Migraine commonly affects women in their childbearing years, so it is not
surprising that many women with migraine ultimately become pregnant. A
cooperative relationship between the migraine sufferer and her physicians is
essential in minimizing the impact of migraine during pregnancy.
The good news is that the majority of migraine sufferers will note
significant improvement in their headaches during the second and third
trimesters. Well-done studies have repeatedly shown that while headaches may
worsen somewhat in the first trimester, two-thirds of women suffering from
migraine without aura will note significant improvement in their headache in the
last two trimesters, especially if their migraines correlated closely with the
onset of menstruation, occurred around the time of their menstrual periods, or
with the onset of birth control pill use. Migraine headaches usually resume
their pre-pregnancy pattern in the postpartum period. Tension-type headaches are
not generally thought to be related to hormones and are largely unaffected by
pregnancy.
The majority of fetal development occurs in the first trimester. Thus, though
non-drug approaches are emphasized throughout the pregnancy, they are especially
important in the first trimester. Fortunately, it should be noted that there is
no evidence of increased incidence of birth defects in the offspring of patients
with migraine.
It is important to stop all over-the-counter medications except prenatal
vitamins as soon as you know that you are pregnant. Most vitamin supplements and
herbal preparations have not been extensively studied in pregnancy. You must
report all medications used, including over-the-counter medications and herbal
products, to your headache physician and OB at every visit during the pregnancy.
Your doctor will maximize non-drug therapies throughout your pregnancy but especially
in the first trimester. Below are specific suggestions to prevent or treat
headaches:
Rest - This cannot be overemphasized. A temporary decrease in work
responsibilities, especially in the first trimester, is preferable to using
medications.
Stress - A conscious effort to reduce stress is important. Sharing
responsibilities, decreasing commitments, and obtaining adequate rest and
exercise is strongly encouraged.
Sleeping/eating patterns - It is very important to regulate sleeping and
eating patterns to minimize headache. Skipping meals is strongly discouraged
as this often triggers headaches.
Caffeine - Caffeine should be eliminated or reduced as much as possible,
especially in the first trimester.
Trigger identification - This also is important. Try to identify specific
triggers that consistently bring on your headaches (food, MSG, alcohol, bright
lights, lack of sleep, certain odors, etc.) and strictly avoid them if at all
possible.
Nausea - Treat nausea early and aggressively. Avoid strong odors. Use
Seabands, and/or finger acupressure over acupressure point P6 (information
sheet available on request).
Hydration - Avoid becoming dehydrated. Use clear liquids, soups,
Popsicles, etc., and a bland diet such as rice, bananas, crackers, etc. If
dehydration worsens, we can give you IV fluids in the office.
Relaxation techniques - Methods such as biofeedback, guided imagery,
relaxation exercises, etc., can be very helpful (information sheets available
on request).
Massage therapy - Massage therapy and physical therapy can be very helpful
in alleviating certain types of headache pain.
Acupuncture - Please note that acupuncture is generally not recommended in
pregnancy. Ice packs - These should be used early and often in migraine
attacks as an effective non-drug way to improve pain.
Stimulus control - During a migraine, decrease stimulation as much as
possible. Go to a quiet, dark room if at all possible. You likely will need
someone to help watch the kids, take over responsibilities, etc. Plan ahead.
Medications
If medications are to be used, certain principles are to be followed:
All medications used, including over-the-counter medication, should be
reported to the OB and headache physicians.
Non-drug methods should always be tried first.
If meds are used, their use should be delayed until the second and third
trimesters, if at all possible.
The lowest dose of medication for the shortest period of time is
recommended.
The medications used will be those that pose the least threat to the
mother and fetus.
Information will be made available to the patient and treating OB
physicians.
The first line agent is acetaminophen. One or two
regular-strength tablets can be used (or a rectal suppository if nausea is
present).
If this is not helpful, the second line medications generally are simple
narcotics or pain relief medications such as meperidine or oxycodone. These
can be constipating and should be used sparingly. They are rarely used to
treat migraines in non-pregnant patients because better alternatives are
available for the non-pregnant patient. Their safety in pregnant patients is
well established.
Summary
Migraines can occur in women who become pregnant.
They usually get better during the second and third trimesters.
All over-the-counter medications (except prenatal vitamins) and herbal
preparations should be stopped during pregnancy.
Non-drug treatments must be maximized.
If medications are used, the initial agent of choice is acetaminophen
orally or rectally.
Your doctor will be available to help you throughout your pregnancy with your
headaches.
Resources
For a list of articles on women's headache issues,
click here.
