How Is A Migraine Treated During Pregnancy
The first trimester generally provides a good idea about whether a woman experiences migraines, as well as the best way to treat them. If a pregnant woman experiences a migraine attack, she should see her physician. Then, this woman and her physician can determine how to address migraine pain.
Preventative migraine medications are typically not recommended for use during pregnancy. These medications sometimes cause nausea and vomiting to worsen during pregnancy. They can also increase a pregnant womans risk of experiencing dehydration.
In one study, researchers indicated pregnant women should first use nondrug therapies to help treat migraine pain. These therapies may include relaxation, sleep and massage, along with the use of ice packs and biofeedback therapy. Following the use of nondrug therapies, pregnant women may consider paracetamol as the initial drug treatment for migraine pain. The risks of using aspirin and ibuprofen to treat migraine pain are usually lower than those associated with other types of migraine medications thus, pregnant women may sometimes use aspirin and ibuprofen to address a migraine attack.
Furthermore, pregnant women may use the antipsychotic medication prochlorperazine to treat nausea associated with a migraine. Research shows that prochlorperazine is unlikely to put a woman in danger during pregnancy and helps alleviate nausea.
How Frequent Are Migraines During Pregnancy
The incidence and reoccurrence of migraine attacks in women vary widely. Some of them experience for the first time in pregnancy, while some women experience increasing migraine symptoms during the first trimester.
According to the American Migraine Foundation, around 50 to 80% of pregnant women experience reduced attacks . This reduction in symptoms is attributed to the increasing levels of estrogen during pregnancy.
When To Consult Your Healthcare Provider
You must consult a doctor, if:
Timely action may help you mitigate the problem.
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What Happens To Migraine During The Third Trimester Of Pregnancy
Things tend to improve. But the third trimester may be a time when healthcare providers are particularly concerned about the secondary causes of headache. Please report any change in headache characteristics to your healthcare provider. Also, a black box warning for the use of nonsteroidal anti-inflammatory drugs after 20 weeks gestation has been recently issued by the FDA because of potential complications that can be caused by these treatments.
Are Migraines During Pregnancy Bad For The Baby
Migraines can be so severe, you might worry theyâre affecting your baby too. âThe good news,â Dr. Crystal says,â is that large studies have not shown increased rates of birth defects or stillbirths in migraineurs.â
That being said, women who have migraines so severe that they end up in the emergency room have a higher risk of complications such as pre-eclampsia, preterm delivery, and low birth weight, according to the National Headache Foundation.
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How Can I Treat A Headache In Pregnancy
If you have a mild headache, its safe to take paracetamol. Make sure you follow the instructions on the packet for how much you can take.
There are some painkillers you should not take while youre pregnant. These include tablets or capsules that:
- contain added caffeine
- contain codeine
- are anti-inflammatory, like ibuprofen or aspirin.
Some women may be advised to take a low dose of aspirin as a treatment if they have had miscarriages before or they are at risk of pre-eclampsia. This will be prescribed by a doctor. Aspirin should not be taken as treatment for a headache.
Try to take the lowest dose of paracetamol that works and for the shortest amount of time. Your midwife, GP or pharmacist can give you more advice if the pain is ongoing and doesnt go away with paracetamol.
Find out more about drugs and medicines in pregnancy.
Drugs To Prevent Migraine
If daily medication is considered necessary to prevent migraine during pregnancy, the lowest effective dose of propranolol is the drug of choice.9 Low dose amitriptyline is a safe alternative.9 There are no reports of adverse outcomes from pizotifen used during pregnancy or lactation, although it is less often used than the drugs above.
In contrast, sodium valproate, should not be taken during pregnancy for migraine as there is a high risk of fetal abnormalities. Indeed, women prescribed sodium valproate for migraine must use effective contraception.
Topiramate should not be used for migraine during pregnancy and breastfeeding as there are insufficient data regarding safety.
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What Are The Symptoms Of Migraine Headaches
The two most common types of migraines are classic migraines and common migraines. The following are the most common symptoms. However, each woman may experience symptoms differently. Symptoms may include:
Migraine aura. A type of migraine that involves the appearance of neurological symptoms, called an aura , 10 to 30 minutes before an attack. An attack may last one or two days. Pain associated with classic migraines may be described as:
Intense throbbing or pounding felt in the forehead, temple, ear, jaw, or around the eye.
Starting on one side of the head, but may spread to the other side.
Migraine without aura. A type of migraine that is generally not preceded by an aura, although there may be a variety of symptoms prior to its onset. Common migraine pain may last three or four days. Symptoms may include:
Diarrhea and increased urination
Nausea and vomiting
The symptoms of migraines may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.
If I Tend To Get Migraines During My Period Will I Also Get Them During Pregnancy
For women who get them, they tend to hit just before or at the start of your period. The quick drop in estrogen and progesterone that occurs before your period starts could be what triggers menstrual migraines, according to the US Office on Womenâs Health.
If you suffer from menstrual migraine, you might worry that youâll also be prone to get migraines triggered by hormonal changes that happen in your body during pregnancy, but thereâs good news. Dr. Crystal points out that many women who get menstrual migraines actually see an improvement in their migraines while pregnant.
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What Can I Take To Treat My Migraine If I Am Breastfeeding
The same drugs used in pregnancy can be taken whilst breastfeeding, with the following exceptions aspirin is excreted in breast milk, so should be avoided during breastfeeding because of the theoretical risk of Reyes syndrome and impaired blood clotting in susceptible infants metoclopramide is not generally recommended during lactation since small amounts are excreted into breast milk. The licensing for sumatriptan indicates that a 12 hour delay between treating and breastfeeding is necessary. However, the breastfeeding can continue without interruption during treatment with sumatriptan.13 Almotriptan,eletriptan, frovatriptan, and rizatriptan are licensed for use in breastfeeding providing that you do not breastfeed within 24 hours of the last dose. We would recommend similar advice for naratriptan and zolmitriptan.
Who Can Help Me Manage Migraine During Pregnancy
In addition to treating people with migraine, Starling lives with the disease of migraine. I’ve gone through multiple pregnancies and have two children, and I was able to figure it out and manage migraine in collaboration with my healthcare professional. I know it can be scary for patients, but it’s totally doable, she says.
Try to channel those feelings into being proactive in how you will manage your migraine during pregnancy, says Starling. I always encourage patients to find a healthcare professional, whether it be your primary care doctor, your neurologist, or your headache specialist, who will collaborate with your ob-gyn to figure out how best to manage your migraine during pregnancy, she says.
Pregnancy is hard enough for many different reasons, and I think that if we can manage migraine better, it makes it so much easier, she adds.
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What Causes Migraine Headaches During Pregnancy
Migraine headaches seem to have a genetic component, which means they tend to run in families. That said, theres usually a triggering event that unleashes them. One of the most common triggers at least for women is fluctuating hormone levels, particularly the rise and fall of estrogen.
Moms-to-be who get migraine attacks tend to experience them most often in the first trimester of pregnancy, when hormone levels, including estrogen, havent yet stabilized.
An increase in blood volume, which is also common in the first trimester, can be an additional factor. As blood vessels in the brain expand to accommodate extra blood flow, they can press against sensitive nerve endings, causing pain.
Other common migraine triggers, whether youre pregnant or not, include:
When Headaches Are Secondary To Other Problems
Headaches can result from other conditions, some of which are life-threatening:
Stroke: Sudden and severe headaches might be a sign of a stroke. Women who have strokes during pregnancy or after delivery typically describe the pain as the worst headache of their lives. They also might report other symptoms, such as speech problems, vision issues, or functional problems on one side of the face or body. At the emergency room, the doctor will evaluate you for stroke symptoms, such as visual changes, facial drooping, and arm or leg weakness. If you are having or had a stroke, we will get you emergency treatment at our Advanced Comprehensive Stroke Center.
Preeclampsia: A headache with preeclampsia can indicate a dangerous spike in blood pressure. The doctor will assess you and might admit you to the hospital for management of blood pressure and treatment to prevent seizures.
Spinal fluid leak: A headache after an epidural or spinal block can indicate a spinal fluid leak, especially if it worsens when you sit or stand up. The most effective treatment is an epidural blood patch, in which the doctor injects a sample of your blood into the leaking area, essentially plugging the hole. This therapy provides dramatic relief right away.
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Pregnancy And Migraine Medication
Pregnant women have to be very careful about what they put into their bodies, which is also true for most migraine medications. Women in early stages of pregnancy and on migraine medication should call their doctor as soon as they learn that theyre expecting. For women who do experience migraine attacks during pregnancy, some medications are safe for pregnant women to use, including Benadryl and Tylenol, but call your doctor to confirm. An obstetrician should work quite closely on a treatment plan with a mom-to-bes migraine management team, whether that includes a primary care physician, neurologist, headache specialist, or someone else. Of course, migraine and the experiences of pregnancy vary from person to person. Women who have their headaches accompanied by aura may not see the same improvement other migraine sufferers do, Robbins said.
Viii Review Of Key Questions
The Agency for Healthcare Research and Quality posted the Key Questions on the AHRQ Effective Health Care Website for public comment. The Evidence-based Practice Center refined and finalized them after reviewing of the public comments and seeking input from Key Informants. This input is intended to ensure that the Key Questions are specific and relevant.
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How Can I Treat A Migraine Attack While Pregnant
For migraine attacks that occur during pregnancy, there are several nonspecific migraine medication options, meaning they were not designed specifically to treat migraine, says Starling.
Metoclopramide is typically used as an anti-vomiting medication, but it actually has benefits for stopping the migraine attack itself, and that, in combination with the acetaminophen, can be really helpful, she says.
Sometimes I’ll even add a little bit of Benadryl in there, too, because that can help with providing some sleepiness or sedation. The idea is that the combination can help someone take a nap, and when she wakes up, the migraine attack will hopefully be done, says Starling.
Migraine Headaches During Pregnancy
Headaches are quite common in pregnancy. The most common are tension headaches and migraine headaches. Most headaches come and go, but others may be more bothersome or may be caused by other problems. It is important to talk with your healthcare provider about any headaches you have before, during, or after pregnancy.
Many pregnant women have migraine headaches. Over half of women find that their migraines happen less often in the last few months of pregnancy. But migraines may get worse after birth, during the postpartum period. Although migraine headaches may cause you severe pain, they do not harm your developing baby .
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Never Be Afraid To Consult Your Doctor
If you have a very severe headache or one that onsets very quickly, it is best to consult your doctor. Its better to be safe than sorry. One phone call can give you that peace of mind.
Remember, headaches are a normal part of pregnancy so try not to become alarmed every time you develop one.
The First Three Months Of Pregnancy
During the first three months the symptoms of pregnancy can make your migraine worse. Morning sickness can mean that you feel like eating and drinking less which can cause low blood sugar and dehydration. If you are not careful this can make your migraines worse. You should try to eat small frequent meals and drink frequent small amounts of water to prevent this. You will also be helping reduce any pregnancy sickness.
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Headache And High Blood Pressure
If you know you have been experiencing higher-than-normal blood pressure, you should take major headaches seriously. A headache associated with high blood pressure is a strong indicator of preeclampsia. This can put both you and your unborn baby at risk .
Preeclampsia usually begins after 20 weeks of pregnancy and can be carefully controlled by your physician. Some tests can be conducted to confirm whether or not you have this complication.
Other symptoms of preeclampsia include blurred vision, blind spots, or dizziness. Any combination of these with headaches can be concerning.
Pregnancy Can Have A Significant Impact On Migraine Symptoms And How Women Should Treat Them Heres What Experts Have To Say
First, the good news: Between 50 and 80% of pregnant migraine patients actually experience a reduction in migraine attacks during their pregnancy, according to David Dodick, a professor of medicine at the Mayo Clinic School of Medicine in Arizona. Many doctors believe rising estrogen levels help reduce migraine frequency and intensity. Hormone replacement therapy that mimics pregnancys effect on the body is increasingly being used in migraine treatment plans, especially for those who experience migraines around the time of menstruation. Caution does need to be used however in women who have migraines with aura, as the increased risk of stroke may further be increased by the addition of an estrogen-containing oral contraceptive pill.
However, some women experience migraine for the first time during pregnancy and some experience an increase in migraine symptoms especially during the first trimester. The appearance or worsening of migraine in pregnant women should be taken very seriously: Studies show that migraine symptoms, when accompanied by high blood pressure, can increase the risk of developing preeclampsia or other vascular complications. Women whose migraine symptoms dont decrease during pregnancy should be particularly vigilant. Its important to work with your obstetrician and your headache doctor when you have migraine to establish a safe treatment plan.
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When Should I Call A Doctor Or Midwife About A Headache In Pregnancy
Call your midwife, doctor or hospital maternity unit if you have a very bad headache or a headache that wont go away. This could be a symptom of pregnancy induced hypertension. This is a type of high blood pressure that develops after 20 weeks and goes away within 6 weeks of the baby’s birth. Its also known as gestational high blood pressure or gestational hypertension.
Call your midwife, doctor or hospital straight away if you have a headache and vision problems and sudden swelling on your hands, feet, face or stomach. This could be a sign of pre-eclampsia, a pregnancy condition that can be dangerous for you and the baby if it is not monitored and treated.
- discomfort in the lowest part of your stomach
- back pain
- loin pain
- needing to wee a lot or an uncontrollable need to wee
- cloudy, foul-smelling or bloody wee
- a raised temperature
- feeling sick and vomiting.
This could be a sign of a urinary tract infection. UTIs cab be treated with antibiotics that are safe to use in pregnancy.
When Should I Call My Doctor
Whether you experience headaches or not, its always important to discuss your pre-pregnancy history, obstetrical history and concerns with your doctor for an individualized assessment and management plan. However, if none of the above treatments resolve your mild headache or your headaches become more frequent and severe, talk to your doctor to determine the cause.
This includes new headaches that present after 20 weeks, a sudden onset of severe headaches, headaches associated with a fever, mental health changes, elevated blood pressure and vision changes, Dr. Saunders said. Its important to keep an open line of communication with your physician and let them know about any changes in your health so they can rule out anything serious.â
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