Pregnancy can be a scary time for any female. For those that struggle with migraines, this can be even more anxiety provoking. The worry of “what if an attack occurs” or “how will this medication affect my baby’s development” are very real and are very valid concerns. The good news is that about 50-80% of women with migraines will experience improvement in migraines during pregnancy and breastfeeding.

Migraines and Hormones

There is a lot that can be said about hormones in relation to women and migraines. Estrogen and migraines can have quite a complicated relationship. Women who have menstrual-related migraines typically have a spike in migraines when there is either a significant drop in estrogen(ovulation) or low levels of estrogen(period). Higher estrogen levels can decrease frequency and severity of migraine attacks.

Estrogen has a profound effect on pain. Studies have shown that both estrogen and progesterone play a role in our body’s perception of pain. The fluctuations of hormones, which women experience during their menstrual period, cause an increase likelihood of experiencing more pain.

During pregnancy and breastfeeding estrogen levels remain high. This is likely why migraines improve during this time frame. It is not always an option for the mother to breastfeed but is encouraged if able as this can provide additional migraine control and benefits to pain response.

Medications and Pregnancy

There are several medications used in migraine treatment that are not considered safe in pregnancy. This is why talking with your provider about options during the family planning stage is so important. Some of the medications can cause injury before the mother even knows she is pregnant. This further emphasizes the importance of coming up with a treatment plan that is safe and effective.

Most often it is recommended to utilize non-pharmacologic treatments during pregnancy such as massage therapy, physical therapy, cognitive behavioral therapy and mindfulness exercises to name a few. Routine and focusing on healthy lifestyle factors can also provide significant benefit to the pregnant mother. These include, but are not limited to:

• Adequate hydration– It is typically recommended to drink approximately 64 ounces of water per day. During pregnancy, this amount may be a bit higher. The American College of Obstetricians and Gynecologists(ACOG) recommends closer to 80 ounces of water per day. It is also important to know that caffeine can have a dehydrating effect. It is recommended that pregnant women consume no more than 200mg of caffeine per day, or about one 12-ounce cup of coffee. This is also the general recommendation for caffeine intake for migraine patients as well.
• Routine exercise– Exercise is always important in any stage in life. In pregnancy specifically it helps to improve mood, increase muscle tone and strength, reduces swelling and can help with the prevention and treatment of gestational diabetes. It can be difficult to exercise during pregnancy due to the changes the woman’s body. Walking, swimming, yoga or even stretching exercises can all be of significant benefit.
• Good sleep hygiene– It can be quite difficult to maintain a routine sleep schedule during pregnancy and after baby is born. Simply prioritizing sleep when able will help to minimize headaches and migraine attacks. The age old saying of “sleep when baby sleeps” is highly encouraged.

The Food and Drug Administration(FDA) provides a guide for both prescription and non-prescriptions drugs for use in pregnancy. For more information, simply go to Medicine and Pregnancy | FDA for more detailed information.

There is no medical reason to not become pregnant if you experience migraines. Have a plan, as well as a back up plan, for treatment. This can help to make your pregnancy less stressful, more enjoyable and allow the new mother and baby to bond without further interruptions. Becoming a mother is an experience that words cannot describe. Don’t let migraine attacks control your decision. Talk to your provider or headache specialist about your options.