What to Know about Migraine and Pregnancy

January 26, 2024
March 7, 2022
What to Know about Migraine and Pregnancy

Pregnancy is a time of great transition for the female body, and it's not surprising that these changes can impact migraine as well. The good news is that pregnant women tend to see an improvement in their migraine. Migraine improves by the first trimester for about 50% of women and by the third trimester for about 87% of women.

Although migraine improves for most women as pregnancy progresses, pregnancy can be a tough time for some women with migraine. Some women can initially develop migraine, or have changes to their migraine - such as new aura during pregnancy.

Lifestyle changes recommended during pregnancy

Managing migraine through lifestyle and behavioral changes are typically recommended in pregnancy given that they are completely safe for the growing fetus. These include focusing on self-care, such as hydration, healthy eating, regular sleep, and regular exercise. However, these can get challenging in pregnancy since being pregnant is most likely going to alter your usual lifestyle. Pregnancy can lead to fragmented sleep, nausea, change in eating habits, fatigue, a reduction in exercise, mood changes, all of which can contribute to headaches. Don’t pressure yourself! Focus on realistic expectations; you are making a new life!

If you are not able to eat well, make sure to supplement your diet with enough folic acid, calcium, vitamin D, iron, vitamin B2 (riboflavin), and protein. Discuss your diet and symptoms with your doctor as they may recommend blood work too. Be sure to inform your doctor if you have negative feelings, depression, or anxiety. Pregnancy support groups can also be very helpful - you are not alone and can talk with others going through a similar experience.

If you are not able to exercise anymore, stretch your neck for a few minutes daily when in your bath or shower. Warm water helps relax the muscles. Neck care will go a long way in helping with migraine prevention.

Treatment options for migraine during pregnancy

There are safe treatment options for migraine in pregnancy, both pharmacologic and non-pharmacologic. Please discuss the safety of each medication (and supplement) you consider taking in pregnancy with your doctor.

Acute medications

The preferred options for acute treatment for migraine attacks in pregnancy are acetaminophen/Tylenol and metoclopramide/Reglan (an anti-nausea medication).

Two large studies of sumatriptan use by pregnant women did not show any association with adverse outcomes or baby malformations. There is a theoretical risk of spasm of the blood vessels around the placenta, so the use of sumatriptan is considered controversial - ask your headache specialist and obstetrician if they are comfortable with you using sumatriptan.

Given currently available data, NSAIDs, opiates, butalbital-containing agents such as Fioricet, gepants such as ubrogepant/Ubrelvy and rimegepant/Nurtec, and lasmiditan/Reyvow are to be avoided in pregnancy.

Preventive medications

Preventive medications commonly used in pregnancy include propranolol, verapamil, memantine, and cyproheptadine. However, topiramate, valproic acid, venlafaxine, lisinopril, candesartan, and CGRP monoclonal antibodies are not recommended in pregnancy.

Non-pharmacological options

In addition to lifestyle and behavioral measures discussed above, supplements such as riboflavin (vitamin B2) CoQ10, and relaxation techniques such as progressive muscle relaxation, biofeedback, and cognitive behavioral therapy can be helpful for migraine prevention in pregnancy and are safe.

The Cefaly device, a nerve stimulator, is FDA approved for acute and preventive treatment of migraine. It is not associated with adverse pregnancy outcomes or baby anomalies when used in pregnancy. Many of the other devices used for migraine are considered safe in pregnancy as well.

What to do about new headaches in pregnancy

Some women without a history of migraine develop migraine in pregnancy, usually in the first trimester. In women who have a prior history of headaches, about 80% of headaches during pregnancy are migraine attacks. Pregnancy is, of course, a time of change and comes with lots of reasons to get headaches.

Because pregnancy is a high-risk period, there are unique conditions to be concerned about, and headache may be a warning sign for these conditions. If you develop a rapid onset headache or a new type of headache that just feels different than your regular migraine attacks, especially if it presents with new symptoms such as vision changes, weakness, numbness, imbalance, vertigo - you should seek urgent medical attention.

In summary, there are many treatment options in pregnancy. Being pregnant does not mean your migraine attacks should go untreated. Pregnancy is a time of active change, although a healthy lifestyle is important for migraine prevention, set realistic expectations and be forgiving of yourself. Pregnancy is hard work!

If you are looking to get more information about your specific headache or migraine condition before or during pregnancy, join Neura Health today and talk to a board-certified neurologist about the best treatment plan for you.

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Olivia Begasse De Dhaem, MD
Dr. Olivia Begasse de Dhaem is a board-certified and fellowship-trained neurologist and headache specialist, and an Advisor to Neura Health.
About the Author
Dr. Olivia Begasse de Dhaem is a board-certified neurologist and Headache Specialist at Hartford HealthCare in Milford CT. She graduated from Columbia University College of Physicians medical school. She attended her neurology residency at the Columbia University Neurological Institute. She completed her headache medicine fellowship at Harvard University. She is an emerging leader of the American Headache Society. She is involved in advocacy and feels strongly about supporting people with headache disorders in the workplace.

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