Managing migraine throughout pregnancy can be a challenge, but there are options that can help limit attacks.

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Everyone says it’s difficult, but nothing quite prepares you for the challenges that come when managing migraine while pregnant.

Not only are you dealing with wild hormonal changes, but there’s also not a lot you can do when you need relief from attacks.

This past year I went through in vitro fertilization (IVF) treatments, which ended in a successful embryo transfer. Thrilled with our viable pregnancy, I had no idea that my first trimester would bring an increase in my vestibular migraine attacks.

Not only was I having to supplement estrogen and progesterone to sustain the pregnancy, but I was also dealing with horrible “morning” sickness — that actually lasted all day. It was especially bad in the evening hours, when I couldn’t keep anything down until about 18 weeks.

When managing migraine, we know that sleep quality, hydration, and diet can be essential elements toward lowering the frequency of attacks. But what happens when you’re trying to manage an increase in attacks and only given the option of Tylenol?

Here are some options for managing challenges you may face during pregnancy:

The Food and Drug Administration (FDA) has a registry of pregnancy medications that may have an exposure risk to the fetus.

Many expecting moms with migraine have been given the advice to wean off a daily preventive medication, as most are in higher risk categories and haven’t been approved for use during pregnancy.

However, in some cases, your OB-GYN can work with your neurologist and determine if your quality of life would suffer enough that continued use of a migraine preventive medication would be worth the risk. This is obviously a highly personal discussion.

Luckily, certain beta-blockers, which are often the first line of therapy if a medication is needed, are approved for use during pregnancy.

Talk with your providers about all medications you use, which risk category they fall into, and the risks of continuing and discontinuing use during pregnancy.

While you may not be able to take certain medications during pregnancy, there are some supplements that can help.

One supplement that may be useful for migraine prevention and has benefits throughout pregnancy is magnesium.

Not only is deficiency in this mineral common in people with migraine, but it may also increase the risk of chronic hypertension and premature labor.

Research suggests that magnesium supplements may reduce some risk for additional complications, like fetal growth restriction.

If a migraine attack gets really bad, or fluids are low, a magnesium IV treatment might be suggested. This was particularly helpful for me when I was incredibly sick my first trimester.

Vitamin D supplementation has also been associated with preventing migraine and promoting a healthy pregnancy.

Vitamin D deficiency has been linked to preeclampsia and gestational diabetes, as well to people who experience frequent migraine attacks.

According to the American Migraine Foundation, loss of sleep as well as oversleeping can be a trigger for migraine attacks.

Maintaining a regular sleep schedule with the amount of hours that work best for you can help combat these attacks.

However, people with migraine are more prone to sleep disorders like insomnia. Combine that with the discomfort of a growing belly, frequent nighttime trips to the bathroom, and overwhelming exhaustion that can lead to more daily naps, and your regular sleep schedule might be more difficult to maintain.

A few things that helped me maintain my sleep schedule as best I could were evening rituals and avoiding naps as much as possible.

If I couldn’t help it, I would try to nap earlier in the day.

As for a ritual, ending the evening with a calming meditation, reading a book with green light therapy, and applying magnesium lotion to sore legs and feet would help me relax and have a more restful sleep.

Try to drink more fluids earlier in the day, tapering off in the evening to avoid frequent nighttime bathroom trips.

Adequate hydration is a key factor in managing migraine, but if you have extreme morning sickness, it can be difficult to manage.

This proved to be my biggest challenge, as I noticed my vestibular migraine attacks peaked on days I was most sick in my first and second trimesters.

With hydration, if you get behind, it can be really difficult to keep up.

Replacing electrolytes is also important. Often, this can be managed at home by drinking more water, using low-sugar electrolyte powders or drinks, and sipping broth or light soups.

Small, more frequent sips can help you to keep down liquids, as drinking too quickly can cause some dehydrated people to vomit.

If you’re not making progress, IV hydration therapy can be used. This typically includes a normal saline solution, sometimes mixed with magnesium. Typically, your OB-GYN and neurologist can help facilitate this.

A migraine elimination diet was essential for discovering my food triggers and gaining control over my attacks.

However, pregnancy cravings can derail even the most committed person. This sometimes leads us to order MSG-filled food items that we know aren’t best for our heads.

Nearly all advice seems to suggest that eating ginger will help nausea, but I found it to be almost too spicy for me to handle, or I would get tired of eating it all the time.

Focusing on quick soups that I could make in my Instant Pot — like butternut squash soup or chicken and rice — were the best thing for me to stock in the freezer. Crackers with limited ingredients, and anything sour (green grapes, Granny Smith apples, fresh fruit popsicles) seemed to help a lot.

Staying away from trigger foods as best as I could, along with other conservative treatments, seemed to help manage bad attacks.

At the end of the day, managing migraine through pregnancy can be a challenge, but working with your neurologist and OB-GYN can help you come up with some creative options that can help limit attacks.

If migraine attacks or headaches are new, persistent, or severe, reach out to your doctor to figure out what the cause may be.

Alicia Wolf is the owner of The Dizzy Cook, a diet and lifestyle website for anyone with migraine, and an ambassador for the Vestibular Disorder Association. After struggling with chronic vestibular migraine, she realized there weren’t many upbeat resources for people following a migraine diet, so she created Her new cookbook “The Dizzy Cook: Managing Migraine with More Than 90 Comforting Recipes and Lifestyle Tips” is available almost everywhere books are sold. You can find her on Instagram, Facebook, and Twitter.