Managing migraine during pregnancy presents unique challenges due to hormonal changes and the necessity to ensure the safety of both the mother and the unborn baby. Migraine often occurs during a woman’s reproductive years and can be influenced by pregnancy-related factors such as hormonal fluctuations, stress, and disrupted sleep. While migraine may worsen in the first trimester, many women experience significant improvement in later stages of pregnancy. This post sheds light on important considerations for pregnant individuals with migraine, including safe treatment options and potential risks.
Pregnancy is a sensitive situation in medicine. Please discuss any questions with your healthcare provider before making health decisions.
Migraine commonly occurs during a woman’s reproductive years. Treating migraine during pregnancy can be challenging as the migraine pattern may change, and the medications used must be safe for both the mother and her unborn baby. For physicians, pregnancy is also considered a “red flag” in patients complaining of headache. It’s important to look for other causes of headache during pregnancy before considering migraine.
What happens to my migraine if I get pregnant?
Many factors during the nine months of pregnancy and six weeks postpartum can influence your migraine, including hormonal changes, stress, interrupted sleep, nausea, and dehydration.
Several studies have shown that migraine may worsen in the first trimester. However, up to 60-70% improvement can be seen by the second and third trimesters.
Is it dangerous to have a migraine attack during my pregnancy?
No, you can have a migraine attack without danger to you or your unborn child. However, pregnant individuals with migraine may be at an increased risk of some conditions like pre-eclampsia, premature birth, and low birthweight. This should be monitored by your family doctor or your obstetrician.
When should I be concerned about headache during pregnancy?
If you have any concerns about headache during pregnancy, seek medical attention. Here are some headache symptoms that would make a doctor consider more urgent tests:
What treatments are safe to take for migraine during pregnancy?
First-line therapy: Always start with non-medical strategies if possible, such as:
Next, consider over-the-counter pain medications that have been shown to be relatively safe during pregnancy. In the first trimester, the following are considered relatively safe, though they may cause rare side effects involving the liver, heart rhythm, and nerves:
Some anti-inflammatory medications are considered relatively safe only in the second trimester. They should never be used in the first trimester due to the risk of abnormal placental implantation, or in the third trimester due to risk of premature closure of the ductus arteriosus in the unborn baby.
Procedures such as nerve blocks using a numbing medicine called Lidocaine have been shown to be safe and effective for severe migraine during pregnancy. Acupuncture is also considered safe.
Triptans have been used by pregnant women, and registries do not suggest a significant risk for the baby. Sumatriptan has the most information available. However, the use of triptans may increase the risk of hypertension during pregnancy and bleeding afterward. They should be avoided if possible, but if a woman has severe attacks that respond well to triptans, using Sumatriptan could be considered after a careful risk/benefit discussion with a physician.
***Please consult your family doctor to see if you are a candidate for these medications or procedures. Your family doctor may refer you to a pain specialist or headache specialist for nerve blocks***
What about my migraine prevention medications? Can I continue these medications?
Most of these medications will need to be stopped months before planning for pregnancy. If you become pregnant while taking them, do not take your next dose and contact your family doctor for advice.
Generally, migraine improves during the latter part of pregnancy, so you may not need your preventative medications during this time. However, there are relatively safe preventative medications available for use during pregnancy, which you can discuss with your doctor.
Overall, it’s best to be cautious and avoid using medications for migraine treatment during pregnancy to prevent side effects for you and your unborn child.
If I improve during pregnancy, will the migraine attacks return after delivery?
Migraine attacks tend to return around 1 to 2 months after delivery, although this can vary. Factors influencing how fast migraine returns include breastfeeding, sleep patterns, stress, diet, and hydration.
How does breastfeeding impact migraine?
Women with migraine who breastfeed tend to have fewer migraine attacks than those who do not. The theory is that the hormone prolactin released during breastfeeding prevents menstruation, thereby preventing estrogen levels from fluctuating.
It is also important to follow up with your doctor for advice on which medications are safe to use during breastfeeding.
References
- Todd C, Lagman-Bartolome AM, Lay C. Women and Migraine: The Role of Hormones. Current neurology and neuroscience reports. 2018;18(7):42.
- Robbins MS. Headache in Pregnancy. Continuum (Minneapolis, Minn). 2018;24(4, Headache):1092-107.
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