Migraine and Pregnancy
Migraine and Pregnancy: Migraine is likely to improve during pregnancy. 60% experience improvement, particularly during the second and third trimesters. It is thought that the more stable levels of circulating oestrogen and progestogen at this time is responsible for the improvement, but improvement may also be as a result of other changes during pregnancy such as increased endorphin production. Usually, the pre-migraine patterns will return when the pregnancy is over and the patient has began menstruating again.
However, about 15% of women report worsening or new onset migraine during pregnancy, and as such, there is no definite way to predict how or if migraine will change during pregnancy. However, it has been noted that improvement is most likely in women who have migraine without aura or who have menstrual or menstrually-related migraine. Women who have migraine with aura are more likely to continue having attacks during pregnancy.
Worsening or new-onset migraine does not have an effect on the outcome of the pregnancy and the patient needs to be reassured of this. Most women that experience migraine for the first time during pregnancy will continue to experience migraine thereafter.
Management of Migraine During Pregnancy
Management of migraine during pregnancy must begin by ruling out secondary causes if the headaches are occurring for the first time. Once a diagnosis of migraine has been made, a treatment regime based on the following principles can be considered:
Few drugs have been tested for safety in pregnancy, so acute therapies are limited to the use of paracetamol with or without an anti-emetic. Triptans and prophylactic measures are not advised.
Because most drugs exert their greatest impact on the foetus during the first trimester, medications should be discontinued immediately after pregnancy is confirmed. Prophylactic treatments should also be discontinued if the patient is trying to become pregnant. Feverfew, a common herbal remedy should also be discontinued during pregnancy due to its potential to induce miscarriage.
Patients should be reassured that their migraine is likely to improve during the second and third trimesters, even if attacks become initially worse in the early stages of pregnancy. Patients may also need to be reassured about the safety of the foetus if they have inadvertently taken medication before they discovered they were pregnant.
Non-pharmacologic treatments include:
- Sleep / Rest / Retreat
- Cold therapy
- Light exercise
- Massage /Relaxation therapy
- Trigger avoidance
- Increase water intake or eat a small snack, especially if nausea and vomiting occur early in pregnancy
- Complementary therapies such as acupuncture, reflexology and yoga have no proven efficacy in treating migraine but anecdotally some women find benefit from complementary therapies during pregnancy