Olivia Begasse De Dhaem, MD, Neurologist and Headache Specialist

For many women, migraine is a part of the entire pregnancy package. Add nausea, reflux and general discomfort, and a migraine can really feel overwhelming! The good news is that there are steps you can take to reduce migraine attacks during pregnancy.

Dr. Olivia Begasse De Dhaem of Stamford Health Neurology shares her expertise.

1. Plan early to get started on the right path.

Think of migraine as part of your pregnancy planning checklist. If you have a history of migraine and are trying to conceive or are in the early stages of pregnancy, raise the following points with your doctor:

Ask about the safety of your current migraine medications, if any. Certain medications are not safe for the developing baby, even very early on before you know you’re pregnant.

• For example, nonsteroidal anti-inflammatory drugs like ibuprofen are not safe in the first and third trimesters.
• Some of the migraine preventive therapies (medications taken regularly to prevent migraine attacks) are not safe in pregnancy and need to be discontinued months before conception such as the new CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab).

2. Know migraine has a good chance of improving during pregnancy.

While pregnancy can also be a tough time for women with migraine, here are some reassuring facts:

• About 50% of women with migraine have an improvement by the first trimester.
• About 87% of women with migraine have an improvement by the third trimester.

It’s also important to understand that pregnancy hormones can cause lack of sleep, nausea, change in eating and exercise habits, fatigue, and mood changes. All of these factors can contribute to headaches and migraines. Here are some tips for self-care that will ultimately help with the headaches:

• Stay hydrated
• Eat healthy
• Practice good sleep
• Incorporate exercise whenever possible
• Stretch your neck for a few minutes daily when in the bath or shower. Neck care can go a long way in helping with migraine management and prevention.

Some of these are easier to achieve than others, so the key is to set realistic expectations! Maybe you can aim for 6 hours of sleep a night if 8 are not possible, or for 30-60 minutes of exercise 3-5 times a week instead of every day. If the thought of eating certain foods nauseates you even more, talk to your doctor about any supplements or vitamins you should be taking in addition to your prenatal vitamin. Above all, listen to your body and comfort level.

Your emotional and mental health is equally important. If you develop negative feelings, depression or anxiety, talk to your doctor and consider joining support groups.

3. Explore pregnancy-safe migraine medications and other treatment options.

There are medical options that are safe in pregnancy. Please discuss the safety of each medication you consider taking in pregnancy with your doctor. There are two main types of treatment for migraine:
1) Acute (sudden onset) treatment to take as needed to stop or reduce the severity of a migraine attack, and
2) Preventive treatment to decrease the frequency and severity of migraine attacks.

Acute treatment options in pregnancy include:

• Acetaminophen, which can be combined with metoclopramide (an anti-nausea medication).
• Sumatriptan. Two large studies of sumatriptan use by pregnant women did not show any association with adverse outcomes nor baby malformations.

Preventive treatment options in pregnancy include:

• Riboflavin (vitamin B2) supplements, over-the-counter
• Oral prescription medications, but your doctor will let you know which ones are not safe
• Lidocaine injections under the skin to numb the nerves involved in migraine (nerve blocks)
• Stress management therapies such as progressive muscle relaxation, biofeedback and cognitive behavioral therapy
• Cefaly, which is an over-the-counter FDA approved nerve stimulator device to be placed on the forehead for migraine prevention and acute therapy
  
  

New headaches in pregnancy:

Many women develop headaches during pregnancy for many different reasons including changes in eating habits, hormone levels, and blood flow. Some women without a history of migraine develop migraine in pregnancy, usually in their first trimester. Don’t jump to conclusions, but, if you develop a new type of headache in pregnancy or have a headache with new symptoms such as vision changes, weakness, numbness, imbalance, vertigo, please go to the emergency room for further evaluation as it is better to be on the safe side.

Remember, being pregnant does not mean you cannot treat your migraine attacks! It takes planning, patience and care from a doctor who specializes in prenatal headache management.

Please note: the content on this page is not intended to replace the medical advice of your doctor. Please always consult your doctor with any questions you might have about a medical condition. If you don't have a doctor, find one here.