If you’ve ever experienced migraine, you know this type of headache can cause severe throbbing pain or a pulsing sensation, often accompanied by nausea, vomiting, and extreme sensitivity to light and sound.
Migraine attacks can last for hours to days, with pain so severe it can interfere with even day-to-day activities. These episodes tend to be more common in women than men, at a reported ratio of 3:1. Evidence suggests that migraine symptoms are also typically most severe in women, with symptoms peaking around age 35.
Research shows that female hormones are responsible for this greater migraine burden in women. Estrogen, a critical hormone that rises significantly during pregnancy and decreases after childbirth, has been increasingly linked to migraine. Antoinette Maassen van den Brink, a pharmacologist at the Erasmus University Medical Center in Rotterdam, the Netherlands, explains: "It's not the absolute levels of hormones, but more the fluctuations in hormones that cause the migraine attacks."
A special note: It’s important to understand that a serious or continuous headache during pregnancy could be caused by pre-eclampsia, eclampsia, or multiple other causes. The symptoms of pre-eclampsia can be very similar to migraine, except that migraine pain is typically unilateral. It’s imperative to consult a healthcare professional to evaluate unusual or severe head pain.
Migraine tends to be most active during a woman’s first trimester, with improvement occurring as the pregnancy progresses.
Why does migraine tend to worsen in the first trimester of pregnancy? Possible common triggers include:
Sleep Deprivation: Insomnia can be common both during pregnancy and in the postpartum period, due to hormonal fluctuations, changes in the body, and the need to provide constant infant care.
Sleep deprivation and migraine frequency have been linked for decades, with sleep deprivation triggering migraines and migraine causing insomnia. In an extensive study of people living with migraine, half indicated that sleep disturbances aggravated their headaches. On average, those who slept just 6 hours a night had more frequent, severe headaches than those who got the recommended amount of 7 or more hours a night.
In the early weeks of pregnancy, increased hormone progesterone levels, lower blood sugar levels, lower blood pressure, and increased blood production can sap an expectant mother’s energy. During this time, women with migraines can experience greater fatigue and exhaustion, which may well spur a migraine.
Morning Sickness: More than half of all pregnant women experience some sort of bout with morning sickness — nausea and vomiting during their pregnancy. Morning sickness may cause you to eat or drink less, leading to low blood sugar and dehydration that may worsen your migraines.
While certain medications are safe during pregnancy, some women prefer to first try home remedies to counter pain and nausea during a migraine episode. Some of these approaches may offer some relief, with the caveat of course that they don't necessarily work for everyone.
Although certain migraine medications are known to be unsafe during pregnancy or are not yet proven unharmful, safe and effective treatment options do exist.
Science is still exploring how medications might affect the developing fetus. The therapeutic landscape of migraine continues to evolve, bringing with it the potential for better treatments for expectant mothers in the future.
Before trying any new medications, over-the-counter drugs, supplements, or herbs during pregnancy, consult a physician for a thorough evaluation of your medical history as well as your medical condition while pregnant.
Acetaminophen: Acetaminophen — the generic name for Tylenol — has been proven safe throughout all trimesters of pregnancy and may offer beneficial relief of migraine symptoms. Tylenol has the best maternal-fetal safety profile so it is typically recommended as the first treatment option. However, excessive or overuse can cause liver damage in people pregnant and otherwise. Consult your physician to understand the dosage acceptable during your pregnancy.
Unless a doctor prescribes it, ibuprofen is not usually recommended in pregnancy, especially if you're more than 30 weeks pregnant. Ibuprofen can affect your baby's circulation and kidneys; there may also be a link between taking ibuprofen during early pregnancy and miscarriage.
Generally, aspirin isn't recommended during pregnancy unless you have certain medical conditions. However, low-dosage aspirin — 60 to 100 milligrams daily — isn't harmful during pregnancy and may be recommended by your prescribing physician.
Drugs to Reduce Vomiting and Nausea
Certain antihistamine drugs are preferred in pregnancy to relieve nausea and vomiting associated with migraine. These include meclizine (25 mg orally), diphenhydramine (25 to 50 mg orally), and promethazine (12.5 to 25 mg orally, per rectum, or intramuscularly).
Metoclopramide is used to treat symptoms of sickness and nausea that often accompany migraine. The drug is generally believed safe for use during pregnancy; however, there is a risk of dyskinesia (movement issues) in the expectant mother. In addition, information is lacking on the risk of specific malformations and fetal death.
Triptans, commonly used in the management of migraine, interfere with the serotonin system to help prevent inflammation in the brain. Although more study is needed, current data suggests that sumatriptan, a common triptan used in migraine, does not increase the risk of birth defects during pregnancy.
In general, triptans should only be considered in patients with moderate to severe symptoms who do not respond to other drugs. Triptans have fewer available studies on their safety, and it’s critical to consult your physician before taking triptans during pregnancy.
Topiramate: Topiramate is an anticonvulsant used to reduce increased neuronal-excitability in migraine. Topiramate is not safe to take during pregnancy, and carries increased risk that your baby may develop a cleft lip and/or cleft palate.
Ergotamines: Ergotamines, frequently used in conjunction with caffeine, help with migraine relief by preventing expansion of blood vessels in the head. These drugs are not recommended during pregnancy — they carry a risk of birth defects, particularly if taken in the first trimester, and may also induce labor contractions and premature birth.
Opioids: Although opioids are rarely prescribed as a treatment for migraine, these classes of drugs must not be taken during pregnancy, as they may cause birth defects and premature labor. Narcotics cross the placenta and can affect a fetus by slowing the heart and breathing.
If you’ve taken opioids before or during pregnancy, it is vital to talk with your physician before stopping. Abruptly stopping these narcotics after chronic use can result in miscarriage or cause withdrawal symptoms in the newborn.
If your migraine or headache during pregnancy lasts for long periods, gets steadily worse, or doesn't go away — or if it’s accompanied by fever, stiff neck, confusion, decreased alertness or memory, or neurological symptoms such as visual disturbances, slurred speech, weakness, numbness, or seizures — it’s time to seek professional medical attention.
And of course, it’s always a good idea to keep an open line with your healthcare provider during pregnancy, especially if you have episodes of migraines.
Although pregnant women may have fewer migraine treatment options, there is always a course of action available to bring you relief.
Try natural remedies, such as a dark quiet space, relaxation techniques, preventative diet choices, good hydration, a cold pack on the forehead, or magnesium supplements.
Start a migraine diary during your pregnancy to help identify possible triggers and reveal causes that might be specific to your head pain. Include the date of your headache, severity and symptoms, duration, diet, environmental settings, and any medication used.
If migraine still persists, consider other medications. But of course, safety always comes first, and any medication — including the typically-safe Tylenol — should be taken only with the prior consent of your prescribing physician.
Have a friend or loved one who experiences migraine? Have them check out the Mable migraine blog.