We’re gonna give it to you straight: Pregnancy can mess with your head. And we’re not just talking about brain fog and forgetfulness. We’re also talking about headaches — migraine attacks, in particular.
Migraine is a type of headache that can cause intense throbbing, usually on one side of the head. Imagine having a 3-year-old living behind your eye socket and relentlessly pounding a drum. Each beat sends waves of agony through your skull. The pain can make natural childbirth seem like a walk in the park.
Well, almost. Maybe we shouldn’t go that far — but migraine attacks can be very painful.
In fact, about 15 to 20 percent of pregnant women experience migraine. Women who have migraine attacks with “aura” — a neurological event that accompanies or proceeds migraine and can manifest as flashing lights, wavy lines, vision loss, and tingling or numbness — generally don’t see their headaches improve during pregnancy, according to experts.
So what’s a mom-to-be to do when a migraine attack strikes? What’s safe to take and what’s not? Is migraine ever dangerous enough that you should seek emergency medical care?
Most headaches during pregnancy — including migraine — are nothing to worry about. But that’s not to say that migraine attacks aren’t incredibly annoying, and, in some cases, dangerous for pregnant women and their babies.
Here’s everything you need to know about migraine during pregnancy so you can tackle the pain — head on.
Migraine headaches seem to have a genetic component, which means they tend to run in families. That said, there’s usually a triggering event that unleashes them. One of the most common triggers — at least for women — is fluctuating hormone levels, particularly the rise and fall of estrogen.
Moms-to-be who get migraine attacks tend to experience them most often in the first trimester of pregnancy, when hormone levels, including estrogen, haven’t yet stabilized. (In fact, headaches in general are an early pregnancy sign for a lot of women.)
An increase in blood volume, which is also common in the first trimester, can be an additional factor. As blood vessels in the brain expand to accommodate extra blood flow, they can press against sensitive nerve endings, causing pain.
Other common migraine triggers, whether you’re pregnant or not, include:
- Not getting enough sleep. The American Academy of Family Physicians recommends 8–10 hours per night when you’re pregnant. Sorry, Jimmy Fallon — we’ll catch you on the flip side.
- Not staying hydrated. According to the American Migraine Foundation, one-third of those who get migraine headaches say dehydration is a trigger. Pregnant women should aim for 10 cups (or 2.4 liters) of fluid daily. Try to drink them earlier in the day so sleep isn’t interrupted by nighttime visits to the bathroom.
- Certain foods. These include chocolate, aged cheeses, wines (not that you should be drinking any of those), and foods containing monosodium glutamate (MSG).
- Exposure to bright, intense light. Light-related triggers include sunlight and florescent lighting.
- Exposure to strong smells. Examples include paints, perfumes, and your toddler’s explosive diaper.
- Weather changes.
A migraine attack while you’re pregnant will look a lot like a migraine attack when you’re not pregnant. You’re apt to experience:
- throbbing head pain; usually it’s one-sided — behind one eye, for example — but it can occur all over
- sensitivity to light, smells, sounds, and movement
When you’re pregnant, you have to think twice about everything you put into your body. Is it OK to have that second cup of coffee? What about a nibble of Brie? When you’re hit with the mother of all headaches — migraine — you want real relief quickly. But what are your options?
These should be your first line of defense to avoid and treat migraine:
- Know your triggers. Stay hydrated, get your sleep, eat at regular intervals, and steer clear of any foods you know bring on a migraine attack.
- Hot/cold compresses. Figure out what eases migraine pain for you. A cold pack (wrapped in a towel) placed over your head can numb the pain; a heating pad around your neck can ease tension in tight muscles.
- Stay in the dark. If you have the luxury, retreat to a dark, quiet room when a migraine attack hits. Light and noise can make your headache worse.
If you’re like a lot of pregnant women, you may loathe the idea of taking medication. Nevertheless, migraine attacks can be intense, and sometimes the only thing that’ll snuff out the pain is medication.
Safe to take
According to the American Academy of Family Physicians (AAFP), drugs safe to use for migraine in pregnancy are:
- Acetaminophen. This is the generic name of the drug in Tylenol. It’s also sold under many other brand names.
- Metoclopramide. This drug is often used to increase the speed of stomach emptying but also sometimes prescribed for migraine, especially when nausea is a side effect.
Possibly safe to take under certain circumstances
- Non-steroidal anti-inflammatory drugs (NSAIDS). These include ibuprofen (Advil) and naproxen (Aleve) and are only OK in the second trimester of pregnancy. Earlier than that there’s an increased chance of miscarriage; later than that there can be complications like bleeding.
- Triptans. These include Imitrex and Amerge. While their use during pregnancy is somewhat controversial — there’s not a lot of well-performed research proving their safety — many doctors think the benefits of their use outweigh any risks.
- Full-dose aspirin. If you’re to kick it old school and pop some aspirin, don’t. Its use during pregnancy has been linked to many problems, including miscarriage and bleeding in you and your baby. Ask your doctor before taking combination drugs like Excedrin Migraine.
- Opioids. According to the
Centers for Disease Control and Prevention (CDC), opioid use during pregnancy can lead to preterm birth, stillbirth, and certain birth defects. If an opioid is prescribed, it should be for limited use and carefully monitored by your doctor.
According to a 2019 study, pregnant women with migraine attacks have an increased risk of certain complications, including:
- having high blood pressure while pregnant, which may progress to preeclampsia
- delivering a low birth weight baby
- having a cesarean delivery
That’s the bad news — and it’s important to keep it in perspective. The fact of the matter is, most women with migraine headaches will sail through their pregnancies just fine. You can head off (pun intended) very serious problems when you know what to watch out for. Get immediate medical attention if:
- you have a first-time headache during pregnancy
- you have a severe headache
- you have high blood pressure and a headache
- you have a headache that won’t go away
- you have a headache accompanied by changes in your vision, such as blurry vision or sensitivity to light
Thanks to a more constant supply of hormones, most women get a break from migraine attacks during pregnancy. For an unlucky few, though, their migraine struggles continue. If you’re one of them, you’ll be more limited in what you can take and when you can take it, but treatment options are available.
Make a migraine management plan with your doctor early on in your pregnancy (and ideally, before), so you have tools at the ready.