Guide to Migraine & Pregnancy

Considering expanding the family, but unsure how migraine may impact your pregnancy?

You’re in the right place!

In this article, we’ll deep dive into how migraine interacts with pregnancy, safe and effective relief strategies, possible risks to consider, and more!

Let’s get started.

What is migraine?

Migraine is a chronic neurological disease that tends to run in families as a genetically inherited condition. It is a type of headache disorder, although not everyone with migraine experiences head pain.

People with migraine have “attacks”, which are a flare-up of symptoms possibly including head pain, light sensitivity, nausea, and many others.

Migraine attacks begin after being exposed to a trigger, which is an internal or external event that causes abnormal activity in the brain. Some common migraine triggers include:

  • Environmental
    • Weather changes
    • Bright lights
    • Strong smells
  • Lifestyle
    • Stress
    • Exercise
  • Diet
    • Dehydration
    • Skipped meals
    • Food sensitivities
  • Hormones
    • Menstrual cycle
    • Menopause
    • Pregnancy

Migraine during pregnancy

Estrogen, a sex hormone, appears to play a prominent role in migraine. This may account for why migraine is three times as common in people who menstruate (1).

During pregnancy, the body produces extraordinary amounts of estrogen. (Apparently, more estrogen is produced during one pregnancy than during a person’s entire life when not pregnant!) Estrogen is rapidly produced during the first trimester.

Changes in estrogen levels, like this rapid increase, can be aggravating to migraine (2). However, the steady increases in estrogen may also be protective against migraine, as we know “estrogen withdrawal” or falls in estrogen during menstruation are strongly linked to migraine (2).

Pregnancy may have any of the following outcomes (3):

  • ~67% of people with migraine report a significant improvement in migraine during pregnancy
  • ~25% report that their migraine is unchanged during pregnancy
  • ~8% report significant worsening in migraine during pregnancy

Typically, pre-pregnancy migraine patterns will return within 1 month (3), although breastfeeding may serve as a protective measure and continue to prevent migraine (4). 

pie chart of potential outcomes of migraine and pregnancy, whether it improves/worsens/is unchanged

Treatments

Migraine is treated from two angles: prevention and relief. A good migraine treatment plan will address both prevention and relief with a combination of medication and holistic strategies.

Medication options are limited during pregnancy, as some options may put the developing baby at risk. Some of these risks may continue during breastfeeding.

If you’re planning on becoming pregnant, any potentially harmful medications or supplements should be discontinued and replaced with safe and effective alternatives.

Managing migraine through holistic (lifestyle and diet) strategies is often the first step to get relief without the risks of some medications. Below, I will share prevention and relief strategies including both holistic and medication options.

Prevention:

Migraine attacks begin after being exposed to a trigger, which is an internal or external event that causes abnormal activity in the brain. Common triggers include changes to our environment, lifestyle, and diet.

Lowering your trigger load, or avoiding exposure to possible triggers, prevents migraine from striking.

Consistency is the best prevention strategy. Some ways to lower your trigger load include:

  • Daily gentle exercise (walking, yoga)
  • Mindfulness or meditation
  • Consistent sleep
  • Supplements (Magnesium is a great place to start!)
  • Eating regularly, at least 3 meals a day

Unfortunately, there are limited medication options available for prevention, although some beta-blockers (migraine medications that were originally designed to treat high blood pressure) are commonly used. 

Nerve block injections are also a possibility, since they work a bit differently than other prevention options. They only act locally, numbing specific nerves, rather than absorbing throughout the body and putting the developing baby at risk.

Relief:

When a migraine attack occurs, there are many holistic tools you may use for relief.

Some popular relief options include:

  • Ice packs
  • Heating pads
  • Electrolyte drinks
  • Essential oils
  • Neuromodulation devices (Cefaly, Nerivio, etc.)
  • Gentle exercise
  • Meditation

While medications are indeed limited, there are several options. Check with your physician to discover your best option.

Over-the-counter painkillers may be effective and safe, like acetaminophen. Non-steroidal anti-inflammatory painkillers (NSAIDs) like aleve and ibuprofen are possible contenders, although they may carry some risk.

Triptan, the “gold standard” prescription medication for migraine, can be a safe and effective relief option – specifically sumatriptan (5).

Risks to consider

Overall, migraine is not a risk factor for pregnancy outcomes (3). However, there are some risks to consider.

Is it migraine?

While migraine is common with pregnancy, head pain may be a symptom of another issue. If you have any unusual symptoms or sudden severe symptoms, see your physician to rule out emergencies like stroke, pre-eclampsia, or tumors.

Migraine as genetic disease

According to the American Migraine Foundation, if one or both parents have migraine, the child has a 50-75% chance of developing migraine.

This reality causes many people with migraine hesitate to start a family. While this is a valid concern, a family history of migraine can help get an earlier diagnosis, start exploring treatment options more quickly, and be the beginning of a solid support network.

Final thoughts 

Migraine is a chronic neurological disease that tends to run in families as a genetically inherited condition. Migraine attacks may be triggered by changes to estrogen, as well as environmental, lifestyle, and diet changes.

During pregnancy, steady increases of estrogen may either worsen or protect against migraine, depending on the individual. Pre-pregnancy migraine patterns tend to return within a month postpartum.

While migraine itself does not serve as risk to pregnancy outcomes, many migraine medications can put the developing baby at risk. There are safe options to explore for both prevention of migraine and to alleviate attacks!

By following me on social media platforms (@migraine.nutritionist), you can get more insights and tips for migraine management.

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