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High-Risk Pregnancy - Migraine Headache

Headaches are quite common in pregnancy. The most common are tension headaches and migraine headaches. Most headaches come and go, but others may be more bothersome or may be caused by other complications. It is important for women to consult their physician about any headaches they may have before, during, or after pregnancy.

What are migraine headaches?

Vascular headaches, a group that includes migraine, are thought to involve abnormal function of the brain's blood vessels or vascular system. The most common type of vascular headache is a migraine. Migraine headaches are usually characterized by the following:

  • severe pain on one or both sides of the head
  • nausea and/or vomiting
  • disturbed vision and intolerance to light

People who get migraine headaches seem to have blood vessels that overreact to various triggers, which may include the following:

  • stress and other emotions
  • biological and environmental conditions
  • fatigue
  • glaring or flickering lights
  • weather
  • certain foods

What are the symptoms of migraine headaches?

The two most common types of migraines are classic migraines and common migraines. The following are the most common symptoms. However, each woman may experience symptoms differently. Symptoms may include:

  • classic migraines
    A type of migraine that involves the appearance of neurological symptoms, called an aura (flashing lights or zigzag lines, or temporary loss of vision) 10 to 30 minutes before an attack. An attack may last one or two days. Pain associated with classic migraines may be described as:
    • intense, throbbing, or pounding felt in the forehead, temple, ear, jaw, or around the eye.
    • starting on one side of the head, but may spread to the other side.
  • common migraine
    A type of migraine that is generally not preceded by an aura, although there may be a variety of symptoms prior to its onset. Common migraine pain may last three or four days. Symptoms may include:
    • mental "fuzziness"
    • mood changes
    • fatigue
    • unusual retention of fluids
    • diarrhea and increased urination
    • nausea and vomiting

The symptoms of migraines may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

How does pregnancy affect migraine headaches?

About 15 to 20 percent of pregnant women have migraines. Over half of women find that their migraines occur less often in the last few months of pregnancy. However, migraines may worsen after delivery, during the postpartum period. Although migraine headaches may cause severe pain for the mother, there are no dangers for the developing fetus.

How are migraine headaches managed in pregnancy?

If a woman has a history of migraine headaches, and there are no other health problems, migraines during pregnancy are not usually a concern. However, if a first-time migraine-like headache occurs in pregnancy, it is important to rule out any other type of condition that may be dangerous, such as bleeding in the brain, meningitis (infection in the brain tissues), or tumors. Further testing may be needed to determine the cause of the headache.

Treatment of migraines in pregnancy may include soothing and non-drug measures such as cold packs, darkened room, and sleep. Avoiding triggers such as certain foods and stress may also be helpful. Medications must be carefully chosen because many drugs pass through the placenta to the developing fetus. Small doses of caffeine and acetaminophen are generally safe after the first trimester of pregnancy, however, only as advised by your physician. Non-steroidal anti-inflammatory drugs are sometimes used but should be avoided in the third trimester because they can have serious health effects on the fetus and newborn. Consult your physician for more specific information regarding treatment for migraines during pregnancy.

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