What to Know About Migraines and Pregnancy
Medically reviewed by Chioma Ndubisi, MD
Migraines are severe headaches that can cause pulsing or throbbing pain and often include nausea, vomiting, and light sensitivity. They are the most common type of headache found with an imbalance of hormones, especially estrogen.
The experience of having migraines while pregnant varies from person to person. Many people have fewer migraines while pregnant, while some get migraines for the first time.
This article discusses migraines and their impact on fertility, gestation, and the postpartum period, the time after the baby is delivered.
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Women and Migraines
The following are statistics regarding how migraines affect women:
Migraine pain and symptoms affect 29.5 million American women.
Around 18% of women experience migraines aggravated by hormone shifts.
An estimated 75% of people who have migraines are women.
Migraines are most common in women between the ages of 20 and 45.
About 40% of women experience migraines before the end of their reproductive years.
Migraines and Fertility
There is no evidence that migraines cause infertility (being unable to get pregnant). However, there are some connections such as:
Stress: The stress that comes with migraines can lead to infertility.
Endometriosis: Endometriosis increases the risk of migraines. While the science is controversial, some studies show that endometriosis also increases infertility risk.
Migraines and ovulation: Many women get migraines around ovulation, which is the most fertile time of the month. Not feeling well may prevent them from having sexual intercourse during this fertility window.
Why Those With Migraines Avoid Pregnancy
While the following reasons do not cause infertility, one study suggests that they are concerns that cause 19.9% of women with migraines to avoid getting pregnant:
Close to 73% believed pregnancy would make migraines worse.
68% thought migraines would make pregnancy difficult.
76% believed migraine medication would affect child development.
14% thought migraines would cause the baby to have abnormalities
The medication involved with fertility treatments, such as in-vitro fertilization (IVF) and intrauterine insemination (IUI), can cause migraines.
Infertility medications include ovulation stimulants such as:
Clomid (clomiphene citrate)
Menopur (menotropins)
Factrel (gonadorelin)
Infertility medications may also include gonadotropin-releasing agonists. They are referred to as ovulation deterrents because they prevent premature ovulation:
Lupron (leuprolide)
Zoladex (goserelin acetate)
Synarel (nafarelin)
Are Migraines Hereditary?
Studies estimate that around 34% to 64% of migraines have a genetic component. This means they run, or cluster, in families.
Migraines and Gestation
As levels of estrogen rise during pregnancy, the frequency and severity of migraines often decrease, especially during the second and third trimesters.
Prevalence of Migraines During Pregnancy
Between 50% and 75% of women report fewer migraines or less painful migraines during pregnancy, especially after the first trimester. This is most likely due to an increase in estrogen levels during pregnancy.
Related: What Is a Pregnant Belly?
Risks
If you have a history of migraines and no other health issues, there is little to no concern about increased risks to the pregnancy or baby. However, migraines increase the risk of developing high blood pressure (hypertension) during pregnancy.
Treatment
Because some medications are unsafe for pregnant women, non-pharmacological (no medicine) treatments are preferred. Non-pharmacological methods include:
Relaxation exercises
Resting in a dark room with a cold pack
Staying hydrated by drinking plenty of water
Massage
While this approach is ideal, healthcare providers know this may not work for everyone. When migraines are not managed, they can cause depression, sleep deprivation, and stress, which is unhealthy for moms and babies.
If you are pregnant or plan to be, talk with your healthcare provider about migraine medications you can take for prevention, pain, nausea, and vomiting. They may want to readjust some medicines to create a safe migraine treatment plan for you and your baby.
Pregnancy and Medication Statistics
According to the Food and Drug Administration (FDA):
About 50% of pregnant women say they take at least one medicine.
Approximately 70% of women take at least one prescription medication during pregnancy.
Related: Migraine Treatments: Everything You Need to Know
Concerning Symptoms
Sometimes headaches can be linked to dangerous pregnancy complications such as preeclampsia. Notify your healthcare provider if you have the following symptoms:
New migraines or changes in the type of pain
High blood pressure
Unusual swelling
Dizziness
Vision changes
Persistent or severe headache
Worst headache of your life
Weakness or numbness
Fever
Stiff neck
Related: Headaches During Pregnancy
Migraines and Postpartum
About 30% to 40% of women report having a headache during the first week after delivering their baby. This includes those who had migraines before and those who did not. This may be from the sudden decrease in estrogen, postpartum depression, or the stress of adapting to the parenting role.
Postpartum Depression (PPD)
The risk of experiencing depression, anxiety, or other mental health concerns increases for those who have migraines. This is especially true for those who have migraines with aura (migraines with sensory disturbances). Migraines and depression affect the body similarly through hormones, serotonin, and dopamine imbalances.
Postpartum depression is depression that occurs within the first year after childbirth. PPD usually begins within the first month of delivery. Pregnant women can also have antepartum depression, which begins during pregnancy, or perinatal depression, which starts during pregnancy and continues after delivery.
Baby Blues vs. Postpartum Depression
Postpartum depression (PPD) differs from baby blues or the normal adjustments to life with a newborn. Baby blues are mild or shortly lived moodiness, crying, or sadness. Common postpartum depression symptoms include:
Feeling restless or agitated
Feelings of sadness or anxiety
Fatigue
Trouble caring for yourself or the baby
Sleep issues (getting too much sleep or trouble sleeping)
No appetite
Rapid changes in weight
Not bonding to your baby
Concentration issues
Feeling guilty or worthless
Thoughts of harming yourself or your baby
In 2023, the Food and Drug Administration (FDA) approved Zurzuvae (zuranolone) for the treatment of PPD. Zurzuvae is the first oral medication approved to treat PPD. If you experience PPD symptoms, talk with your healthcare provider right away. PPD is very treatable but can worsen without treatment. Seeking help early can help you feel better faster.
988 Suicide & Crisis Lifeline
If you have thoughts of suicide or harming your baby contact the 988 Suicide & Crisis Lifeline by dialing 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our National Helpline Database.
Related: What Is Postpartum Anxiety?
Impact on Recovery
Many new moms focus on the baby and forget to care for themselves. Dehydration, not eating well, and sleep deprivation can trigger migraines. If you have a migraine after delivery, the first step is seeking treatment and practicing self-care.
It can be helpful to work with your partner, family, and close friends to develop a childcare plan for when a migraine occurs.
Impact on Breastfeeding
One benefit of breastfeeding is that it can help those who have migraines. Studies show that migraine patterns fall back to prepregnancy patterns 100% of the time for those who bottle-feed compared to 43% for those who breastfeed. This is most likely because breastfeeding prevents estrogen levels from dropping so drastically after birth.
Medication Safety While Breastfeeding
While some medicines can be passed through breast milk and are not suitable for the baby, there are migraine treatments that are safe while breastfeeding.
While it’s best to speak with your healthcare provider about medication safety, the National Institutes of Health (NIH) provides a database called LactMed. It has information about medications and their possible effects on the baby. This database can give you more information while waiting to speak to a healthcare provider.
Summary
Migraines are often from fluctuating hormones, especially estrogen, which increases during pregnancy. Some women find pregnancy improves migraines, while others get them for the first time. Headaches often return when estrogen drops after delivering the baby. However, breastfeeding helps some women keep migraines at bay.
While there is no direct link between migraines and fertility (getting pregnant), stress caused by migraines can delay pregnancy. Also, infertility medications can cause migraines.
Some medications can be harmful to the baby, so non-pharmacological (no medicines) treatments are preferred. However, healthcare providers can help you find safe medications for pregnancy if needed. Medication options increase after the baby is born.
Migraines also increase the risk of postpartum depression, which happens within the first year of delivery.
A Word From Verywell
Bringing a baby into the world is often one of the most exciting times. But being pregnant when you experience migraines can be scary. Keep in mind that hormone shifts from pregnancy can bring relief, especially after the first trimester.
Talk with your healthcare provider if you are concerned about migraine medication while pregnant or breastfeeding. While it’s true that some medicines are not safe during this time, there are safe options for you and the baby.
Read the original article on Verywell Health.
