Migraines during Pregnancy
Headache pain during pregnancy and what to do about it
The sex hormone estrogen plays an important role in causing migraines. Many scientific studies have demonstrated that fluctuating estrogen levels can cause migraines in women at the onset of menstruation, around the time of menstrual periods, and during menopause. Evidence seems to point to the fact that migraines occur when estrogen levels drop.
Fortunately, pregnancy results in sustained high estrogen levels, typically reducing the frequency and intensity of headaches. The vast majority of women with migraine have fewer headaches while they are pregnant and the improvement gets greater as pregnancy advances. Nearly half of migraine sufferers experience fewer migraines during the first three months of pregnancy. That percentage increases to 83% in the second three months and almost 90% by the last trimester. More than three quarters of pregnant women with a previous history of migraines experience no headaches at all during the last three months of pregnancy.
Experiencing a migraine headache for the first time during pregnancy is a very rare occurrence and deserves immediate and careful evaluation by a physician.
In the small minority of women who continue to have migraines during pregnancy, the mainstay of prevention and treatment is lifestyle adjustments. Maintaining a migraine diary can help identify headache triggers such as stress, specific foods, altered sleep patterns, long distance travel, missing meals, strenuous exercise, and unpleasant sensory experiences like bright lights and strong smells. Dehydration is another common trigger for migraines, which can come into play when early pregnancy causes nausea and vomiting.
Medications used for migraine during pregnancy differ significantly from those used for migraine in women who are not pregnant. Even the use of over-the-counter pain relievers should be significantly adjusted. Acetaminophen is considered to be the safest drug for treating migraines during pregnancy, carrying the lowest risk of adverse effects for mother and baby. Aspirin should be avoided early in pregnancy and in the last three months. Other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil®, Motrin®) and naproxen (Aleve®) lack enough safety information during pregnancy to suggest that they can be used without risk.
Prescription medications for migraine, such as Imitrex®, Zomig®, and Relpax®, are contraindicated during pregnancy. Cafergot® and other ergotamine derivatives should also be avoided. Narcotic pain relievers carry a risk of birth defects and should be used only under the close supervision of a physician.
Beta blockers, such as propranolol, are frequently used during pregnancy to treat hypertension and are the preventive medication of choice for pregnant women who experience migraines. Pregnant women who experience a prolonged aura may be able to take the calcium channel blocker, verapamil. Other classes of medications, such as antidepressants, should be used only under the close supervision of a doctor who's experienced in treating migraines during pregnancy.
Natural migraine remedies should also be used with caution and only while closely supervised by a physician. Feverfew has been reported to cause birth defects and miscarriages and should be avoided. Butterbur is contraindicated during pregnancy. Magnesium is sometimes used to prevent pregnancy complications like eclampsia, preeclampsia, and leg cramps; however, its use to prevent migraines in pregnancy has not been studied enough to establish safety.
The same is true of other dietary supplements that are sometimes used to prevent migraines: riboflavin or vitamin B2, coenzyme Q10, and alpha lipoic acid. While each of these is a naturally occurring element of a well-rounded diet, the safety of doses used to prevent migraines has not been established in pregnancy.
In general, medications that are contraindicated for migraine during pregnancy are also contraindicated while nursing. Fortunately, breast-feeding after childbirth also seems to provide some protection from migraine headaches.