Pregnancy and Migraine 2024
Migraine is a genetic/familial condition present in 12% of the world population. Twenty-five percent of women and six % of men have migraine. Migraine carries with it significant medical problems in addition to the suffering of disabling migraine attacks which come with nausea, sensitivity to light and sound and the need to be down in bed.
When a woman with migraine is pregnant, there are additional special medical problems.
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This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, Migraine textbook author, Podcaster, YouTube video producer, and Blogger.
Related questions:
Problems that are comorbid with migraine. Migraine is associated with respiratory problems such as allergic rhinitis and asthma, cardiovascular problems, such as stroke, hypertension, angina, Raynaud’s disease and Raynaud’s phenomenon, congenital heart disease, mitral valve prolapse, patent foramen ovale, and atrial septal defect.
Migraine is associated with the endocrinological problem of hypothyroidism, and the dermatological problem of psoriasis. Migraine is associated with G.I. disorders such as helico-bacterial infection, irritable bowel syndrome, gastroparesis, hepatobiliary disorders, celiac disease, and alterations in gut microbiota.
Migraine is associated with the rheumatologic problem of fibromyalgia, the neurologic problems of epilepsy, tension type headache, and multiple sclerosis. It is associated with the psychiatric disorders of depression, generalized anxiety disorder, dysphoria, agoraphobia, chronic fatigue syndrome, obsessive-compulsive disorder, attention deficit disorder and attention deficit hyperactive disorder, bipolar disorder, and panic disorder.
All these disorders may be active during pregnancy which is a stressful event of a woman’s life.
The joys of motherhood
Articles relating special problems for women with migraine during pregnancy.
Migraine affects 28% of women in their pregnancy-capable years and then comes with systemic inflammation, endothelial dysfunction, and increased risk of pregnancy-associated thromboembolic events.
Eliza C. Miller MD, et al writing in the American Journal of Obstetrics and Gynecology in May 2022 on “Migraine and adverse pregnancy outcomes: the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be.”
The multi-center Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be (nuMoM2b) study enrolled 10,038 nulliparous US participants with singleton gestation in early pregnancy, following them prospectively through delivery.
The found that a history of migraine is associated with adverse pregnancy outcomes (APO) of placental origin, including hypertensive disorders of pregnancy (HDP) and preterm birth (PTB).
Annet M, et al wrote in Obstet Gynecol Survy, 2019 Dec;74(12):738-748 on “Associations Between Migraine and Adverse Pregnancy Outcomes: Systematic Review and Meta-analysis.”
Abstract
Importance: Migraine is a highly prevalent disorder associated with cardiovascular diseases. Cardiovascular diseases are also associated with preeclampsia (PE). The adverse pregnancy outcomes PE, preterm birth (PTB), low birth weight (LBW), small for gestational age (SGA) and placental abruption share aspects in their pathophysiology, which are also found in patients with migraine, such as inflammatory stress and hypercoagulability.
Objective: To determine the association of adverse pregnancy outcomes including PE, PTB, LBW, SGA, and placental abruption with a history of migraine through a systematic review and meta-analysis.
Evidence acquisition: MEDLINE (PubMed), the Cochrane Library, and EMBASE, were searched from inception to November 11, 2018. Cohort studies and case-control studies evaluating migraine history and pregnancy complications were eligible.
Results: Of 1388 screened references, fourteen studies were included in the systematic review. There were higher risks of PE (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.51-2.85; I2 = 76%) and LBW (OR, 1.18; 95% CI, 1.03-1.34; I2 = 9%) in women with migraine compared with women without migraine. We observed no significant association between history of migraine and PTB (OR, 1.23; 95% CI, 0.97-1.55; I2 = 61%) or SGA (OR, 1.06; 95% CI, 0.98-1.15; I2 = 0%).
Conclusions: A history of migraine is significantly associated with an increased risk of adverse pregnancy outcomes including PE and LBW. We hypothesize that shared pathophysiology due to underlying preclinical cardiovascular risk in women with migraine might play a role during pregnancy.
Relevance: Pregnant women with a history of migraine should be considered at higher risk of adverse pregnancy outcomes and should be informed, monitored, and treated preventively accordingly.
Chen HM, et al wrote in Cephalalgia. 2010 Apr;30(4):433-8. doi: 10.1111/j.1468-2982.2009.01935.x. Epub 2010 Feb 15 on “Increased risk of adverse pregnancy outcomes for women with migraines: a nationwide population-based study.”
Abstract
Using a 3-year nationwide population-based database, this study aims to examine the risk of adverse pregnancy outcomes in women with migraines, including low birthweight (LBW), preterm birth, infants born small for gestational age, Caesarean section (CS) and pre-eclampsia.
We identified a total of 4911 women with migraines who gave birth from 2001 to 2003, together with 24,555 matched women as a comparison cohort.
NEWS RELEASE 24-FEB-2022
Is migraine tied to complications in pregnancy?
AMERICAN ACADEMY OF NEUROLOGY
MINNEAPOLIS – Women with migraine may have a higher risk of pregnancy complications like preterm delivery, gestational high blood pressure and preeclampsia, according to a preliminary study released today, February 24, 2022, that will be presented at the American Academy of Neurology’s 74th Annual Meeting being held in person in Seattle, April 2 to 7, 2022 and virtually, April 24 to 26, 2022.
Researchers also found that women with migraine with aura may have a higher risk of preeclampsia than women with migraine without aura. Auras are sensations that come before the headache, often visual disturbances such as flashing lights. Preeclampsia involves high blood pressure with additional symptoms, such as protein in the urine, during pregnancy, which can threaten the life of the mother and baby.
Sick with pregnancy, sick with migraine
In summary
During pregnancy women with migraine have increased medical problems and risk factors. These include accelerated preterm delivery, gestational hypertension, preeclampsia, children with low birth weights, children who are small for gestational age, increased numbers of C-section births, and increased risk of thrombotic events.
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Although this site provides information about various medical conditions, the reader is directed to his own treating physician for medical treatment.
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All the best.
Britt Talley Daniel MD