Managing Migraine During Labor & Delivery

Question: My friend had a terrible Migraine during the delivery of her last baby. They left it untreated and the delivery was very difficult for her. Can you give us some ideas of treatments she might request for her next labor and delivery should a Migraine hit her?

Expert Answer:

The good news for your friend is that every pregnancy is different, so having a bad migraine at the end of this pregnancy doesn’t predict that she’ll follow the same pattern with her next pregnancy.

First, your friend should talk to her obstetrician about what happened during this delivery. Was this a “typical” migraine for her or an unusual headache that may suggest she needs a more careful evaluation. Also, did she receive any treatments during her delivery that might have triggered a migraine? Many medications have headache as a side effect. Also dehydration, muscle strain, etc. can be treatable factors.

If this was just a typical migraine and she’s planning on another pregnancy, she should mention her concerns about her next delivery with her doctor. There are a number of pain medications that obstetricians are comfortable using during delivery and it would be helpful to develop a plan before she would near her next delivery date. She might also want to talk to her doctor about what she usually uses to treat her migraine and see if she could bring this to her next delivery. She may or may not be able to, but restrictions during delivery can be different than during pregnancy. For example, the migraine drug dihydroergotamine is contraindicated during pregnancy; but researchers have used dihydroergotamine to help speed up delivery in women with stalled labor. This doesn’t mean your friend’s obstetrician would recommend dihydroergotamine during delivery, but it does show that some drugs that can’t be used earlier in pregnancy because of concerns for the growing baby may not be restricted close to delivery. (Dihydroergotamine is currently contraindicated during pregnancy as a migraine treatment. Higher doses near delivery have been shown to be harmful.)

The specific medication is probably less important than having a plan both your friend and her obstetrician are comfortable with so she can approach her next delivery with confidence rather than fear of another bad migraine. And with any luck, her next delivery will be quicker and easier and migraine free.