Migraine Headaches and Pregnancy

If you're pregnant, you're no doubt experiencing new aches and pains. If you're also one of the millions of pregnant women who experience migraines, you might be glad to know that pregnancy eases migraine headache symptoms for many women. But even if it doesn't for you, the information in this article can help you cope.

Causes of Migraine Headaches

Exactly what causes migraine headaches isn't known. But migraines appear to involve changes in nerve pathways, neurochemicals, and blood flow in the brain.

Researchers believe that overly excited brain cells stimulate a release of chemicals. These chemicals irritate blood vessels on the brain's surface. That, in turn, causes blood vessels to swell and stimulate the pain response.

Estrogen is thought to play a role in migraines. That's why pregnancy, menstruation, and menopause often change a woman's pattern of migraine headaches.

The neurotransmitter serotonin also appears to have a key role in migraines.

Tracking Triggers With a Migraine Diary

Hormone changes during pregnancy are not the only thing that can trigger migraine headaches. Most women have a combination of triggers. For instance, stress, skipped meals, and lack of sleep may all trigger a migraine. And something that triggers a migraine one day may not bother you at all the next.

Some migraines last a few hours. Others, if left untreated, could last a full day or even two. Migraines are quite unpredictable. So while pregnancy may make them worse for one woman, they might completely disappear for another.

A headache diary can let you track your particular triggers. This will help your doctor decide on what treatment will work best to relieve your specific symptoms. It may also help you recognize a pattern that tells you which triggers to avoid while you're pregnant.

Each time you have a headache, write down:

  • Your specific symptoms: where you feel the pain, what the pain feels like, and any other symptoms such as vomiting or sensitivity to noise, smells, or bright light
  • The time your headache started and ended
  • Food and beverages you had during the 24 hours before the migraine
  • Any change in your environment, such as traveling to a new place, a change in weather, or trying new kinds of food
  • Any treatment you tried, and whether it helped or made the headache worse

Common headache triggers include:

  • Chocolate
  • Caffeine
  • Foods that contain the preservatives MSG (monosodium glutamate) and nitrates
  • Aspartame, the sweetener in NutraSweet and Equal

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Tests for Migraines

Headaches can be caused by a pregnancy complication called preeclampsia. So your doctor may evaluate you for that condition before making a diagnosis of migraine. Be sure to tell your doctor about all the medications you're taking, including over-the-counter products and natural supplements. Also let your doctor know whether anyone in your family has had migraines.

The doctor often can diagnose migraine from a headache diary and your medical history. CT scans and other radiology tests to rule out other causes of your headaches aren't usually advised in pregnancy. That's because of the potential risks to the fetus.

Self-Care of Migraines

Your first line of defense against migraine headaches is a healthy lifestyle and self-care. Here are some tips to help you manage migraines during pregnancy:

  • Avoid your known triggers, such as specific foods, as much as possible.
  • Keep a predictable schedule of meals and snacks.
  • Drink plenty of water.
  • Get plenty of rest.
  • Consider taking a class in biofeedback or other relaxation techniques.
  • When pain strikes, try ice packs, massage, and resting in a quiet, darkened room.

Medications for Migraines

If you're pregnant -- or planning to get pregnant soon -- your doctor will generally advise you to stay off medications unless they're absolutely needed. Together, you'll have to weigh the potential effects of a drug on your unborn baby. In some cases, a decision will need to be made based on scant or inconclusive research into a particular drug.

Many of the anti-migraine medications to treat or prevent migraine headache and its symptoms should be avoided during pregnancy. That's because they've been linked to birth defects in babies. Other medications are associated with pregnancy complications. For instance, some have been associated with bleeding, miscarriage, or intrauterine growth restriction (IUGR), a condition in which the uterus and fetus don't grow normally.

Acute Migraine Treatment

Acute treatment aims to stop a migraine attack after its first signs appear.

Pain relievers, also called analgesics, may help ease the intense pain of migraines. These general pain-relieving drugs, though, aren't specific to the migraine pain pathway:

  • Acetaminophen is generally considered low-risk during pregnancy.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, may carry a risk of bleeding and miscarriage if taken near the time of conception. There is also a possible risk of blood pressure complications in the baby if they are taken in the third trimester. Aspirin taken near delivery may lead to excess blood loss in mothers during birth.
  • Most NSAIDs, including ibuprofen -- sold over the counter under the brand names Advil and Motrin -- and naproxen -- sold as Aleve and other brands -- don't have enough controlled human research studies to assess all their risks in pregnancy.
  • Narcotic pain relievers should generally be avoided. There is a dual risk of addiction in both mothers and babies if they are used for prolonged periods of time.

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Ergotamines work specifically for migraine pain. But doctors advise against taking these drugs during pregnancy. They carry a risk of birth defects, especially if taken in the first trimester. These drugs may also stimulate labor contractions and premature birth.

Triptans work specifically on the migraine pain pathway. Triptans aren't known to cause birth defects. But most research to date has focused on animals, not humans. In 2008 The Journal of the American Medical Association renewed its warning against combining triptans with two common classes of antidepressant:

  • selective serotonin reuptake inhibitors (SSRIs)
  • selective serotonin/norepinephrine reuptake inhibitors (SNRIs)

The combination carries the risk of a life-threatening condition called "serotonin syndrome."

Other medications may be prescribed for relief of specific symptoms of a migraine during pregnancy. For instance, antiemetics help soothe the vomiting and nausea that can accompany a migraine. But many of the drugs typically used for migraine haven't been adequately studied in pregnancy, so their safety or risk to the fetus has not been determined.

Preventive Migraine Treatment

If you have severe, recurring attacks, preventive treatment may stop future attacks or reduce their severity. Many of the drugs used for prevention were originally used for other conditions, such as high blood pressure.

See a neurologist experienced with treating pregnant women. She'll prescribe a medicine in the lowest dose needed to help you and likely recommend some kind of talk therapy. Relatively safe medications for migraines include beta-blockers, such as propranolol and labetalol, as well as calcium channel blockers such as verapamil.

When you're pregnant, always talk with your doctor before taking any drug, herbal product, or natural medicine.

If you can't take medications or wish not to, a device might be worth considering. Cefaly is the first FDA-approved device for preventing migraines in people over age 18. The portable headband-like device gives electrical impulses on the skin at the forehead. This stimulates a nerve associated with migraine headaches. Cefaly is used once a day for 20 minutes, and when it's on you'll feel a tingling or massaging sensation.

If you're seeing a headache specialist, double-check with your obstetrician or certified midwife about the safety of any medications during pregnancy. While migraine pain may be excruciating, taking a risk with your baby's health could cause lifelong health problems for your child.

WebMD Medical Reference Reviewed by Richard Senelick, MD on September 04, 2016

Sources

SOURCES:

National Women's Health Information Center: "Migraine."

Migraine Research Foundation: "About Migraine."

OB/GYN News: "Migraine Drugs."

National Headache Foundation: "Migraine."

Northwestern University Medical School and Illinois Department of Public Health: "Migraine Headache and Pregnancy."

American Headache Society: "Commonly Used Acute Migraine Treatments."

U.S. News & World Report: "Migraine Medications May Cause Serotonin Syndrome."

National Guideline Clearinghouse: "Special Treatment Situations: Standards of Care for Headache Diagnosis and Treatment."

HHS: Indian Health Service: Maternal Child Health: "Migraine and Pregnancy."

American College of Obstetricians and Gynecologists: "Headache."

News release, FDA.

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