Migraines, characterized by severe headaches often accompanied by nausea, vomiting, and sensitivity to light and sound, are a common neurological condition. Pregnancy influences migraine patterns, with about 15% to 20% of pregnant women experiencing them. While over half of women find their migraines improve, especially in the last two trimesters, some may experience worsening symptoms or even their first migraine during pregnancy. Safely managing these headaches is important for the well-being of both the expectant mother and the developing baby.
Non-Drug Strategies
Non-pharmacological approaches are often the first line of defense for managing migraines during pregnancy. Adequate rest is beneficial, as overtiredness can be a trigger, especially in the first and last trimesters. Staying well-hydrated and eating small, frequent meals can help prevent low blood sugar and dehydration, which are common migraine triggers, particularly with morning sickness.
Applying cold compresses to the forehead or neck can help constrict blood vessels and alleviate pain, while a warm compress or shower may relax tense muscles. Relaxation techniques, such as meditation, deep breathing exercises, biofeedback, or even gentle activities like yoga and massage, can also provide relief and reduce frequency. Maintaining a regular sleep schedule and avoiding excessive physical exertion also help manage migraines.
Medications for Migraines
When non-drug strategies are insufficient, certain medications may be considered, always under the guidance of a healthcare provider. Acetaminophen is considered the safest pain reliever for mild-to-moderate migraines throughout pregnancy and is often the first choice. It has been extensively used with no apparent harm to the developing baby.
For more severe cases, or if acetaminophen is not effective, triptans like sumatriptan may be an option, as studies have shown no major increase in birth defects, prematurity, or miscarriage. Sumatriptan is often preferred due to more extensive safety data. Antiemetics, such as metoclopramide or prochlorperazine, can be used to manage associated nausea and vomiting.
Certain medications are avoided or used cautiously during pregnancy. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen should be avoided after 20 weeks of pregnancy due to risks such as premature closure of the ductus arteriosus in the fetus. Ergotamines, including dihydroergotamine, are contraindicated due to their potential to cause uterine vasoconstriction and have been linked to low birth weight and preterm birth. Other medications like sodium valproate, topiramate, and candesartan are also not recommended due to potential harm to the baby.
Identifying and Avoiding Triggers
Understanding and avoiding personal migraine triggers can significantly reduce the frequency and severity of attacks during pregnancy. Hormonal fluctuations, particularly changes in estrogen levels, are a common trigger, although pregnancy often leads to more stable estrogen levels which can improve migraines. Stress, fatigue, and changes in sleep patterns are also frequent culprits.
Certain foods, such as aged cheeses, chocolate, and processed meats containing nitrates, along with caffeine withdrawal, can trigger migraines. Environmental factors like bright or flashing lights, loud noises, and strong smells (e.g., perfumes or paint thinner) are also common. Keeping a detailed headache diary, noting when migraines occur, their intensity, and any preceding factors or consumed foods, can help identify individual triggers for avoidance.
When to Seek Professional Help
Prompt consultation with a healthcare provider is important for any new or worsening headaches during pregnancy. A sudden, severe headache, often described as a “thunderclap” headache, warrants immediate medical attention. Headaches accompanied by vision changes, such as blurring or seeing flashing lights, or new neurological symptoms like numbness, weakness, or confusion, are concerning signs.
Additional red flags include headaches with high blood pressure, fever, severe nausea and vomiting not typical of morning sickness, or sudden swelling in the face, hands, or feet. Any headache that feels different from usual migraines, is debilitating, or causes significant concern should be discussed with a doctor. These symptoms could indicate underlying conditions like pre-eclampsia, which require urgent evaluation and management.