What to Do About Migraines During Pregnancy

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No one knows for sure what causes migraine headaches, but it likely involves changes in nerve pathways, chemicals, and blood flow in your brain. Migraines differ from stress or tension headaches in that migraines involve the dilating of blood vessels in the brain.

Estrogen is thought to contribute to migraines, which is why women are more likely to experience migraines than men. It also explains why pregnancy, menstruation, and menopause can change a woman’s experience with migraines. At each of these hormone-fueled life stages, migraines can get better or worse, often without apparent rhyme or reason.

Roughly 1 in 5 pregnant women will experience a migraine during pregnancy. If you are pregnant, read on to learn what you need to know about safely managing these headaches.

Symptoms

Migraines usually begin as a dull headache that becomes a throbbing, pulsating pain in the temples, the front of the head, or the base of the head. A migraine may be accompanied by nausea and vomiting and/or light sensitivity. Some people experience an aura, the appearance of wavy or jagged lines or dots of flashing light, or even hallucinations. Others experience tunnel vision or blind spots with a migraine.

Although migraines can cause near-debilitating pain for a woman, they pose no threat to a developing fetus.

Triggers

Migraines are unpredictable. They can last hours or days, and what makes them better for one person might make them worse for another.

Migraines can be triggered by many substances and exposures other than hormones. Stress, irregular meal patterns, and lack of sleep may influence the onset of a migraine. Common triggers include chocolate, caffeine, some aged cheeses, certain preservatives found in foods (MSG and nitrates), and some artificial sweeteners (Aspartame).

One way to help manage your migraines is to keep a headache diary, especially while you are pregnant. Every time you experience a migraine, write down exactly when, where, and how you experience symptoms; the time your headache started and stopped; the food you ate the 24 hours before the headache started; recent changes in your environment (even temperature); and any treatments that you tried and if they made your symptoms better or worse.

Self-care

A healthy lifestyle is the first step in managing your migraines. Avoid any known triggers, and eat regular meals and snacks and stay well hydrated. Get plenty of rest and consider trying relaxation techniques if stress is a particular trigger for you.

If you develop a migraine, rest in a quiet, dark room. Try using ice packs or warm compresses to soothe the pain. A massage of the head, neck, or shoulders may also provide relief. Exercise may help improve migraine symptoms for some people.

Medications

Most medications that are appropriate for the prevention or treatment of migraines, such as ergotamines, should not be used during pregnancy because of a risk of birth defects. If you experienced migraines before you got pregnant and have been taking a medication to help prevent them, you and your doctor should discuss whether or not you should continue taking the drug while you are pregnant. The decision will depend on the severity and frequency of your migraines, as well as other health- and lifestyle-related factors.

Most women are able to safely take occasional acetaminophen (Tylenol) during pregnancy, and this may relieve some of the pain associated with migraines. Other pain relievers, known as non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, should not be taken near conception or during the last trimester of pregnancy. Opioid pain relievers should not be used to treat migraine-related pain during pregnancy.

Talk to your doctor or pharmacist before taking any medication or supplement during pregnancy.

Non-drug treatment

Several devices are available to relieve migraine pain that do not contain medicine. You may wish to try these if you are worried about taking medications while you are pregnant. There are portable electronic and magnetic headbands or hand-held devices that stimulate nerves leading to the brain. These can be used at the first sign of a headache, and they offer little to no risk to you or your baby.

Medical evaluation

If you experienced migraines before pregnancy, continuing to have them while you are pregnant is not usually a cause for concern. New-onset migraines during pregnancy are also usually not alarming, but discuss your headaches with your doctor to rule out any unusual or dangerous causes.

Most women don’t require specialized care for migraine during pregnancy, but make sure to call your doctor right away if your migraine is accompanied by a fever, if it won’t go away or if it returns frequently, or if you are experiencing blurred vision. These may be signs of a more serious condition.

If you and your doctor decide that a full work-up is necessary for your migraines, make sure you see a specialist who has experience treating migraines during pregnancy. Once you come up with a management plan, make sure you know it and incorporate it into your life. Know what medications you will take and when you will take them, and understand what types of symptom relief are best for your migraines.

Jennifer Gibson
Dr. Jennifer Gibson earned a Bachelor of Science degree in Biochemistry from Clemson University and a Doctor of Pharmacy degree from the Medical College of Virginia School of Pharmacy at Virginia Commonwealth University. She trained as a hospital pharmacist and is the author of clinical textbooks, peer-reviewed journal articles, and continuing education programs for the medical community, as well as a contributor to award-winning healthcare blogs and websites. In her free time, she enjoys running, reading, traveling, and spending time with her family.

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