Managing Migraine During Pregnancy

Most people who have migraine find that their migraine improve during pregnancy. This is especially true for people who have migraine without aura. The high and steady estrogen levels during pregnancy help protect against migraine.¹

But others do not notice improvements during pregnancy or may have their first migraine during pregnancy. So it is crucial to have a treatment plan in place. This plan should be made with the help and approval of your obstetrician. You might need to consult with a headache specialist if your doctor is uncomfortable or unfamiliar with evaluating and treating migraine during pregnancy.¹

Developing a migraine treatment plan for pregnancy

Ideally, a treatment plan for managing migraine during pregnancy begins before you get pregnant. Your treatment plan should answer the following questions:^1,2

• What should you take for migraines during pregnancy? Will your current treatments be safe to continue, or will you need to change drugs? If you need to make changes, do you need to do this before getting pregnant?
• What can you do or take to prevent migraine attacks during pregnancy?
• What are some treatments that can help during pregnancy, other than medicine?
• How long should this treatment plan last after delivery? Should it continue if you are breastfeeding?

Non-drug options during pregnancy

There are nondrug options that might help treat or reduce migraine attacks during pregnancy. These include:^1-3

• Stay hydrated – Make sure you drink enough fluids during the day. Drinking enough fluids is important for all pregnant women, but especially for those with migraine.
• Add magnesium – Magnesium is a mineral found in the body and in many different foods. It is a supplement commonly used to prevent migraine. Because of its low risk of side effects, it is considered safe to use during pregnancy. Talk to your doctor about using this supplement.
• Consider using caffeine – Many women cut caffeine completely out of their diets when they find out they are pregnant. But small amounts of caffeine can help prevent migraine and are considered safe during pregnancy. Talk to your doctor about how much caffeine per day is safe for you to consume.
• Prioritize sleep – Do your best to go to sleep and wake up at the same time each day. Not getting enough sleep can be a trigger for migraine, so practice good sleep habits.
• Find and avoid your triggers – Certain foods like chocolate or processed foods can trigger migraine in some people. pay attention to foods or other things that might bother you and trigger your symptoms. This process of elimination might be time-consuming. But try to avoid these triggers as much as possible.
• Explore mind-body therapies – With guidance from your doctor, see if other preventive and healing therapies might be helpful. Options include massage, acupuncture, biofeedback, meditation, yoga, physical therapy, and drug options.

At times, you might need drug treatment to manage migraine during pregnancy. Doctors generally try to use as few drugs as possible with the smallest doses available to treat any health conditions during pregnancy. This is also true for treating migraine.²

Your doctor may ask you to continue some of the migraine drugs you took before pregnancy to help prevent or stop your migraine. The most common are called triptans, like sumatriptan (Imitrex). But these drugs may not be right for everyone. Your doctor will be able to guide you on the best choices for your treatment plan.²

Your doctor may prescribe some antinausea drugs during pregnancy. These drugs can also help with migraine. There is no one answer on which drug is best and safest to take. All drugs come with risks. But there is also the risk of not getting enough nutrients if you have severe nausea and vomiting during pregnancy. It is best to talk to your doctor about your drug and non-drug options if you are pregnant and have nausea with migraine.²

Over-the-counter drugs

Some over-the-counter (OTC) drugs like acetaminophen (Tylenol®) are generally considered safe during pregnancy. But even the drugs sold at your local pharmacy can be dangerous if taken incorrectly.²

Other OTC drugs called nonsteroidal anti-inflammatory drugs (NSAIDs) – like ibuprofen or naproxen – may also be safe during pregnancy for migraine. In general, your doctor will tell you these are safe but need to be taken cautiously during pregnancy. This is because your baby is still developing, and the lowest amount of medicine is usually recommended. Talk to your doctor before taking any drug, including any OTC drugs.²

Migraine, vessel disease, and pregnancy

Some evidence suggests that migraine might be related to changes in blood vessels. These changes can include swelling, spasms, and the constricting (narrowing) of blood vessels. Vessel disease can also lead to pregnancy complications such as preeclampsia.⁴

Preeclampsia is a serious condition that can cause seizures, stroke, and other health problems for both you and your unborn baby. Preeclampsia can have symptoms that are similar to those of migraine. This similarity can be confusing and might delay emergency care.^4,5

Knowing the symptoms of preeclampsia is important to prevent life-threatening complications. These symptoms include:⁵

• High blood pressure
• Protein in your urine
• Increased swelling in your hands and feet
• Nausea and vomiting
• Severe headaches
• Changes in your vision, such as sudden loss of vision, light sensitivity, or blurred vision
• Decreased urine output
• Trouble breathing

Many of these symptoms can be mild or may not be related to preeclampsia. Contact your doctor to discuss your concerns.⁵