Women's Healthcare Topics

Is it Normal to Get Migraine Headaches During Pregnancy?

Reviewed by James Brann, M.D.

What Are Migraines?

Migraine headaches during pregnancy are an often unwanted but sometimes common side effect of pregnancy. If you experienced migraines prior to pregnancy, you will find your condition either drastically improves or possibly gets worse during pregnancy.

Migraine headaches are different from other forms of headaches including tension or cluster headaches. Migraine headaches typically result when blood vessels in the brain dilate to extremely uncomfortable levels. Increasing levels of hormones can contribute to migraine headaches in pregnant women. Some women experience a migraine headache for the first time while pregnant.

A migraine headache is typically characterized by a dull aching that eventually worsens until the patient feels a strong, pulsating pain usually on one side of the head or temples. Migraines are often accompanied by vomiting, nausea and in some cases an aura. An aura is the perception of lights or spots before the eyes. Some women with migraines experience blind spots or other vision problems. Many also report sensitivity to noise and lights.

Migraine headaches are usually not dangerous for the mother or baby, unless they persist for several days or come with unusual frequency. If you do experience a migraine accompanied by vision disturbances it is important you consult with your health care provider to rule out other potential causes (such as pre-eclampsia, which also causes headaches and vision disturbances).

Preventing Migraine Headaches

While there are no guarantees that you can prevent migraine or any other type of headache, scientists have discovered certain triggers that can stimulate a migraine. These vary from person to person, but common triggers often include:

  • Wine (which you should avoid anyways while pregnant).

  • Aged cheeses including sharp cheddar.

  • Chocolate.

  • Excessive anxiety or stress.

  • Muscular tension.

  • Hormones.

  • Weather fluctuations.

  • Coffee.

If you find that something triggers a migraine consistently your best bet is to simply avoid that trigger as much as possible.

Migraine Treatments

Learn about migraine headaches in pregnancy.

The treatment of migraine headache in pregnancy is different from the treatment when not pregnant, because of the risks associated with traditional treatments. The safest medication for a migraine headache in pregnancy is acetaminophen (Tylenol). If Tylenol is ineffective, then your doctor will try other medications in the order listed below.

Acetaminophen alone or combination therapy — Acetaminophen (1000 mg) can be an effective treatment of migraine headaches. It is safe and it does not increase the risk of adverse effects on pregnancy or the baby.

Migraine headaches that do not respond to Tylenol alone may be relieved with combination therapy such as acetaminophen (650 to 1000 mg) and metoclopramide (10 mg); acetaminophen-codeine; or acetaminophen-caffeine-butalbital.

Butalbital should only be used for a limited time, and not more than four to five days each month. Codeine use should also be limited to just nine days per month. These medications can cause medication overuse headaches if used for longer periods of times.

The above treatments are generally safe for the baby. Although, extended use of butalbital or codeine before delivery can cause withdrawals and vitamin K deficiency bleeding in the newborn.

NSAIDs and aspirin — Nonsteroidal antiinflammatory drugs (NSAIDs), such as naproxen or ibuprofen, are a second-line treatment choice, and safest in the second trimester. In the third trimester, their use should be limited due to concerns for the baby.

Opioids — Opioids (eg, oxycodone, Demerol, morphine) are a third-line treatment choice. They are habit-forming and their overuse can cause chronic daily headaches. The opioid medications may increase the nausea and vomiting already associated with your migraine headache. Plus they can also increase constipation which is normally seen with pregnancy. All of the opioids medication are addictive and can cause newborn withdrawals; thus, they should not be used for extended periods of time.

Triptans — For moderate to severe migraine headaches that do not respond to other drugs, Sumatriptan (100 mg orally, 4 to 6 mg subcutaneously, or 5 to 25 mg intranasally), can be used and is highly effective in treating migraine headaches. Sumatriptan usage during pregnancy is not associated with an increased risk of birth defects or miscarriage.

Nonpharmacologic therapies — Your doctor may recommend non-pharmacologic therapies for you. Resting quietly in a dark and cool room, even falling asleep can be effective for mild migraine headaches. Many women find applying an ice pack or cool cloth to the head helpful for constricting blood vessels. A cold shower will serve the same purpose. Acupuncture and even chiropractic manipulation can be very helpful for relieving migraines during pregnancy. Massage therapy can also help reduce muscular tension, stress or anxiety that may contribute to migraine headaches.


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