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How To Treat Migraine In Pregnancy

Pregnancy And Migraine Medications

Pregnancy Tips : How to Treat Headaches During Pregnancy

Pregnancy is a step into the unknown. It can be the most wonderful time in a persons life, but it can also be intimidating. For women living with migraine disease, contemplating pregnancy can be downright frightening.

I always assumed I would not have children. Motherhood and pregnancy seemed like an unthinkable undertaking to someone experiencing daily migraine since the age of four. But very suddenly, after 26 years of perfecting various migraine strategies and medications, I won my personal migraine battle. This was so life-changing for me that after a month without daily migraines I noticed flowers were beautiful for the first time. Four years later, I got up the courage to become pregnant. In truth, I was practically paralyzed with fear.

Last month, in an article on breastfeeding and migraine medications, I pointed out that our culture puts a lot of pressure on breastfeeding mothers to avoid medications. The stigma and cultural pressures are even more prevalent for expectant mothers. Studies have demonstrated that not just pregnant women, but also their healthcare providers tend to overestimate the risks associated with using medications during pregnancy.

NON-PHARMACOLOGICAL STRATEGIES

HOW THE FDA RATES THE SAFETY OF MEDICATIONS FOR USE IN PREGNANCY

When contemplating the use of a medication during pregnancy it is important to understand the code the FDA uses to rate the safety of medication during pregnancy. The FDA pregnancy categories 5 are as follows:

Botox

Does Migraine Affect The Outcome Of Pregnancy

Migraine has long been mentioned as a possible predictor of complications in pregnancy, although because migraine is so common in females systemically establishing a link to complications in pregnancy has been a challenge. Several associations have been proposed, including miscarriage, pre-eclampsia, congenital anomalies, and low birth weight, but these associations remain clouded by a lack of well controlled studies.

Pain Medications For Migraines

Some of the safe migraine medications your doctor might suggest are as follows :

In the first trimester and beyond

  • Paracetamol/Acetaminophen helps reduce pain
  • Metoclopramide treats nausea and vomiting symptoms during pregnancy
  • Triptans, such as Imitrex and Amergecan, can ease migraine headaches

After the second trimester:

  • Nonsteroidal anti-inflammatory drugs , such as ibuprofen and naproxen, can help. However, these can cause severe complications such as preterm birth and birth defects if consumed in the first trimester.

Some of the medications you should avoid

  • Aspirin: It can cause miscarriage and bleeding.
  • Opioids: These can cause severe complications, such as stillbirth, premature deliveries, and congenital disabilities.

Recommended Reading: Migraine Healthline

What Causes Your Migraines And Headaches

There are many different triggers for migraines, but estrogen is the primary culprit for pregnant women. It is even possible for a woman never to experience a migraine until she becomes pregnant. The elevated estrogen levels increase the probability of migraines.

Some lucky women notice their migraines disappear once they become pregnant, but others notice an extreme increase in intensity . There is significant evidence linking migraines to hormones.

Of course, there are other reasons you may suffer from one of these nasty headaches. Some triggers include:

  • Chocolate.
  • Sleep deprivation.
  • Caffeine.

In addition to chocolate and caffeine, processed food is often thought to be a migraine trigger. Try to avoid processed food if at all possible, and eat a balanced diet throughout your pregnancy. Also, I always tell my patients to remember to eat. It may sound ridiculous, but pregnancy brain can make you forget a surprising number of things! Low blood sugar from not eating can also be a migraine trigger.

Editor’s Note:

Dehydration can also be a big trigger for pregnancy-related migraines, especially in the first trimester when you are likely to suffer from morning sickness . Be sure you are hydrating as best you can, and call your doctor if you cannot keep anything down.

It should come as little surprise that many pregnant women will be sleep deprived or under some stress. Its not an easy feat to adjust your life and body around the growing baby inside you.

Coping With Headaches In Pregnancy

Migraine Medications That Are Safe During Pregnancy

Paracetamol is the first choice of painkiller if you’re pregnant.

However, for safety, if you take paracetamol in pregnancy, take it for the shortest possible time.

You can get advice from your pharmacist, midwife or GP about how much paracetamol you can take and for how long.

There are some painkillers you should avoid in pregnancy such as those containing codeine, and non-steroidal anti-inflammatory drugs like ibuprofen unless prescribed by your doctor.

You can also make changes to your lifestyle to try and help prevent and treat headaches. Try to:

  • drink plenty of fluids to prevent dehydration

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Headaches In Early Pregnancy

Nearly all women have occasional headaches, but having a headache in pregnancy is not fun. And, managing headaches is especially tricky in the first trimester when you should avoid many medicines. Whether your headache is from tension or is a full-blown migraine, there are some things you should know.

What Advice Do You Have For A Migraine Sufferer Who Just Learned Shes Expecting

Instead of waiting until the first time you have a migraine attack while pregnant, Dr. Crystal recommends talking to your doctor to work out a treatment plan in case you get an attack.

When you find out youâre pregnant, youâll probably need to work with both your obstetrician and the health care provider you see for headache treatment. Make sure to mention all of the medications you take for headaches, including supplements, and other migraine symptoms.

With so many changes in your body, itâs important to âbe extra vigilant about avoiding triggers,â adds Dr. Crystal, and to avoid skipping meals, getting dehydrated, or developing poor sleep habits.

Of course, with pregnancy symptoms like morning sickness and trouble sleeping, that could be easier said than done. But do your best to maintain healthy habits.

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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.

Pregnancy Can Have A Significant Impact On Migraine Symptoms And How Women Should Treat Them Heres What Experts Have To Say

PREGNANCY HEADACHES | Headache RELIEF during Pregnancy (NO MEDS) | Migraine during Pregnancy

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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Causes And Treatment Of Headaches During Pregnancy

Headaches are a common discomfort of pregnancy. From hormone changes to the sudden end of drinking coffee to not sleeping well, there are plenty of reasons pregnancy can bring on a headache. Headaches may be a pain in the neck but they are usually not dangerous for moms and babies. Heres what you need to know about the causes, prevention, and treatment of headaches during pregnancy.

If I Tend To Get Migraines During My Period Will I Also Get Them During Pregnancy

According to the Migraine Research Foundation, menstrual, or âhormonal,â migraines are a type of migraine that affects 7â19% of women.

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 Do During Pregnancy To Decrease The Chance Ill Get A Migraine

Since so many migraine treatments are off the table while pregnant, it might feel like your arsenal is running low.

With fewer medications to turn to, lifestyle changes can make a huge difference in keeping your migraines under control while youâre pregnant.

Dr. Crystal recommends:

  • Avoiding your known migraine triggers
  • Dental evaluation for a night guard, if necessary
  • Eating frequent, small meals
  • Getting good sleep, and enough of it
  • Physical therapy for neck pain and muscle spasms
  • Prenatal massage
  • Reducing stress as much as possible, and exploring techniques for managing stress

Headache And High Blood Pressure

Migraine During and After Pregnancy

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.

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Migraine Pain And Pregnancy Hormones

Between 50 and 80% of pregnant migraine patients actually experience a reduction in migraine attacks during their pregnancy. Migraine and estrogen have a complicated relationship, Robbins says, but in general higher estrogen levels result in reduced migraine.

Most women report improvement in migraine: in how frequent the attacks are, and how severe the attacks are, says Dr. Matthew Robbins, an associate professor of neurology at the Albert Einstein College of Medicine in New York and a neurologist at the Montefiore Headache Center. This improvement usually continues through pregnancy to the end, and often even after delivery if a woman is breastfeeding.

Breastfeeding can prevent estrogen levels from dropping after a woman gives birthwhich can help lower the frequency of migraine attacks in women. Just as higher estrogen levels can decrease the frequency and severity of migraine during pregnancy, Robbins said, the high estrogen levels maintained while babies are nursing can maintain that pain-suppressing effect.

We always encourage our patients to breastfeed, especially if they have migraine, because it might confer an added benefit, Robbins said. As breastfeeding tapers off, Robbins said, migraine frequency may start to increase again.

Migraine Relief And Remedies During Pregnancy

A migraine bearing down on you? Stay away from ibuprofen and talk to your doctor before taking an aspirin. Try the following instead:

  • Relax. If you suspect a migraine coming on, lie down in a quiet, dark room with a cold compress on your neck or forehead for two or three hours. With any luck, youll fall asleep and wake up migraine-free.
  • Pop an acetaminophen. While you should never take any pain medication over the counter, prescription or herbal without the OK from your doctor, the occasional use of Tylenol is considered safe during pregnancy. Check with your practitioner for recommendations on dosing.
  • Talk to your doc. If you relied on strong migraine medications before you conceived, you may have to avoid them until the baby arrives . Your doctor may be able to recommend safer drug options, or refer you to a migraine specialist, who can suggest other strategies for managing your pain.

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When Should I Be Concerned

When a headache is severe, or just doesnt go away, or when you have dizziness, blurred vision, or changes in your field of vision, you should contact your healthcare provider. Headaches can sometimes be related to blood pressure problems in pregnancy. If they are persistent or severe and happen after 20 weeks of pregnancy, let your healthcare provider know. Although strokes during pregnancy are rare, migraines can increase a pregnant womans risk for them. If you have migraines, report them to your healthcare provider.

Migraine Triggers During Pregnancy

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Hormonal change is a common trigger for women with migraine. During pregnancy, oestrogen levels increase sharply, while progesterone levels decrease and rise again towards the end of the pregnancy.

Overall migraine improves during pregnancy especially during the second and third trimesters. This improvement may be due to the increased oestrogen levels and increased levels of natural pain-killing hormones .

These hormones are several times higher during pregnancy, and though the relief from migraine attacks they provide might last the whole pregnancy, the levels settle back down after delivery, normally allowing migraine attacks to return.

However, not everyone will see an improvement in their migraine, especially in the early weeks of pregnancy. For some women, their migraine is unaffected. Some women experience worsening migraine during pregnancy although this is rare.

During breastfeeding, stable oestrogen levels continue to be protective against having headache again after pregnancy.

However you are affected, it can help to identify any migraine attack triggers that you have, such as lack of sleep, stress, missed meals and dehydration. Keeping a headache diary may help pinpoint your triggers so you can avoid those things. Log when the headache happened, what triggered it, and how long it lasted. Common triggers include but are not limited to:

  • Stress
  • Hormones

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Should Migraine Factor Into Family Planning

Migraine disproportionately affects women, often during the period in their lives when theyre most likely to become pregnant. For many women living with migraine, uncertainty about how pregnancy may affect their migraine treatment plan is a source of anxiety. Will they have to stop taking medication? If so, how will they manage their symptomsand will those symptoms worsen or improve?

Pregnancy can impact migraine symptoms, and certain medicines are not safe for babies during pregnancy. But luckily for the 25% of women who experience migraine during their lifetime, pregnancy often has positive effects on migraine, and doctors say there are no reasons to not get pregnant if you have migraine.

What Can I Do About Headaches

Steps to manage headaches include the following:

  • Avoid any known headache triggers, including allergens and certain foods, like monosodium glutamate, cured meats, and strong cheeses.

  • Smoking is never a good idea in pregnancy. You should also avoid secondhand smoke.

  • Try to eat well and drink plenty of fluids, especially if you are prone to morning sickness.

  • Reduce your stress level. Try a massage or cold pack to help with tension headaches.

  • If your headache is a migraine, rest in a cool, dark room with no noise, and try using warm or cold compresses or an ice pack.

There is good news, however. Most women have fewer headaches during pregnancy, especially after the first trimester. And those with a history of migraines often find there is improvement during pregnancy.

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What Medications Should I Avoid When Im Pregnant

Starling recommends against taking NSAIDs such as ibuprofen and naproxen during pregnancy. Thats because in the first trimester, these drugs are linked to an increased risk of spontaneous abortions, and in the third trimester, there are concerns about fetal kidney issues, and other issues with the fetus, she says.

A study published in 2018 in the American Journal of Obstetrics and Gynecology found that NSAID use in women around conception was associated with an increased risk of miscarriage, especially in women with a lower body mass index .

The FDA issued a safety warning in 2020 that recommends avoiding NSAIDs in pregnancy at 20 weeks or later because they can result in low amniotic fluid and may cause rare kidney problems in unborn babies.

I Am Pregnantbut What Is Going To Happen To My Migraine

Know More About a Migraine During Pregnancy: Overview

Results from studies suggest that up to 80% of women who have migraine without aura experience improvement in migraine during pregnancy, particularly during the second and third trimesters.1-4 Since migraine without aura is often associated with falling levels of oestrogen, the reason for improvement in pregnancy is often considered to be the more stable levels of oestrogen. However, there are many physical, biochemical, and emotional changes in pregnancy that could also account for improvement, including increased production of natural painkillers known as endorphins, muscle relaxation, and changes in sugar balance. In contrast to migraine without aura, attacks of migraine with aura follow a different pattern during pregnancy as attacks are more likely to continue and aura may develop for the first time.5-7

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