Pregnancy is more common among women experiencing migraines compared to those who don't have these headaches.
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The lead author of a recent study, Nirit Lev, presented findings on the management of migraines during pregnancy at the 7th Congress of the European Academy of Neurology (EAN). The study examined various factors, including the mode of delivery, medical and obstetric complications experienced in each trimester, and medication use throughout pregnancy.
Migraines, one of the most common neurological disorders, affect at least 1 in 10 people. Recent studies have shown that migraines are three times more common in women than men, and hormonal changes related to menstruation, menopause, and childbirth can trigger more severe migraine attacks.
High-risk pregnancies are a concern for women with migraines, as they are associated with a higher risk of being admitted to a high-risk department for pregnant women. The study found that the rate of admission for pregnant women with migraines was 8.7%, compared to 6% for women without migraines.
The high-risk protocols for managing migraines during pregnancy prioritize nonpharmacological measures and careful medication use to minimize obstetric and postpartum complications due to the vulnerability of both mother and fetus.
Nonpharmacological management (first line) includes lifestyle modifications such as moderate exercise, healthy diet, regular sleep schedule, hydration, trigger avoidance, relaxation techniques, behavioral therapy, biofeedback, and acupuncture. These measures are preferred to reduce migraine frequency and intensity safely during pregnancy.
When it comes to medication use, acetaminophen (paracetamol) is generally considered safe as the first-line medication for acute migraine during pregnancy. Second-line options, used with caution, especially in the second trimester, include NSAIDs. Triptans, specifically sumatriptan, have the most evidence supporting their safety in pregnancy and can be considered if acetaminophen is insufficient. Medications to avoid include ergot alkaloids (due to induction of uterine contractions and risk of miscarriage) and opioids (risk of neonatal withdrawal syndrome and worsened nausea/vomiting).
Prophylactic therapy should be considered only if migraine significantly impairs quality of life and after lifestyle measures. First-line prophylactics include beta-blockers (like propranolol), magnesium, or amitriptyline, but only under specialist guidance to weigh maternal benefits against fetal risks.
Special considerations for high-risk patients include pregnant patients with status migrainosus refractory to outpatient therapy, inability to tolerate oral intake, or medication overuse headache, who may require hospitalization for supervised treatment. Close monitoring for obstetric complications is necessary because migraines in pregnancy are associated with increased risk of preeclampsia, stroke, and postpartum complications. Thus, interdisciplinary care involving neurology and obstetrics specialists is advised.
In summary, high-risk migraine management during pregnancy emphasizes non-drug measures first, cautious limited use of pregnancy-compatible medications (acetaminophen, sumatriptan, second-trimester NSAIDs), avoidance of ergot derivatives and opioids, and specialist involvement for prophylaxis or severe cases, aiming to reduce migraine impact while minimizing obstetric and neonatal risks.
The study analyzed the pregnancies of 145,102 women over a period from 2014 to 2020. Pregnant migraine sufferers have a significantly higher risk of gestational diagnoses of diabetes, hyperlipidemia, and blood clots. The pain associated with migraines typically worsens with movement or activity, making it a highly debilitating condition. The rate of epidural anesthesia during childbirth was higher in women with migraines.
- The study on migraines during pregnancy by Nirit Lev highlighted that women with migraines have a higher risk of being admitted to a high-risk department for pregnant women due to the increased risk of medical conditions such as diabetes, hyperlipidemia, and blood clots.
- Migraines, being one of the most common neurological disorders, are three times more common in women than in men, with hormonal changes related to menstruation, menopause, and childbirth often triggering more severe attacks.
- In managing migraines during pregnancy, health and wellness, including women's health, emphasizes non-drug measures first, followed by cautious limited use of pregnancy-compatible medications, and specialist involvement for prophylaxis or severe cases, to reduce the impact of migraines while minimizing obstetric and neonatal risks.
