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Why pregnancy headaches need special attention

Dr. Joseph Rotella is the founder of Scottsdale Medical Center, a comprehensive family practice and chiropractic office handling adolescents through adults. The practice, run by Dr. Joseph Rotella, MD, DC is particularly well-versed with...

Headaches & pregnancy

Headaches are a common complaint among pregnant women, and any woman who is suffering from them, whether they began before or during pregnancy, requires special attention, as there are different concerns for the mother and the growing fetus. Both primary headaches, such as migraine and tension-type headaches, and other secondary headaches that mimic them are often reported among pregnant women.

Getting pregnant may prevent migraines – but not always

Woman with Headache

If you suffer from migraines and are planning to get pregnant anytime soon, there's good news. Recent studies have shown that most migraine sufferers experience a significant improvement – fewer migraines – after becoming pregnant.

The reason? It may be related to the fact that during pregnancy, rising or sustained estrogen levels may prevent or lessen migraines, especially in women who normally experience them around their menstrual cycles. However, before you rush off to purchase a basal thermometer and ovulation kit, it is important to note that a small percentage of women in these studies actually reported a worsening of their headaches.

Falling estrogen levels are a common precursor to migraines. This is especially true shortly after delivery, and is called a postpartum migraine. Another cause of headache after delivery what is referred to as a post epidural puncture headache (PPH). This should not be confused with the former headache. Note that PPH occurs much more frequently when there is personal or family history of migraines.

Pregnant with Migraines- What can you do?

1See your healthcare provider to treat your migraines

Reducing the frequency and intensity of migraine symptoms should be at the front of any treatment. Migraines are associated with a headache, nausea and vomiting that can disrupt or delay daily activities as well as heighten negative emotions concerning pregnancy.

Furthermore, a prolonged duration of these symptoms can cause harm to the fetus, and sometimes the side effects of medical treatments may outweigh the risks of harm from symptoms. While pregnant, it is important to remember that conservative care always comes first.

2Prioritize proper nutrition

Chronic migraineurs have been shown to be deficient in certain vitamins such as magnesium, vitamin D and others. Proper nutrition is key, and if a sufferer is deficient in any or all of these vitamins, supplementation may drastically improve symptoms.

3Understand the risks of pharmaceutical treatments

As with all medications and/or supplements during pregnancy there are safety FDA risk categories ranging from controlled human studies that (A) show no risk, (B) show no evidence of risk in humans without controlled human studies, (C) risk to humans has not been ruled out, (D) show positive evidence of risk to humans, and lastly, (E) contraindicated medications. Again, it is extremely important to work closely with your physician to determine the safest course of treatment for yourself and your fetus if you find you need medication.

Magnesium, although not FDA approved, is considered category B and clinical evidence has shown it to be effective in reducing the frequency of migraines.

An FDA-approved treatment that is category B is a beta adrenergic block (labetolol) and while it has been shown to reduce the frequency of migraines, it has also been shown to cause intrauterine growth retardation.

Another technique used to prevent migraines is an occipital nerve block. Using only Lidocaine and withholding the steroid which is usually used, the injection resets the nerve which can be triggering recurrent migraines.

4What migraine treatments are safe for pregnancy?

Nausea and vomiting can be problematic with and without migraines. Treatment options range from the conservative to more aggressive, ranging from over-the-counter remedies to IV fluids and medication depending on the severity of symptoms.

Safe treatments include ginger caps and vitamin B6. There are others that require prescriptions such as Metoclopramide (Reglan), which have been shown to be gastric stimulating and have anti-headache properties as well. If severe nausea and vomiting occur, contact your physician.

Acute treatment of a migraine is difficult in pregnancy as most medications (for example, triptans), are not recommended and category C. Tylenol is category B and is the most commonly prescribed; however, one must be aware of overuse as it can lead to rebound headaches in migraineurs.

Caffeine, which is listed as category B, is another acute intervention, and again watch for overuse and it may precipitate rebound headaches. An alternative treatment option is ginger, which is reported to be safe in pregnancy,and its
medicinal uses include migraine headaches and morning sickness.

5Consider complementary or alternative treatments

In addition to pharmaceutical treatments, biofeedback therapy, stretching, massage therapy, trigger point therapy, chiropractic manipulation, and of course avoiding all triggers may have an effect in reducing migraines.

There always exists a possibility to have concomitant headaches, meaning that tension-type headaches may act as a trigger for a migraine. But, the goal is to reduce all potential triggers and reduce the frequency of migraines.

6Lifestyle changes that can reduce migraines

Headache hygiene is an important lifestyle modification that can help. As the famous German writer, Johann Wolfgang Von Goethe said, "Out of moderation a pure happiness springs".

Up next: Examples of lifestyle changes that can drastically reduce migraine frequency >>

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