Seeing a positive sign on a pregnancy test is a moment of elation for many women. Yet for others with chronic diseases, it can be terrifying when you don’t know how pregnancy will affect your condition and your management of it. Some women with migraine feel a great sense of powerlessness because much of migraine management involves medication – medication that pregnant women may be afraid to take.
The good news is that migraines usually actually improve during the second and third trimester of pregnancy. Because estrogen levels in pregnancy are almost twice what they are in a non-pregnant state, neurological and serotonin may be higher, leading to less frequent migraines. Women with migraine without aura report an up to 70% reduction in symptoms during pregnancy. Women with migraine with aura may continue to experience migraine symptoms in the first trimester, but will likely see some improvement after the 13-week mark.
Women who don’t see an improvement in migraine symptoms during pregnancy may be at an increased risk for preeclampsia. Preeclampsia is a potentially serious condition of pregnancy that involves high blood pressure and can lead to organ damage and seizures. Migraine and preeclampsia may share some features related to vascularization and clotting. Because of this potential complication, both an obstetrician and headache specialist should follow women with migraine during pregnancy.
Migraine Medications During Pregnancy
For some reason, women are often told that they need to avoid absolutely everything that isn’t a salad while they’re pregnant. Thankfully, this simply isn’t true. There is enough safety data on many medications to say that often the benefits outweigh the risks.
One extremely useful tool for pregnant women with migraines is the MommyMeds app (available for iPhone and Android). MommMeds is a database of medication safety information compiled by the InfantRisk Center at Texas Tech University and Dr. Thomas Hale, the leading researcher in the field of perinatal pharmacology. The vision of Mommy Meds “is to provide up-to-date, evidence-based information on the use of medications, and the effect of some disease conditions, during pregnancy and breastfeeding.” Many women, doctors and lactation specialists (including many La Leche League groups) trust the app as a resource on safe medication use during pregnancy.
Treating Migraines During Pregnancy
Dr. Hale recommends that all pregnant and lactating women first attempt to treat migraine symptoms with non-pharmacologic methods like eating on a regular schedule, staying hydrated, sticking to a sleep schedule, exercising and avoiding stress as much as possible. Biofeedback techniques, transcranial magnetic stimulation, ice massage and acupuncture have also shown some promise at safely reducing headache during pregnancy.
Drug therapy for pregnant women should begin with acetaminophen, a drug that has been shown to be safe in pregnancy. Some women find that caffeine may work wonders on a migraine during pregnancy, and caffeine is safe in low doses. NSAIDS can be taken in the first trimester, but should be avoided in the third trimester due to potential effects on the fetal kidneys. Certain triptans have good records of safety for use during pregnancy.
If you want to know more about what migraine medications are safe to take while you are pregnant, talk to both your obstetrician and headache specialist and consult the MommyMeds app for more information. Remember that taking good care of yourself during pregnancy is the best thing you can do to take care of your baby.
- MommyMeds. (2016). Migraines during pregnancy and breastfeeding. Retrieved from http://mommymeds.com/content/migraines-and-pregnancy
- Varney, H., Kriebs, J. M., & Gregor, C. L. (2004). Varney’s midwifery. Jones & Bartlett Learning.