Headaches During Pregnancy

Abstract

Among primary headaches, migraine is the form more sensitive to the ovarian hormonal milieu. Migraine without aura (MO) benefits from the hyperestrogenic state of pregnancy and the lack of hormonal fluctuations, while migraine with aura (MA) presents distinctive features. Indeed, a very strong improvement of MO has been documented across gestation, and only a minority of pregnant women still suffers during the third trimester. On the other hand, fewer women with MA report improvement or remission, and new onset of aura may be observed during pregnancy. After delivery, breastfeeding exerts a protective action on migraine recurrence. The persistence of migraine during gestation seems to affect neonatal outcomes, and several studies indicate a link between migraine and an increased risk of developing gestational hypertension/preeclampsia and other vascular complications.

Sex Hormone, Pituitary, Parathyroid, and Adrenal Disorders and the Nervous System

“…In some women, breastfeeding appears to protect against migraine recurrence. 4 Occasionally, migraine arises for the first time or appears to worsen during gestation 5 or the perimenopausal period. 6 A first approach to the management of gestational migraine should be nonpharmacologic (e.g., relaxation training, biofeedback), especially during the first trimester when risks of teratogenicity and embryotoxicity are greatest.…”

Neuroendocrine aspects of migraine in women

“…Migraine improves or disappears, in most women, during pregnancy [39,40]. Improvement usually starts from the first trimester, while women with headaches persisting into the second trimester are less likely to improve thereafter.…”

“…The majority of data available are retrospective and the percentage of improvement during pregnancy varies broadly from 43% to 86% [40]. A recent prospective study demonstrated a very favorable effect with an improvement of MO (46.8%, first trimester; 83.0%, second; 87.2%, third), with complete remission at term in 78.7% of the women.…”

“…Even neonatal outcomes may be affected by the persistence of migraine during gestation. Until further evidences will become available, migraine should be considered a potential risk factor in obstetric care [40].…”

Pharmacological treatment of migraine during pregnancy and breastfeeding

“…4,5 Spontaneous remission is less common in patients with migraine with aura or migraine unrelated to the menstrual cycle. 6 Of women with any type of migraine, 4-8% get worse during pregnancy, 7 and in a few individuals, migraine appears for the first time during gestation, usually in the first trimester. 8 In more than half of women who experience improvement during pregnancy, migraine will return to the level that preceded pregnancy within a month after delivery.…”