Can you get a pregnancy migraine?

Pregnancy causes a variety of changes in the body, and shifts in hormone levels and body shape can lead to many unexpected symptoms. For some women, migraine headaches may be part of a pregnancy, but there also may be treatments available to provide safe relief.

Generally, headaches are common during pregnancy, and the most common types experienced by pregnant women are tension headaches and migraines. However, 50% to 80% of women who experienced migraines prior to pregnancy report fewer episodes while pregnant. This is likely due to increased levels of estrogen.

Among women who do experience migraines during pregnancy, the frequency often declines during the second and third trimesters, but then they may increase during the postpartum period when estrogen levels decline.

During pregnancy, the symptoms of a migraine are similar to those that people who aren't pregnant experience, and include:

• Throbbing or pulsating pain on one or both sides of the head
• Sensitivity to sensory stimuli, like light, noise and smells
• Digestive problems, like vomiting, abdominal pain and nausea
• Sweating
• Chills
• Reduction in appetite
• Scalp tenderness

These symptoms may continue for a few hours or up to a few days. At the beginning of a migraine or shortly before, you may experience sensory symptoms called an aura. Around 15% to 25% of migraine sufferers experience aura symptoms, which may include:

• Temporary loss of vision or blind spots
• Seeing bright spots, flashes of light, waves or jagged lines
• Ringing in the ears
• Changes in sense of taste or smell
• Pins and needles sensation in the arms or legs
• Numbness or tingling of the skin
• Muscle weakness on one side of the body or face
• Trouble recalling words or inability to speak
• Slurred speech

During the hours or days before a migraine attack, you may experience a prodrome phase, marked by the following symptoms:

• Irritability and mood swings
• Sensitivity to noise and light
• Food cravings
• More frequent urination
• Stiff muscles
• Problems concentrating or reading
• Insomnia and fatigue
• Yawning

About 80% of migraine sufferers have symptoms after an attack during what's called the postdrome phase of a migraine. Some people experience feelings of elation, while others describe being depressed or extremely fatigued. Brain fog and trouble concentrating are also common post-migraine symptoms.

Although migraine symptoms can interfere with your daily activities, the headaches aren't an indication that something is wrong with your baby. Migraines don't impact the health of the fetus. However, symptoms of migraines can be similar to more serious conditions during pregnancy, such as hypertension, so you should report your symptoms to your healthcare provider for evaluation.

Some common migraine treatments can pass through the placenta and pose risks to a baby. As a result, medical providers must exercise caution when recommending treatments. The following are some potential solutions for migraine management. They may not be ideal for all pregnant women, making it important that you talk to your healthcare provider before taking any medication.

Over-the-counter pain relievers

Generally, healthcare providers advise against taking nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen, during pregnancy. In some cases, they may recommend the occasional use of small amounts of over-the-counter migraine medications.

Prescription medications

Promethazine may help with the nausea component of migraines. In rare cases of severe migraines, opiates may be considered for a short duration, but healthcare providers must weigh the potential benefits against possible side effects.

Trigger tracking and avoidance

Many things can trigger migraines, such as:

• Alcohol
• Aged and processed foods
• Aspartame
• Bright lights
• Too much caffeine or a lack of caffeine
• Changes in sleep patterns
• Exercise
• Loud noise
• Monosodium glutamate (MSG), a food preservative
• Sex
• Skipping meals
• Stress
• Strong odors
• Weather

Healthcare providers may recommend that pregnant women keep a migraine journal, recording their activities, diet and fluid intake for each day and noting when they experience migraines. Over time, this may help you identify triggers, and you can then take steps to avoid these triggers during pregnancy.

If you never had migraines before you were pregnant, they may subside within a few months of delivery. However, migraines may persist in some women. Your healthcare provider can continue to adjust your migraine treatment plan during the postpartum period and beyond as needed to manage pain and potentially decrease the frequency of attacks.

Whether you're a long-time migraine sufferer or experiencing migraines for the first time, talking to your healthcare provider about your symptoms is important during pregnancy. Any headache that’s accompanied by vision loss, one-sided numbness or weakness, or other neurological symptoms should be reported to your provider immediately. They can help you explore over-the-counter and prescription medications for migraine relief that are safe for you and your baby. In addition, you can discuss lifestyle changes and other nonmedicinal interventions that can help you deal with migraines during pregnancy.

Published December 2022.