Becoming pregnant may be a wonderful moment in life — but it can be anxiety provoking in women who have chronic medical conditions. Though migraine is often considered to be “benign,” it can severely impact a woman’s level of family, social and professional functioning and is a common source of disability. In pregnancy, migraine may impact the well-being of both the mother and her unborn baby. Here are some points regarding the relationship between migraine and pregnancy that may be helpful to discuss with your practitioners.
1. Preconception counseling. The best way to manage migraine during pregnancy is to already have planned a strategy before even trying to conceive. This may include making changes to any medication regimen before attempting to become pregnant, as well as knowing what may be safe and effective around the time of conception, pregnancy and breast-feeding.
2. Understanding the prognosis. Migraine generally improves during pregnancy, because of increasing levels of estrogen and a lack of the periodic estrogen decline that ordinarily happens around the time of menstruation. Women who have migraine attacks associated with their periods, as well as those who do not have aura (a reversible neurological symptom such as a visual change that may precede, accompany or occur separately in someone with migraine attacks), may particularly see this improvement. Breast-feeding may also help reduce migraine recurrence after the baby is born.
3. Coordinating with your obstetrician. Migraine treatment can sometimes be complicated and interdisciplinary, involving treatments that might include medication and non-medication approaches. If your obstetrician is not the provider who ordinarily manages your migraine, then the practitioner who does should have open communication with your obstetrician to ensure there is mutual agreement on how your migraines are managed.
4. Non-medication treatments are paramount. Certainly, avoiding medications during pregnancy is ideal to minimize any impact on the fetus’ development, though this is not always possible. However, much can be done to manage migraine without using any medications at all. Understanding how to avoid triggers, maintaining a regular and healthy lifestyle and embracing strategies to help migraine — like behavioral techniques — may be just as important as any prescription medication used.
5. Establishing a medication plan. Pregnant women with migraine often feel powerless to treat their attacks because of maternal and fetal safety concerns. However, there is a wealth of information available to guide medication treatment during this time. Many medications are safe, and many of those that are thought to not be as safe can in fact be used during pregnancy in moderation. In addition, preventative treatment — medications that are used on a daily basis to suppress migraine over a period of time — may not be necessary at all during pregnancy because of its favorable natural history as the gestational weeks advance. However, some women with severe migraine may require daily medicine to suppress migraine, and there are many options that both headache practitioners and obstetricians are comfortable using during pregnancy.
6. Creating a backup plan. Sometimes medications taken for migraine attacks may not work or are not used early enough to treat attacks during pregnancy. Pregnant women with migraine should speak to their practitioner about having a backup plan if a particular migraine attack is severe and not able to be treated effectively, or if their migraine frequency escalates rapidly. Examples of such treatments may include intravenous medications and peripheral injections of local anesthetics to break a pain cycle.
7. Understanding pregnancy complications that could be related to migraine. Though migraine is so common, occurring in up to a quarter of women of childbearing age, it has been associated with a higher rate of different medical and obstetrical complications, including preeclampsia. You should always tell your obstetrician that you have a migraine history. Also, if a headache you experience during pregnancy seems unusual to you, particularly if it is lasting much longer than they typically do, you should not hesitate to contact your provider for an evaluation.
Most women with migraine do very well in pregnancy in terms of both their health and their baby’s health. However, a proactive approach before conceiving, and an open communication with all of your providers, should help ensure migraine treatment before, during and after pregnancy is both effective and safe.
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Managing Migraine During Pregnancy originally appeared on usnews.com