How to Deal with Migraine in the Postpartum Period

January 26, 2024
May 6, 2022
How to Deal with Migraine in the Postpartum Period

Headaches in the postpartum period can be due to a combination of factors such as a big change in your life with the new baby, lack of sleep, and a drop in estrogen levels.

About 1.5% of women develop a headache from epidural anesthesia, which is mostly managed by laying horizontally, caffeine, and hydration. If the headache persists and/or is very severe, the next step is called a “blood patch” - an anesthesiologist injects some of your blood, close to the location where the needle was inserted for the epidural, to “patch” closed the little hole that was made with that needle with the blood’s natural ability to clot.

Postpartum headaches are common; they affect about one-third of women. The most common postpartum headaches are the resurgence of the headaches you had pre-pregnancy, such as migraine attacks. However, if your headaches are different from your prior headaches, if you develop a new headache, or you have new symptoms with your headache such as vision changes, weakness, numbness, imbalance, vertigo, please either notify your medical team if you are in the hospital or, if you're at home, go to the Emergency Room for further evaluation.

Neurological Risks Around Pregnancy

Pregnancy and the postpartum period are times of increased risk of serious neurological diseases such as stroke and eclampsia. You know your body best. In case of changes or doubt, it is always safer to get it checked out. The risk of stroke increases threefold around pregnancy. Pregnancy-related strokes happen in about 30 out of 100,000 pregnancies. The stroke risk is highest towards the end of pregnancy and within the 6 weeks following delivery. Your stroke risk might be higher or lower based on the presence or absence of other factors such as diabetes or blood clotting disorders.

This information is not meant to scare you and should not. It is important to be informed so you know what to do if you notice new symptoms. Once again, the most likely cause of post-pregnancy headache is the recurrence of your pre-pregnancy headache.

Breastfeeding and Migraine

Breastfeeding or pumping milk might actually help from a headache standpoint. Although breastfeeding limits some medical options for migraine, it also delays the recurrence of migraine attacks post-pregnancy. The rate of migraine recurrence at one-month post-pregnancy is 86% for women who are not breastfeeding and 50% for women who are breastfeeding. The rate of migraine recurrence at six months post-pregnancy is 96% for women who are not breastfeeding and 71% for women who are breastfeeding.

Medication-wise, some acute, rescue, and preventive treatments are compatible with breastfeeding. It is important to tell your doctor you are breastfeeding and discuss the migraine treatment options available to you and their safety profiles. The good news is that you can take ibuprofen again. Domperidone can help with nausea, and also increases breast milk production. Butalbital-containing agents such as Fioricet should be avoided and may make the baby sleepy.

Some triptans such as eletriptan and sumatriptan are considered safe because their concentration in breastmilk is very low. In addition to preventive medications, daily riboflavin (vitamin B2) can be helpful. It is safe in breastfeeding but might color your milk a little yellow. Most headache specialists allow you to resume receiving Botox injections even while breastfeeding, however, the CGRP injectables are still avoided.  

In summary, the most common cause of post-pregnancy headache is the recurrence of your pre-pregnancy headache. However, please seek medical evaluation if you are concerned about a new headache or new symptoms with your headache. Breastfeeding helps delay the recurrence of headaches post-pregnancy and does not limit all therapeutic options. If you are going through a postpartum period right now and you seeking access to help, join Neura Health and get to see a specialist without leaving your house.

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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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