What to Expect When You’re Expecting with Migraine?

There isn’t a lot of information available about migraine and pregnancy. What information there is tends to boil down to individual differences. Most doctors say that during pregnancy women with migraine may get better, may get worse, or may stay the same in terms of frequency and severity of attacks. But what does that mean for the woman trying to conceive?

I recently interviewed my fellow patient advocate Lisa Benson (a soon-to-be mama) to compare our pregnancy stories in hopes it may provide some insight into the pregnancy with migraine experience. 

Worries and concerns

Sarah: “Were you nervous about being pregnant with migraine? I know I was.”

Lisa: “Yes, definitely. I think pregnancy makes people nervous anyway, but I wasn’t sure what to expect. I had to hope that it wouldn’t be too terrible in terms of migraine, but it was also kind of like, okay, I’m going to go gamble. All for a good end point, of course — to have a kid — but there was really no way to know what to expect.”

Sarah: “What were your top concerns about being pregnant with migraine? When I was pregnant with my first child, migraine wasn’t really on my radar. I hadn’t been diagnosed yet, and I’d moved from what I know now was my first intractable period to an episodic pattern. I was also really young, and I had a lot of concerns that didn’t center on my head. With my second child though, I’d been through a second intractable period, gotten diagnosed, and been chronic for years. I also knew how exhausting pregnancy could be, so I had a ton of concerns about coping with both pregnancy and migraine at the same time. How about you?”

Lisa: “I was mostly concerned about becoming chronic again. I had brought my migraines down from chronic to episodic, and I was — and am still — nervous about reversing that. At first, I was nervous because of the pregnancy itself, and now I’m nervous because of the postpartum period. I worried whether I’d be able to keep working the same amount of hours during pregnancy that I had been prior. I also worried about what would happen once I had the baby; if I was in a bad space with my head would I be able to care for the child?”

Unexpected surprises

Sarah: “When it comes to migraine and pregnancy has anything surprised you?”

Lisa: “When I spoke to my doctors about migraine and pregnancy before becoming pregnant I was told that I’d get better, worse, or stay the same. The thing that surprised me the most was that that’s actually varied by trimester. The first trimester was worse, and I wasn’t informed beforehand that that might not be a full-pregnancy thing. Luckily, I figured that out as I went along. I was hopeful that it would go back down as I went along and it did.”

Trimester by trimester

Sarah: “I remember my first trimester as months of severe head pain, weakness, dizziness, and nausea. Between migraine nausea and morning sickness, I lost 14 pounds in the first three months I was pregnant, and my migraine symptoms were more severe than they’d been in a long time. How did your first trimester go?”

Lisa: “In terms of pregnancy symptoms, I was definitely really nauseous. I didn’t lose weight, but what I could eat was pretty restricted. I had a lot of food aversions and fatigue. There were some days I had to take off from work because I needed to sleep. I don’t know if the fatigue was a trigger, though; it was more about hormones at that stage.

“Before being pregnant, my migraine attacks were one to four times a month. During the first trimester, they were a couple times a week and some of them were more severe then I’d had in a while. Part of that was because I was switched from Maxalt to Imitrex, because there’s safety data for that, but Imitrex isn’t as helpful for me. During those months, I didn’t make plans with friends a lot or do extra things. I just tried to make it through. It was a tough time, but I knew a lot of what I was experiencing was probably going to go away. It was like a countdown: If I can do this for a few weeks longer, I’ll be in a better part of the pregnancy.”

Sarah: “I was definitely a lot better during my second trimester. I could finally eat again, and I had a lot more energy. My migraine attacks also grew less frequent and severe, not only compared to how they had been during the first trimester but also compared to how they’d been for a long time before that. During those precious months, I was finally episodic again. How did your second trimester go?”

Lisa: “At the beginning, I was still having first trimester symptoms, but I also got two colds. That didn’t help. But that cleared a few weeks into the second trimester. After that, I didn’t have another migraine attack until the end of the second trimester, and that one was a moderate one. Not too severe.”

Sarah: “How about the third trimester? During those last months, my migraine attacks returned with a vengeance. I was so dizzy I could barely walk. About four to six weeks to my due date, I ended up on doctor-required bed rest for a number of reasons that had nothing to do with my migraine, but I remember the pain being pretty bad during that time. Though not as bad as the boredom! How have you felt so far?”

Lisa: “I haven’t had any more attacks since the first weeks of the second trimester. The funny thing, though, is that the entire time — even when I’ve been doing better — I’ve felt susceptible to the attacks. So I still take a lot of the same precautions. Some women say they’ve never gotten an attack during pregnancy, but that hasn’t been the case for me. It’s just been better.”

Preparing for baby

Sarah: “How are you preparing for delivery? Are you concerned about migraine at that time?”

Lisa: “It’s funny, I actually thought about that the other day for the first time. I’d never thought of it before. It was less of an ‘Oh, what am I’m going to do?’ worry, and more like ‘Wouldn’t it be an interesting experiment to finally know which is worse: childbirth/labor or a migraine?’ I know there isn’t an actual answer because every labor is different and every migraine is different. But I hadn’t thought about it in terms of labor before. I’m more concerned about the actual labor. [laughs] I will have my medication with me, but I don’t know if they’ll let me take it during labor anyway. But I don’t think I’ll get one during labor; I tend to get them after stressful experiences. I have asked for low lighting, so I’m not worried about a secondary trigger, either. If the lighting is okay then I’m less susceptible.”

Sarah: “What about after delivery? Have you made extra preparations for care in those first weeks and months with migraine in mind?”

Lisa: “I think it’s included in the overall equation of not trying to overload my own sense of what I need to be doing. We actually are moving the first month after the baby is born. I’ve already decided I’m not going to pack everything, and I’m not going to unpack anything. Movers are going to finish up the packing and the moving, and then our family is going to unpack. So planning for the postpartum period is more about what I want my philosophy on mothering with migraine to be than it is about anything else. I want to focus on getting as much sleep as possible, and I’ve already given myself permission to let the place be a mess if it needs to be a mess for as long as necessary so I can nap. So I’m preparing mentally, not physically.”

Sarah: “That makes sense to me. Sleep is vital for new moms and for those of us with migraine. Congratulations on the upcoming delivery, and thank you so much for taking the time to speak with me. Hopefully, this discussion will give some other women in the community an idea of what they might expect when it comes to being pregnant with migraine.”