as premature rupture of membranes. The membranes serve as protection against infection for your baby. Signs of premature rupture include any leakage, a sudden rush of fluid, a small tickle or if you feel wet. Do not wait for labor or hope it will stop. Come to the Saint Francis Family BirthPlace immediately. Infection can happen quickly, harming you and your baby.

Urinary Tract Infections: If you have any of these symptoms, see your doctor immediately:

  • A feeling you have to urinate all the time
  • A burning sensation when you pass urine
  • Only passing a drop or two of urine
  • Sharp lower abdominal pain
  • Elevated temperature

To prevent urinary tract infections:

  • Drink lots of water, unsweetened citrus or cranberry juice
  • Avoid coffee, tea (even decaffeinated) and alcohol
  • Do not hold your urine
  • Take your time, lean forward to help empty your bladder
  • Wear cotton or cotton-lined panties
  • Don’t wear tight pants or pantyhose under your pants
  • Sleep without panties
  • Avoid perfumed soaps, sprays or powders
  • Wipe from front to back
  • When taking antibiotics, eat unsweetened yogurt or frozen yogurt, which contain active cultures that help protect against getting a urinary tract infection
  • Get plenty of rest and sleep
  • Do your relaxation exercises and avoid stress

Warning signs of a potential problem during the second trimester of pregnancy may include:

  • A gush or steady leaking of fluid from the vagina
  • Pain or burning when urinating and/or fever more than 101 F
  • Vision problems, blurring
  • Severe headache for more than 2 to 3 hours
  • Swelling or puffiness of hands and face, especially with a headache
  • Sudden weight gain if you haven’t overeaten
  • Coughing up blood

If you experience any of these signs before your 20th week, go to the Level III Emergency and Trauma Center at Saint Francis Medical Center. After 20 weeks, go directly to the Saint Francis Family BirthPlace.

Third Trimester (28–40 Weeks)

During the third trimester of pregnancy, you will visit the doctor every two weeks and then once a week beginning at week 36. Visits will include weight, blood pressure, and urine testing; measuring the height of the uterus, the size/position of your baby, and the baby’s heart rate. We will also be checking for signs of swelling and asking about Braxton Hicks contractions. At 36 weeks your doctor will perform blood work, an internal examination and repeat cultures.

Physical Symptoms:

  • Fatigue (report extreme fatigue to your doctor, as it may be a sign of anemia)
  • Changes in fetal movement; more squirming due to less room
  • Increase in whitish discharge
  • Lower abdominal ache
  • Constipation
  • Occasional headaches and nasal congestion
  • Occasional nosebleeds and bleeding gums
  • Leg cramps and backache
  • Discomfort and achiness in the buttocks and pelvic area
  • Mild swelling of the ankles and feet
  • Varicose veins and hemorrhoids
  • Shortness of breath
  • Difficulty sleeping
  • Braxton Hicks contractions
  • Clumsiness
  • Colostrum
  • Loss or gain of appetite

Emotional Symptoms:

  • Increased apprehension and irritation
  • Absentmindedness
  • Increased dreaming, fantasizing and boredom
  • Feeling tired may or may not increase as you carry more weight
  • Trouble sleeping (try sleeping on your left side with a pillow between your legs)

Third Trimester Care and Changes

Exercise: There are several exercise programs for expecting and post delivery mothers. Your doctor can suggest some, but you’ll need to know your own limitations. This is not the time to start an exercise program if you have never exercised before. Try walking.

Diet: A balanced diet is still key. Frequent, smaller meals will make you feel more comfortable. After your baby drops, you will experience less stomach discomfort. Before labor begins, many mothers actually lose weight or stop gaining.

Sexual relations: If you have a normal pregnancy you can have sex, but you may have to look for a more comfortable position. It’s normal to lose temporary interest in sex. If you have risk factors for premature labor, have any bleeding or are carrying multiples, sex may be restricted. Check with your doctor.

Regular activities: Continue with your activities of daily living, as long you do not tire. Take rest periods throughout the day. Get off your feet, raise your legs, listen to relaxing music or take a nap. Slowly decrease the amount of bending, lifting, stooping and pushing you do as your pregnancy advances. Avoid carrying heavy laundry baskets and groceries, especially in your last trimester. Keep yourself hydrated by drinking lots of fluids, especially in warmer weather. By taking care of yourself you are taking good care of your baby.

Swelling (Edema): Swelling is very common late in your pregnancy, especially in the evenings, during warm weather and after standing or sitting for a long time. Most swelling disappears overnight or if you lie down for a long time. Prevent swelling by wearing comfortable shoes, avoiding elastic-top socks and stockings, and wearing support hose. Fluids to help flush out wastes and avoiding excessive salt should help control swelling. If swelling lasts more than 24 hours with a rapid weight gain, headaches, or vision problems, see your doctor.

Safety: Your balance is poor because your center of gravity keeps shifting and your joints are less stable. Daydreaming may cause accidents. Be careful and report any falls to your doctor. If you notice vaginal bleeding, leaking fluid, abdominal tenderness or uterine contractions, come directly to the Saint Francis Family BirthPlace.

Hiccups: Believe it or not, your baby can get hiccups while in the womb. Don’t panic. This will not hurt your baby.

Backache: The pressure of your growing uterus can affect the sciatic nerve, causing low back, buttock and leg pain. Get off your feet, lie down, rest and relax. Warm compresses may reduce pain.

Dreams and Fantasies: Dreams give clues into your feelings that can help you with your transition to motherhood. You can expect them during your last trimester. They can be both horrifying and pleasant and occur during the day and night. Each dream and fantasy may express one or more of these concerns:

  • Being unprepared, losing things, forgetting things
  • Being attacked or hurt by intruders/animals or falling
  • Gaining too much weight, forgetting to drink milk
  • Losing appeal, not being attractive
  • Sexual encounters, both positive and negative, pleasure or guilt provoking
  • Death, loss, resurrection
  • What your baby will be like

Stress Incontinence: The pressure of your growing uterus on your bladder can cause stress incontinence (leaking urine when you laugh, cough or sneeze). Kegel exercises may help prevent incontinence.

Braxton Hicks Contractions: These contractions are usually painless but may be uncomfortable because of the tightening of your uterus. They become more frequent as you get closer to delivering. Changing your position may stop them completely. Try lying down and relaxing or getting up and walking. Report these contractions to your doctor if they are very frequent, are accompanied by pain or unusual vaginal discharge, or if you are at high risk for premature labor.

Bathing: Tub bathing is safe in normal pregnancies until your membranes rupture or the mucous plug is expelled. Safety is most important. Make sure someone is available to help you in and out of the bathtub. When showering, make sure there is a nonslip surface to help prevent falls.

Lightening (engagement): This is when your baby drops into the pelvis. With a first pregnancy, this usually happens two to four weeks before delivery. In women who already have had children, it rarely occurs until they go into labor. Your belly seems lower and tilted forward and you can breathe easier. There is less discomfort when you eat but more pressure on your bladder. Your center of gravity shifts again, and you may feel off balance, so be cautious.

Urinary Tract Infections: If you have any of these symptoms, see your doctor immediately.

  • A feeling you have to urinate all the time
  • A burning sensation when you pass your urine
  • A small amount or only drops of urine
  • Sharp lower abdominal pain
  • Elevated temperature
  • Blood in your urine

Prelabor Symptoms:

  • Lightening (engagement)
  • Sensation of increased pressure in the pelvic and rectum area
  • Loss of weight or cessation of weight gain
  • Change in energy level (energy spurts, nesting instinct)
  • Change in vaginal discharge, loss of mucous plug, pink or bloody show
  • Braxton Hicks contractions increase
  • Diarrhea

False Labor Symptoms:

  • Contractions are not regular and do not get longer or stronger
  • Pain is in your lower abdomen rather than your lower back
  • Contractions stop if you walk around or change positions
  • Fetal movements increase briefly with contractions (A lot of activity or movement could mean your baby is in distress and you should see your doctor.)

Real Labor Symptoms:

  • Contractions get longer, stronger and closer together and get stronger when you change positions or activity
  • Pain begins in the lower back and spreads to the lower abdomen and may radiate to your legs
  • Pinkish or blood-stained show is present
  • Before labor begins, membranes may rupture in a gush or a trickle.

Warning signs of a potential problem during the third trimester of pregnancy include bleeding and spotting. The answers to “Is it time to have my baby?” and “Is something wrong?” depend upon the type of bleeding. Pinkish-stained or red-streaked mucous appearing soon after sex or vagina examination or brownish spotting 48 hours later is normal and not a warning sign, but you should report it to your doctor. Bright red bleeding or persistent spotting needs immediate attention. Come to the Saint Francis Family BirthPlace. Pinkish or brownish tint or bloody mucous along with contractions could mean labor is starting.

Signs of premature labor (labor pains before 37 weeks) include:

  • Menstrual-like cramps with or without diarrhea, nausea or indigestion
  • Lower back pain or pressure
  • An achiness or pressure in the pelvis, thighs or groin
  • A watery or brownish discharge or passage of a thick gelatin-like plug (mucous plug)
  • A trickle or gush of fluid (rupture of membranes)

If you think your membranes have ruptured, go to the Saint Francis Family BirthPlace immediately. If you have leakage, trickles, a sudden gush or feel very wet, you must see your doctor. Infection can happen quickly and can harm you and your baby.

Warning signs during late pregnancy include:

  • Heavy vaginal bleeding
  • A gush or steady leaking of fluid
  • Painful burning when urinating and/or temperature more than 100.4 F
  • Blurred vision
  • Severe headache for more than 2 or 3 hours
  • Swelling or puffiness of hands and face, especially with a headache
  • Sudden weight gain
  • Coughing up blood


To learn more about how the Family BirthPlace at Saint Francis Medical Center supports mother and baby through all pregnancy stages, call 877–231-BABY (2229).

Pregnancy: Am I Pregnant?

How can a woman know if she is pregnant?

If a woman is tuned in to her body, she might begin to suspect that she is pregnant within the first few days of pregnancy. Most women, however, don’t suspect they are pregnant until they miss a period. A few don’t suspect or believe they are pregnant for months after conception.

A woman should take a pregnancy test if she misses a period. Early prenatal (before the birth) care is important to the health of the mother as well as the baby. A woman should see a doctor right away if she is pregnant.

What are five common signs of pregnancy?

The following are five very common signs of early pregnancy. Women might experience all, some, or none of these symptoms. Pregnancy symptoms vary from woman to woman.

  • A missed period: Missing a period is the most clear-cut sign of pregnancy. However, it is not always a sign of pregnancy. Stress, excessive exercise, dieting, hormone imbalance and other factors might cause irregular periods.
  • Frequent trips to the bathroom: Even before missing a period, many pregnant women report having to urinate more often. A woman might even have to get up during the night to go to the bathroom. A frequent need to urinate occurs after the embryo has implanted in the uterus and begins producing the pregnancy hormone called human chorionic gonadotropin (hCG). This hormone triggers frequent urination.
  • Fatigue: Feeling extremely tired is a very early sign of pregnancy. Fatigue is a result of high levels of the hormone progesterone.
  • Morning (and noon and night) sickness: Feeling queasy isn’t limited to mornings. Most pregnant women who experience morning sickness feel slightly nauseated at other times during the day. Nausea can begin two weeks to two months after conception. About half of pregnant women have vomiting. However, very few have severe enough morning sickness to develop dehydration and malnutrition.
  • Sore (and enlarging) breasts: In pregnancy, a woman’s breasts will probably become increasingly tender to the touch. The soreness may be similar to the way breasts feel before a period, only more so. The nipples might also begin to darken and enlarge. Once a woman’s body gets used to the increase in hormones, the pain will subside.

What are some other signs that a woman is pregnant?

Other signs of pregnancy can include:

  • Spotting (also called implantation bleeding): Some women experience a light spotting or a brownish discharge from the vagina. This spotting can occur about the time the regular period would occur and can last for a few days to a few weeks.
  • Food cravings and constant hunger: Some women begin to crave certain foods, constantly feel that they are hungry, or might avoid foods that they previously liked.
  • Metallic taste in the mouth: Many women complain of a metallic taste in their mouths during the early stages of pregnancy.
  • Headaches and dizziness: Headaches and the feelings of lightheadedness and dizziness are common during early pregnancy and are the result of hormonal changes and changes in blood volume.
  • Cramping: Some women experience period-like cramps. If cramps are felt mainly on one side or are severe, it’s important to contact a doctor immediately.

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Feeling sick or nausea and Unusually tired


  • Alcoholic liver disease
  • Anxiety
  • Heat stroke
  • Hepatitis
  • High altitude pulmonary oedema
  • Morning sickness
  • Pyelonephritis
  • Typhoid fever

Alcoholic liver disease

Alcohol-related liver disease (ARLD) refers to liver damage caused by alcohol misuse.

Symptoms of this condition may include:

  • Feeling sick or nausea
  • Loss of appetite
  • Diarrhoea
  • Unusually tired
  • Memory loss

Our Health A-Z contains more information on Alcoholic liver disease.

If you are worried about this condition you can try our free AI Symptom Checker here.


Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe.

  • Anxiety
  • Unusually tired
  • Feeling irritable
  • Feeling sick or nausea
  • Feeling heart beat

Our Health A-Z contains more information on Anxiety.

If you are worried about this condition you can try our free AI Symptom Checker here.

Heat stroke

Heat exhaustion and heatstroke are two related health conditions that can be very serious if not treated quickly.

  • Unusually thirsty
  • Feeling sick or nausea
  • Vomiting
  • Unusually tired
  • Lightheaded or feeling dizzy

Our Health A-Z contains more information on Heat stroke.

If you are worried about this condition you can try our free AI Symptom Checker here.


Hepatitis is the term used to describe inflammation of the liver.

  • Right sided abdominal pain
  • Yellow skin or eyes
  • Unusually tired
  • Feeling sick or nausea
  • Upper abdominal pain

Our Health A-Z contains more information on Hepatitis.

If you are worried about this condition you can try our free AI Symptom Checker here.

High altitude pulmonary oedema

Altitude sickness is a common condition that can happen when you climb to a high altitude too quickly.

  • Shortness of breath
  • Headache
  • Feeling sick or nausea
  • Unusually tired
  • Lightheaded or feeling dizzy

Our Health A-Z contains more information on High altitude pulmonary oedema.

If you are worried about this condition you can try our free AI Symptom Checker here.

Morning sickness

  • Vomiting
  • Feeling sick or nausea
  • Unusually tired

Our Health A-Z contains more information on Morning sickness.

If you are worried about this condition you can try our free AI Symptom Checker here.


A kidney infection is a painful and unpleasant illness that usually happens when bacteria travel up from your bladder into one or both of your kidneys.

  • Passing more urine than usual
  • Unusually tired
  • Pain when passing urine
  • High temperature
  • Lower back pain

Our Health A-Z contains more information on Pyelonephritis.

If you are worried about this condition you can try our free AI Symptom Checker here.

Typhoid fever

Typhoid fever is a bacterial infection that can spread throughout the body, affecting many organs.

  • Feeling sick or nausea
  • Abdominal pain
  • Constipation
  • Diarrhoea
  • High temperature

Our Health A-Z contains more information on Typhoid fever.

If you are worried about this condition you can try our free AI Symptom Checker here.

Nausea & dizziness

How do I cope with nausea and vomiting caused by a brain tumour?

If you’re diagnosed with a brain tumour, you may have ongoing nausea and vomiting due to the effects of your tumour, or as a side-effect of treatments, such as chemotherapy or radiotherapy.

Below are some suggestions to help manage and treat nausea and vomiting caused by a brain tumour or its treatment:

  • Speak to your healthcare team – they may be able to give you anti-sickness tablets (also called anti-emetics)
  • Tell your doctor straight away if the medication stops working or becomes less effective
  • If you have been prescribed steroids, make sure you take them – they can help reduce any swelling/increased pressure in the brain that may be causing the nausea
  • Make changes to your diet, for example:
    • eat smaller meals more often, rather than fewer larger meals
    • find which times are best for you to eat
    • eat dry foods when you wake up and every few hours in the day
    • avoid hot, spicy or greasy foods – eat bland, easy to digest foods
    • sip clear fluids frequently to prevent dehydration, as dehydration makes nausea worse
    • avoid drinks that are too hot or too cold
    • try sucking on sugar-free mints, or drinking room temperature cola or ginger ale that have slightly lost their fizz
    • remain seated upright for at least 1 hour after eating
  • Avoid strong smells e.g. from cooking or painting
  • Some people have found acupuncture helps
  • If you feel like vomiting, breathe deeply and slowly, or get some fresh air
  • Distract yourself by listening to music, watching a film/TV show or chatting with friends

Weakness and Fatigue

Topic Overview

Weakness and fatigue are terms that are often used as if they mean the same thing. But in fact they describe two different sensations. It is important to know exactly what you mean when you say “I feel weak” or “I am fatigued” because it can help you and your doctor narrow down the possible causes of your symptoms.

  • Weakness is a lack of physical or muscle strength and the feeling that extra effort is required to move your arms, legs, or other muscles. If muscle weakness is the result of pain, the person may be able to make muscles work, but it will hurt.
  • Fatigue is a feeling of tiredness or exhaustion or a need to rest because of lack of energy or strength. Fatigue may result from overwork, poor sleep, worry, boredom, or lack of exercise. It is a symptom that may be caused by illness, medicine, or medical treatment such as chemotherapy. Anxiety or depression can also cause fatigue.

Both weakness and fatigue are symptoms, not diseases. Because these symptoms can be caused by many other health problems, the importance of weakness and fatigue can be determined only when other symptoms are evaluated.


General weakness often occurs after you have done too much activity at one time, such as by taking an extra-long hike. You may feel weak and tired, or your muscles may be sore. These sensations usually go away within a few days.

In rare cases, generalized muscle weakness may be caused by another health problem, such as:

  • A problem with the minerals (electrolytes) found naturally in the body, such as low levels of potassium or sodium.
  • Infections, such as a urinary tract infection or a respiratory infection.
  • Problems with the thyroid gland, which regulates the way the body uses energy.
    • A low thyroid level (hypothyroidism) can cause fatigue, weakness, lethargy, weight gain, depression, memory problems, constipation, dry skin, intolerance to cold, coarse and thinning hair, brittle nails, or a yellowish tint to the skin.
    • A high thyroid level (hyperthyroidism) can cause fatigue, weight loss, increased heart rate, intolerance to heat, sweating, irritability, anxiety, muscle weakness, and thyroid enlargement.
  • Guillain-Barré syndrome, a rare nerve disorder that causes weakness in the legs, arms, and other muscles and that can progress to complete paralysis.
  • Myasthenia gravis, a rare, chronic disorder that causes weakness and rapid muscle fatigue.

Muscle weakness that is slowly getting worse requires a visit to a doctor.

Sudden muscle weakness and loss of function in one area of the body can indicate a serious problem within the brain (such as a stroke or transient ischemic attack) or spinal cord or with a specific nerve in the body.


Fatigue is a feeling of tiredness, exhaustion, or lack of energy. You may feel mildly fatigued because of overwork, poor sleep, worry, boredom, or lack of exercise. Any illness, such as a cold or the flu, may cause fatigue, which usually goes away as the illness clears up. Most of the time, mild fatigue occurs with a health problem that will improve with home treatment and does not require a visit to a doctor.

A stressful emotional situation may also cause fatigue. This type of fatigue usually clears up when the stress is relieved.

Many prescription and nonprescription medicines can cause weakness or fatigue. The use of alcohol, caffeine, or illegal drugs can cause fatigue.

A visit to a doctor usually is needed when fatigue occurs along with more serious symptoms, such as increased breathing problems, signs of a serious illness, abnormal bleeding, or unexplained weight loss or gain.

Fatigue that lasts longer than 2 weeks usually requires a visit to a doctor. This type of fatigue may be caused by a more serious health problem, such as:

  • A decrease in the amount of oxygen-carrying substance (hemoglobin) found in red blood cells (anemia).
  • Problems with the heart, such as coronary artery disease or heart failure, that limit the supply of oxygen-rich blood to the heart muscle or the rest of the body.
  • Metabolic disorders, such as diabetes, in which sugar (glucose) remains in the blood rather than entering the body’s cells to be used for energy.
  • Problems with the thyroid gland, which regulates the way the body uses energy.
    • A low thyroid level (hypothyroidism) can cause fatigue, weakness, lethargy, weight gain, depression, memory problems, constipation, dry skin, intolerance to cold, coarse and thinning hair, brittle nails, or a yellowish tint to the skin.
    • A high thyroid level (hyperthyroidism) can cause fatigue, weight loss, increased heart rate, intolerance to heat, sweating, irritability, anxiety, muscle weakness, and thyroid enlargement.
  • Kidney disease and liver disease, which cause fatigue when the concentration of certain chemicals in the blood builds up to toxic levels.

Myalgic encephalomyelitis/chronic fatigue syndrome is an uncommon cause of severe, persistent fatigue.

If fatigue occurs without an obvious cause, it is important to evaluate your mental health. Fatigue is a common symptom of mental health problems, such as anxiety or depression. Fatigue and depression may become so severe that you may consider suicide as a way to end your pain. If you think your fatigue may be caused by a mental health problem, see your doctor.

Check your symptoms to decide if and when you should see a doctor.

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