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Book Excerpt: What To Expect with Pregnancy and Delivery

The following is an excerpt From: Dawn A. Marcus, MD and Philip A. Bain, MD. The Woman’s Migraine Toolkit, 2011, DiaMedica (New York). You can purchase a copy of the book here.

What Is the Relationship of Hormones to Pregnancy, and How Does This Affect Headaches?

Pregnancy is another monumental milestone in a woman’s reproductive life and, not surprisingly, it has a huge impact on headaches. Once menses occur regularly, pregnancy is possible. When successful fertilization occurs, the fertilized egg is implanted in the uterus and a variety of hormones are produced, including human chorionic gonadotropin, or hCG, the substance that is measured by pregnancy tests. This surge in hormones is thought to be responsible for early pregnancy symptoms such as morning sickness. hCG stimulates the lining of the uterus to begin producing progesterone, which helps to provide nourishment for the developing embryo. The placenta is formed and connects the developing fetus to the uterus. Although the ovaries continue to produce estrogen early on, as pregnancy develops the placenta begins to produce estrogen as well. As the pregnancy progresses, estrogen, progesterone, and hCG levels increase significantly.

Estrogen levels rise dramatically during pregnancy and drop precipitously after delivery. The figure below shows the expected changes in estrogen levels during each trimester and during the postpartum period after delivery. Compared to first-trimester levels, estrogen increases sixfold by the third trimester and then drops to almost undetectable levels after delivery.

Many women find that headaches improve as estrogen levels surge during pregnancy. Improvement usually begins at the end of the first trimester. This tends to continue throughout the remainder of pregnancy, while estrogen levels stay high. When the baby is born, estrogen levels drop and headache protection is lost, causing headaches to begin again.

Sixty to seventy percent of women with migraine will have significant improvement in their headache patterns during the second and third trimesters.

Changes in estrogen levels during pregnancy and after delivery.

Expected changes in migraine activity with each trimester.

What If My Headaches Don’t Go Away During Pregnancy?

Although most women experience headache improvement with pregnancy, some do not. These women may require more intensive treatment during pregnancy. In general, headaches improve by the end of the first trimester. If you’re still having headaches at the time of your first obstetrical visit, they will likely continue during your pregnancy, and you should talk to your doctor about treatment options.

Talk to your doctor if you’re still having headaches when you go to your first visit with your obstetrician.

Some women actually develop their first migraine during pregnancy. Although most headaches during pregnancy are not caused by serious health problems, you should talk to your doctor whenever you develop new headaches, notice a change in your headache pattern or symptoms, or note new health problems. Some medical conditions that may cause headaches during pregnancy include:

  • Infection
  • Preeclampsia/eclampsia (high blood pressure, edema, and other complications of pregnancy)
  • Brain vascular diseases (such as strokes, aneurysms, dissections, and vascular malformations)
  • Brain tumors (especially pituitary adenomas and meningiomas)
  • Increased intracranial pressure not related to tumors (called pseudotumor or benign intracranial hypertension)

Migraine sufferers are at increased risk for developing increased blood pressure with preeclampsia/eclampsia and strokes, although the overall occurrence of these complications is quite small. You can help reduce your risk of high blood pressure and strokes by following these healthy lifestyle habits:

  • Avoid nicotine.
  • Exercise regularly.
  • Maintain normal levels of cholesterol in your diet.
  • Avoid excess weight gain.

Will Having Headaches Hurt the Baby?

Women with migraines are not at increased risk for having a baby with birth defects or giving birth prematurely. Even women having severe migraines during their pregnancy generally have their babies born at full term and of similar weight as headache-free moms.

What Happens After I Deliver?

Even if headaches improve during pregnancy, they typically return during the first 1—4 weeks after delivery. As already noted, estrogen and progesterone levels remain high during the third trimester. Delivery of the placenta after the baby is born causes a sudden drop in progesterone and estrogen. Estrogen levels will remain low for the next several months. The drop in progesterone helps to stimulate the production of breast milk.

In most cases, headaches return to the pre-pregnancy pattern after delivery. If you choose to breastfeed, you’re less likely to have your headache return during the first month after your baby is born.

As a side note, it is recommended that women who breastfeed not take estrogen-containing birth control pills because the estrogen can decrease milk production.

Excerpt From: Dawn A. Marcus, MD and Philip A. Bain, MD. The Woman’s Migraine Toolkit, 2011, DiaMedica (New York)


Share your experiences, thoughts and questions about migraine and pregnancy below for a chance to win a free copy of The Woman’s Migraine Toolkit! You can post your comments on the Blog using your Account or Facebook. The lucky winner will be announced here on April 1, 2011

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • Elizabeth James Lovins
    8 years ago

    I’ve had migraines since gradeschool and now that I’m 41, I thought I’d finally gotten them under control: switched to a much less stressful job, learned to avoid people, foods and situations that trigger them. But now that I am pregnant, I have gone right back to my old migraines. Only this time they seem to come on rapidly, hurt like hell and leave rapidly a day or two later. The Tylenol and ice packs aren’t making a dent in them–I’m missing work, and, once again, finding those around me irritated with my constant canceling of plans. I’m already a high risk pregnancy; now I’m worried about the negative impact this pain will have on my pregnancy and the baby. My usual coping mechanisms aren’t working, and I’m starting to get desperate.

    8 years ago

    Thanks so much for all of your comments and congratulations to Lisa Cooper Ray, the winner of our Book Giveaway! Lisa-we will contact you regarding your free copy of the Woman’s Migraine Toolkit. Be on the lookout for more giveaways in the future!

  • Crissy Diener
    8 years ago

    My migraines went away while I was pregnant. It was great to not have a 3 day or more headache once a month! But alas, they came back as soon as my hormones went back to normal. I wish someone could find a way to trick the body’s hormones into thinking it’s pregnant all the time. I tried birth control pills but that only made me sick. Ah well, menopause should be a treat huh?

  • Lisa Cooper Ray
    8 years ago

    I have had migraines since I was about 12. I expected my migraines to decrease when I got pregnant…they did not! My migraines actually got worse with each pregnancy. My last 2 pregnancies were nightmares all the way through. I was in constant debilitating pain. Spent days of every week in the hospital on IVs, nausea meds and morphine. It was so bad, at 29 weeks pegnant, I was offered an abortion to try to stop the pain. I chose to continue the pregnancy. All my babies were born between 38 and 40 weeks and were average size, except the twins. The twins were 8 weeks early, but were 5 pounds each. All my pain and suffering seems to have not had an effect of the babies. All were healthy. But I am NEVER getting pregnant again! It just hurts too much.

  • Amy Quinn
    8 years ago

    most definatly with all 3 of my pregnancies I had not 1 migraine. with my first I just thought I was cured! haha I realized after my oldest was born it was because I was pregnant they stopped. I loved being pregnant, and not just cuz I was migraine free either.

  • dblmintwin
    8 years ago

    I have had severe uncontrolled Migraines for a little over 2 years. It seems that nothing helps. I have trialed multiple drugs, nerve blocks, Botox, and occipital nerve ablation. I wonder if my migraines will every get better. In January alone, I had 21 Migraine days. In Febuary, I had 18 migraine days. I worry what how my migraines will affect me when I become pregnant. My mom had migraines, but after menopause they stopped. My twin sister had migraines, but after puberty hers stopped. I have noticed my migraines increase around my period, which makes since with hormone levels changing. However, I just wish they would improve.

  • Pat Hawn
    8 years ago

    I don’t remember having a migraine during my two pregnancies, but when I had my ovaries removed, oh my! So, yes, estrogen has a LOT to do with migraines!

  • Sherry Emery LaSota
    8 years ago

    My mother thought I was born with a migraine and had them since infancy! It was miserable to be me. My pregnancy was the only time I went over two weeks w/o a migraine. How nice that was. After I delivered….. BAM! Four years later I had a hysterectomy (age 24) – thought that would be the miracle cure – NOT! Migraines were the boon of my career – never had a sick day left and worked many 16 hour days to make up for lost days. Every special ‘event’ in my life was ruinned by a Migraine. Neuro’s found ‘nothing’ to help – ever! I learned, of course, what foods caused them. I ‘knew’ I would have them any time the barometric pressure changed or I changed altitude. Since I quit working I have learned two things that help more than anything ever did…….. WATER being #1… amazing! And, since I was put on medical mj I haven’t had a bad, 3-day, “real” Migraine.

  • Misty Levenick
    8 years ago

    I had one of the worst migranes of my life after I delivered my first son. I remember the doctors and nurses looking at me so helplessly when I told them the pain killers they were giving me were not working.

  • Julie Cramer Avenick
    8 years ago

    I have suffered with true migraines since just after high school. They increased in intensity after each pregnancy, but did subside a bit during pregnancy. I was not on preventative care during pregnancies and I’ve always wondered if that would have made a difference. It’s interesting though that doctors have told me that my migraines will ease as I get older. I find they are getting worse as I approach the dreaded menopausal stage.

  • Rachel Ayers Graze
    8 years ago

    I have had migraines for the last 12 years or so, and am about to get married. I worry a lot about how my migraine disorder will affect my ability to be pregnant and my ability to be a mother. I’d be interested in reading more, since my fiancee and I are hoping to try to start a family soon after we get married.

  • Sherry Emery LaSota
    8 years ago

    Make ‘sure’ your fiancee trully ‘understands’ migraines and all that comes with them. That way he will know beforehand that there will be days when he will ‘have’ to be the parent w/o your help. Or, have a grandparent or good friend who understands so you always have a babysitter on standby for migraine days. Don’t let your migraines keep you from ‘living’!! (only 3 days at a time 😉

  • Lisa Dirkse Hall
    8 years ago

    PPlease send me a copy of your book. So far, no ex have worked for me, so I am interested in coping strategies. Thank you.

    8 years ago

    Share your experiences, thoughts and questions about migraine and pregnancy on the Blog for a chance to win a FREE copy of The Woman’s Migraine Toolkit! Post your comments on the Blog using your Account or Facebook.

  • Dr Marcus author
    8 years ago

    Dr. Calhoun is spot on in her recommendation. The Woman’s Migraine Toolkit also includes a section called “Pre-pregnancy planning” talking about what to expect, what questions to talk about with your doctor, and what you should do in preparation for planning to get pregnancy. If you’re thinking about pregnancy at some point in the future, it’s never too early to start planning how your migraine treatment will need to be changed, etc.

  • emmyann
    8 years ago

    Great information! I wish twenty five years ago I had the resources there are now. With my first two pregnancies, my migraines went away. With the third, they came back in the third trimester. I even had a migraine with an aura during my third delivery! I tried nursing with the first two, but had daily migraines. My doctor could offer no suggestions except to discontinue nursing. I felt defeated, but had no resources in our rural area to turn to.

  • The Migraine Girl moderator
    8 years ago

    Last weekend at an NHF (National Headache Foundation) conference in Georgia, Dr. Ann Calhoun of the Carolina Headache Center talked a little about migraine and pregnancy (among many other things). She said she likes to see her female patients BEFORE they get pregnant–so if you’re planning to try for a baby, she recommends you schedule an appointment with your neurologist to come up with a plan before you conceive. I hadn’t ever thought much about that before. Thanks for this great overview, Dr. Marcus–hope our paths cross soon!

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