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Effects of Migraines During Pregnancy

Researchers investigate whether migraines during pregnancy are associated with health concerns in mothers and their children.

Migraines are more than a simple headache. Although migraines appear similar to headaches symptomatically with mild to serve head pain. They can last anywhere from 4 to 72 hours and are actually classified as a neurological disorder that involves diverse parts of the brain. Numerous stimuli can trigger an attack ranging from stress to noise and even certain scents. Perhaps one of the most common triggers, in women at least, is low concentrations of estrogen. This is why menstruation, oral contraceptives, pregnancy, and menopause can all affect the intensity and regularity of migraines.

Migraines during pregnancy

Estrogen levels are much higher (100-fold higher) during pregnancy. They progressively increase from the first trimester all the way through to the third. This is the reason for 80-90% of women report an improvement in their headache symptoms during pregnancy. The migraines can return within the first few days to a month after birth because of the severe drop in estrogen levels. There are, however, those unlucky few (4-8%) who get worse migraines during pregnancy. Migraines are one of the most common neurological complaints reported during pregnancy and there has been evidence to suggest that they can have a serious impact on a mother’s health.

Migraines affect the health of the mother and infant

In a recent Danish study published in Headache, researchers wanted to know if having migraines during pregnancy would be associated with negative health outcomes in both mother and child. The scientists used the Danish population registries to gather medical information on pregnant women. They compared 22,841 women who experienced migraines during pregnancy with 228,324 women who didn’t have migraines.

The study showed that women who had migraines had higher rates of hypertension, depression, and asthma before conception. They then went on to show that there was an association between migraines and an increased risk of preeclampsia/eclampsia (high blood pressure), and miscarriage. The scientists also found an association between migraines and a higher risk of infants being delivered by cesarean section. The infants whose mothers had migraines were also more likely to be preterm and underweight. They also had a greater chance of needing neonatal ICU admission and hospitalization.

There was also an increased risk of febrile seizures (seizures due to high fever), epilepsy, and respiratory distress syndrome in these infants. The researchers found no difference between the risk of adverse events in women who were treated for migraines compared to women who had migraines but were not treated. This suggests that the migraine itself is responsible for the higher risk of health complications rather than migraine medications.

The results from this study highlight the negative impact migraines can have on the health of both mother and child. It is, however, important to recognize that this was an observational study. This means that some confounding biases were not taken into account. Socioeconomic status and severity of the migraine are examples. Importantly, many women manage their migraines with over-the-counter medications which could impact the data presented. The migraines reported could result from secondary causes such as meningitis, caffeine withdrawal headache, pituitary diseases, and cerebral venous thrombosis. This was not accounted for in the study. It is also interesting to note there were more first-time pregnancies in the migraine group, which may also contribute to a higher risk of adverse events.

An added assessment to health check-ups

It appears that migraines during pregnancy may negatively impact the health of both mother and child. As a result, it may be prudent for doctors to keep this in mind during regular check-ups with their patients. Although migraines can become milder during pregnancy,  the healthcare service should be particularly aware of pregnant women with migraine.

References

  1. Goadsby PJ, Lipton RB, Ferrari MD. Migraine–current understanding and treatment. N Engl J Med. 2002;346(4):257-270. doi:10.1056/NEJMra010917

2. Burstein R, Noseda R, Borsook D. Migraine: multiple processes, complex pathophysiology. J Neurosci. 2015;35(17):6619-6629. doi:10.1523/JNEUROSCI.0373-15.2015

3. Todd C, Lagman-Bartolome AM, Lay C. Women and Migraine: the role of hormones. Curr Neurol Neurosci Rep. 2018;18(7):42. Published 2018 May 31. doi:10.1007/s11910-018-0845-3

4. Faubion SS, Batur P, Calhoun AH. Migraine throughout the female reproductive life cycle. Mayo Clinic Proceedings. 2018;93(5):639-645. doi:10.1016/j.mayocp.2017.11.027

5. Amundsen S, Nordeng H, Nezvalová-Henriksen K, Stovner LJ, Spigset O. Pharmacological treatment of migraine during pregnancy and breastfeeding. Nat Rev Neurol. 2015;11(4):209-219. doi:10.1038/nrneurol.2015.29

6. Jarvis S, Dassan P, Piercy CN. Managing migraine in pregnancy. BMJ. Published online 2018. doi:10.1136/bmj.k80

7. Wells RE, Turner DP, Lee M, Bishop L, Strauss L. Managing migraine during pregnancy and lactation. Curr Neurol Neurosci Rep. 2016;16(4):40. doi:10.1007/s11910-016-0634-9

8. Allais G, Chiarle G, Sinigaglia S, Airola G, Schiapparelli P, Benedetto C. Estrogen, migraine, and vascular risk. Neurol Sci. 2018;39(Suppl 1):11-20. doi:10.1007/s10072-018-3333-2

9. Skajaa N, Szépligeti SK, Xue F, et al. Pregnancy, birth, neonatal, and postnatal neurological outcomes after pregnancy with migraine. Headache. 2019;59(6):869-879. doi:10.1111/head.13536

Tarryn Bourhill MSc PhD Candidate
Tarryn Bourhill MSc PhD Candidate
Tarryn has a Master’s degree in Molecular Medicine from the University of the Witwatersrand, South Africa. She is currently pursuing a PhD in Molecular Biology and Biochemistry at the University of Calgary. Tarryn specializes in cancer, oncolytic viral therapy and stem cell research. She is passionate about scientific communication and enjoys turning complicated ideas into approachable and engaging conversations. In her spare time, Tarryn is a keen baker and a photography enthusiast.
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