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Migraine and Pregnancy

One in every five women of childbearing age has migraine headaches. Because migraines are common in young women, women often have questions about migraines and pregnancy. The best plan is to talk to your doctor about your headaches before you get pregnant and let him or her know about your plans to start or add to your family. Here are common questions you might want to ask.

What Should I Do Before I Become Pregnant?

Ideally, you will work with your doctor during the months before you begin to try to get pregnant. Headache control should be maximized before conception. Continue using effective contraception while developing a program to minimize the frequency and severity of your headaches:

  • Begin healthy lifestyle habits that improve headaches
  • Eat regular, healthy meals - don't skip breakfast
  • Get eight hours of sleep each night - even on the weekends
  • Limit caffeinated beverages to no more than two cups per day
  • Learn relaxation techniques and biofeedback
  • Learn and practice stress management techniques
  • Practice stretching exercises of the neck muscles each morning and evening before bed
  • Begin daily, aerobic exercise - like walking, biking, or swimming Be sure to ask your health care provider for advice before starting any program, especially if you have other health problems
  • Quit smoking
  • Switch headache medications to those that can be safely used during early pregnancy
  • Start taking a multivitamin with at least 400 micrograms of folate

Your health care provider can suggest medications for you to switch to that might be safer to use when trying to get pregnant and throughout pregnancy.

Will my Migraines Change During my Pregnancy?

Estrogen levels rise throughout the first trimester of pregnancy and then remain high until the baby is born. This rise is estrogen often offers a headache protective effect for most women with migraine. In general, at least half to 80% of women who had migraine before pregnancy will notice an improvement in headaches with pregnancy. Unfortunately, migraines don't improve for everyone or with every pregnancy.

If migraines are going to improve, they will often improve during the first trimester. If you're still having headaches at the end of the first trimester, you may continue to have similar headaches for the rest of this pregnancy. So if you're still having troublesome headaches when you go for your first pregnancy visit, talk to your health care provider about ways to reduce your headaches.

If you develop a new type of headache or your headaches become worse when you're pregnant, be sure to see your health care provider right away. Headaches can be signs of other health problems.

Will Having Migraines When I'm Pregnant Hurt the Baby?

Migraine sufferers have an increased risk of developing pregnancy-related high blood pressure. So let your health care provider know about your history of migraines, even if your headaches are not a problem during the pregnancy. Also, make sure you go to your prenatal appointments regularly throughout pregnancy so that your health care provider can monitor your blood pressure.

The good news is that babies born to mothers with migraine are just as likely to be healthy babies as those born to mothers without migraine. Some women have severe nausea with their migraines. It's important to make sure nausea is not interfering with getting good nutrition, gaining weight and staying hydrated. If you are very nauseated with your migraines, talk to your health care provider about treatments that can reduce nausea and other symptoms of migraine.

What Treatments are Safe When I'm Pregnant?

If you still have migraines during your pregnancy, make sure you treat them with effective non-medication or medication treatments. Don't suffer with your headaches. Untreated headaches can result in dehydration, poor nutrition and depressed mood - none of which is good for the developing baby.

Try non-medication treatments for milder headaches. Effective treatments include:

  • Relaxation techniques - Relaxation techniques reduce levels of pain-provoking brain chemicals. Biofeedback is a type of relaxation technique that is effective for three in four pregnant women.
  • Stress management - Learn to prevent the release of stress chemicals and muscle tension when exposed to daily stresses. Managing stress is effective for two in three women.
  • Cognitive restructuring - Learn to tell yourself positive thoughts about your headaches. Tell yourself, "I have techniques to help reduce my headache," instead of "Oh no - I'm getting a headache! The day is ruined."
  • Distraction - Take your mind off of the pain by going for a walk, listening to soothing music or doing neck stretches.

Disabling migraines may require medications. Medications considered to be relatively safe during pregnancy include:

  • Acetaminophen
  • Intranasal lidocaine
  • Opioid painkillers (when used infrequently)
  • Some nausea medications, such as metoclopramide and ondansetron
  • Topical peppermint oil

If you have nausea with your headaches, you may try these safer therapie

  • Vitamin B6
  • Ginger
  • Metoclopramide (Reglan)
  • Ondansetron (Zofran)

Can I Plan to Breastfeed?

After the baby is born, protective estrogen levels drop to much lower levels. This causes some women to have a return of their migraines during the first few weeks after the baby is born. Breastfeeding may actually help delay the return of migraine headaches.

Breastfeeding has many important health benefits for you and your baby:

  • Gives your baby needed hormones and immune factors
  • Provides essential fats to promote good brain development
  • Promotes bonding between baby and mom
  • Reduces mom's risk for breast and ovarian cancer
  • Delays return of headaches during the first month after delivery

If you choose to breastfeed, you will need to make sure the medications you are using are safe to use when nursing. Safer treatments include:

  • Acetaminophen
  • Ibuprofen
  • Sumatriptan (Imitrex)
  • Opioid painkillers (when used infrequently)
  • Ondansetron (Zofran) for nausea

Above content provided by the National Pain Foundation in partnership with Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted October 2009

Contact Information

Arnold Pain Management Center
Beth Israel Deaconess Medical Center
One Brookline Place, Suite 105
Brookline, MA 02445
617-278-8000
617-278-8065