Women with chronic migraine headaches often find that their symptoms and headache patterns change during pregnancy. Most women who suffer from migraines experience changes in their headaches depending on the hormone changes that occur with their monthly menstrual cycle. This can continue until menopause. Estrogen is one of the hormones responsible for these changes. Since estrogen levels rise and stay high during pregnancy, many women report improvement in headache symptoms throughout their pregnancy. Unfortunately, such improvements are usually temporary. Once hormonal changes start soon after giving birth, migraines usually go back to their original pattern. In rare cases, the pregnancy hormonal changes actually serve as headache triggers. Pregnancy can also make women more vulnerable to medication overuse to relieve headaches. It is important not to take pain medications in excess, including over-the-counter drugs.
Medications and pregnancy
If you are treated for migraines with medications and want to get pregnant, you should speak with your healthcare provider. Certain migraine medications, like any other kind of medication, could be potentially harmful to your baby if you take them while pregnant. Some drugs increase the risk for birth defects, or even influence the ability to carry a baby successfully. The Food and Drug Administration assigns drugs to a safety category for use during pregnancy. This information is based on accepted studies. A drug that is given a Category “A” means that it is most likely safe to use during the pregnancy, Category “B” medications are likely to be safe, as there has been no proof to show any risk to the developing baby. Categories “C”, “D”, and “X” all carry higher levels of risk, and can be dangerous to use.
Migraine medications and pregnancy
While it is important to realize that it may be difficult or impossible to know whether a medication is absolutely safe during pregnancy, some migraine medications have been widely used without any problems, and are generally regarded as safe to use during pregnancy. The key thing to think about is that if you see a specialist for your headaches, you need to make sure there is good communication between that doctor and your obstetrician. Although good choices for acute migraine treatment are available, everyone involved needs to agree to their use during your pregnancy, including you. It is especially important to have these kinds of discussions even if you are only planning to get pregnant, as certain medications that you take to prevent migraines from happening may need to be changed at that time.
Some pregnant women find that non-pharmacological approaches are effective for controlling their migraines. These include stress management programs, relaxation therapy, and biofeedback. Pregnancy massage and acupuncture may both help the expectant mother, and these treatments are generally considered safe for the baby. This is true, whether or not hormones trigger the migraines. There has been little research on the safety of using herbal remedies during pregnancy. The Food and Drug Administration lacks the authority to regulate these products in the same way that they regulate prescription medications. Given this lack of supervision, and the small amount of research about the risks and benefits of herbal or alternative medicines, most doctors advise their patients not to use them.
Suffering from migraines should not prevent you from breastfeeding. Sometimes breastfeeding has actually been shown to delay the return of migraines after pregnancy, most likely due to hormonal effects. It is also good to know that drugs that are considered to be safe during pregnancy are generally safe to take while breastfeeding as well. Obviously, the same discussions need to take place with your healthcare providers about safe use of medications while breastfeeding. In some situations, mothers may have to pump and discard their milk 4–6 hours after taking certain medications.
As more effective medications and treatments for migraines are developed and investigated, the knowledge about migraines and treatment options is increased. By discussing your interest in becoming pregnant and your pregnancy with your health care provider, you can control your headaches without endangering your child.
Young, W. & Silberstein, S. (2004). Migraine and Other Headaches. New York, NY: AAN Press.