What happens to a woman with migraine disorder during pregnancy?
Most women’s migraine attacks go away or get better during pregnancy; however, some women begin to experience them for the first time during pregnancy. Fortunately, there are safe treatments available.
“So we've already talked about the example of the woman who's having regular periods, let's say she's in her teens. Now let's take that same woman, and let's say she's in her mid-20's and she wants to get pregnant. There's a lot of fear about 'What can I take during pregnancy?' Well the good news that I can tell women, is most women — their migraines go away or get better during pregnancy. And that's exciting because then they're able to not take as much medication. And so when you look at what happens during pregnancy, a woman's own estrogen climbs. It climbs very high, but then it stays fairly constant through the cycle. So, the nice thing about that, that kind of proves that estrogen's not the enemy of menstrual migraine, it's usually the drop or change.
“And it's so interesting that I have so many women, their migraines go away during pregnancy, they'll actually say ‘Dr. Hutchinson, could I just be pregnant all of the time?’ Now that's true for most. Unfortunately there are a few women that migraines start for the first time during pregnancy. And if that's the case, it's more likely to be migraine with aura. So in that case we have to be a little more careful. Fortunately there are treatments that can be done during pregnancy and that's kind of an individual decision between, let's say myself and the OB, so I have to respect the OB. But I will tell you that when you look at the class of triptans they're all category C, which means you weigh the risks versus the benefit. So, again that's an individual thing. Some women take acetaminophen, which is Tylenol, during pregnancy, some have a little caffeine. But fortunately for most women, I can tell them — most likely your migraines are going to go away or get better during pregnancy.”
Fortunately, migraines seem to disappear completely or get better for the majority of women during pregnancy. This is due to steady levels of estrogen during this time. However, some women begin to experience migraine for the first time during pregnancy, and this is often experienced as migraine with aura. Fortunately, there are safe treatments, such as acetaminophen and a little caffeine, and even some triptans can be taken in a risk vs. benefit fashion. Certainly, these treatments should be discussed with both a woman’s obstetrician and her headache doctor.
Susan Hutchinson, MD
Author - The Women's Guide to Managing Migraine
Orange County Migraine & Headache Center
Dr. Susan Hutchinson is a headache specialist and board-certified family practice physician. In February 2007, she founded Orange County Migraine & Headache Center, dedicated to serving patients with headache and mood disorders. Although she is not a psychiatrist, she has developed a special interest in treating mood disorders as well as headache. The mood disorders she treats include depression; anxiety; bipolar disorder; ADHD; and panic attacks. Dr. Hutchinson suffers from migraine headaches which gives her an empathy with her patients.
She felt such a calling to help patients with headache and mood disorders that she decided to specialize and devote her career to alleviating the suffering caused by both headaches and mood disorders. She lectures nationally on the subject of headache; has written dozens of articles for medical journals; participated in headache research projects and is very active in numerous professional organizations such as the American Headache Society and the National Headache Foundation.
She is the immediate post-chair of the Women’s Issues section of the American Headache Society after serving in the chair position for 5 years. Dr. Hutchinson is a dynamic and sought-after speaker. She speaks for community groups as well as professional groups. In 2010 she became the President of The Orange County Chapter of the California Academy of Family Physicians.