Migraines During Pregnancy
The first trimester of pregnancy is often associated with an increase in migraine frequency that correlates to a sudden surge in estrogen and other pregnancy-related hormones. The good news is that as hormone levels stabilize and pregnancy progresses, migraines may decrease. Almost half of pregnant migraineurs report an overall improvement in their headaches. And one study of pregnant women with migraine without aura found that 80 percent had no migraines during the third trimester of pregnancy, a finding confirmed by subsequent studies.
Of course, pregnancy presents specific challenges to the migraineur. Normal medication regimens may have to be abandoned for safety reasons, and alternatives must be found. By working with both your OB/GYN and your primary doctor for migraine, you can determine what treatments are right for you.
Medication use of any kind in pregnancy is usually a risk-versus-benefit decision. If the benefit to the mother's health outweighs any potential of risk to mother or fetus, and there are no other viable treatment options that will have similar efficacy, then a health care provider may recommend the drug.
Unfortunately, the majority of migraine medications aren't appropriate for pregnant women. They have either been proven unsafe in pregnancy through case reports or animal studies, or we simply do not have enough clinical data about their use in pregnant women to be able to make an educated “risk-versus-benefit” decision.
Many women with menstrual migraine will experience an improvement in the frequency of their attacks during pregnancy, usually starting toward the end of the first trimester. This migraine “honeymoon period” can even last into the postpartum period if you choose to breastfeed.
One treatment option with proven efficacy and no side effects or safety issues is biofeedback. Biofeedback is a system of monitoring your body's biological signals, such as temperature, heart rate, and muscle tension, and learning how to regulate those functions through relaxation and visualization techniques. Once you learn the skills of biofeedback, you are able to train your body to reduce migraine pain once it begins. When coupled with progressive relaxation techniques, biofeedback can be a highly effective treatment option for the first trimester and beyond. (See Chapter 7 for more information on biofeedback.)
Acupuncture may also be a safe migraine treatment alternative for pregnant and breastfeeding women. It can also have the added benefits of alleviating pregnancy-related nausea and vomiting. For more on the use of acupuncture in migraine treatment, see Chapter 9.
Unless they are a pregnancy-related treatment, most drugs aren't studied in pregnant women. Pregnant women are excluded from most clinical trials on an ethical basis, and the research that is available is in the form of animal studies and retrospective studies that analyze voluntary self-reported use of a particular drug or therapy in pregnancy after the fact.
Both menstrual migraine and chronic migraine (with and without aura) typically resurface during the postpartum period as estrogen levels drop. An estimated 94 percent of women report that their migraines return after delivery. Women under age thirty appear to have a more rapid return to prepregnancy migraine patterns.
If you experience a severe headache following delivery, alert your doctor. While it may just be a migraine, there are several other causes of an immediate postpartum headache — including spinal headache, reaction to anesthesia, and eclampsia — that should be ruled out by your physician as a safety measure.
However, there is some evidence that breastfeeding will extend the improvement of migraine into the postpartum period for many women — another of the many health benefits of breastfeeding to mother and child. If you choose to breastfeed, keep in mind that many migraine prescription and over-the-counter drugs are contraindicated for nursing mothers because they pass into breast milk and their impact on an infant is unknown.
