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Pregnancy and Migraine

Migraine Management in Pregnancy

  • Migraine affects 25% of the female population during childbearing years (18-49)

  • 60-70% improve in frequency of migraines ( particularly in the 2nd and 3rd trimesters)

  • 4-8% of women with migraines symptoms worsen.

  • Approximately 10% of migraine cases start during pregnancy.

  • Pre-pregnancy headache patterns return almost immediately postpartum.

  • 50% to 85% of migraine patients report an improvement in headache during early pregnancy, particularly when

    • Migraine is not accompanied by an aura

    • Migraine began as menarche

    • Migraine is related to menses

-  Women with ongoing headaches at the end of the first trimester are unlikely to experience further reduction of headache.

Aube M Neurology. 1999;53(S1): S26-S28.

Silberstein SD. Neurologic Clinics. 1997; 15(1): 209-231.

Lipton et al. Headache. 2000; 41: 646-657

The Pregnant Migraineur

  • Pregnancy is a symptom-producing event

  • The incidence of migraine in pregnancy is unknown.

  • Retrospective data has shown up to 60% incidence improvement during pregnancy however, patients with more frequent headaches may not see any improvement during pregnancy.

Impact of Migraine on Pregnancy

  • In comparison to non-migraineurs there has been no evidence of altered fertility rates.

  • No increased incidences of toxemia, abnormal labor, miscarriage, congenital malformations, or stillbirths reported in a study which compared 777 migraineurs versus 182 non-migraineurs.

Aube M Neurology. 1999;53(S1):S26-S28.

Silberstein SD. Neurologic Clinics. 1997; 15(1): 209-231.

Maternal Use of Medicines

  • Drug consumption during pregnancy is increased
  • WHO study of 14,778 women

    • 86% took prescription drugs pregnancy

    • Consider taking all natural supplementation such as HeadAid to help reduce your symptoms and lower risk to fetal development.

    • 50% of pregnancies unplanned so inadvertent fetal exposure to medications is likely.

    • 10% of cognitive abnormalities are thought to be due to environmental exposures.

Cragan J, Matern Child Health J. 2006 Sept:10 (Supple7) 129-135

Non-Pharmacological Options

  • Rest

  • Ice Pack/ Heat Pad

  • Message

  • Avoiding triggers

  • Regular exercise

  • Physical Therapy

References

American Pregnancy Organization 

Williams Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 55. National Headache Foundation, www.headaches.org

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