Longitudinal Prospective Study of Headache During Pregnancy and Postpartum

Abstract

Chronic headache fluctuates in response to changes in hormonal levels. Headache generally improves with rising estrogen levels, and worsens with falling levels. Headache should, therefore, predictably improve with pregnancy and worsen postpartum. Several retrospective studies have confirmed this pattern. In this study, 49 pregnant women with chronic headache (18 with migraine, 16 with tension-type, and 15 with combined migraine and tension-type) were followed prospectively. Headache activity was recorded daily throughout pregnancy and for 3 months postpartum. Overall, there was a 30% improvement in headache between the second and third trimesters for the entire sample. This was not statistically significant. Headache improved significantly for 41% of the women, with a slightly greater tendency for headache to improve in women with migraine compared to those with tension-type or combined migraine and tension-type headaches. Headache activity was not influenced by history of menstrual migraine, history of headache change with prior pregnancies, parity, or breast-feeding. In general, women reporting headache at the end of their first trimester continued to report headache throughout pregnancy and postpartum.

Association Between Migraine and Diabetes in Pregnancy

“…Moreover, the frequency and duration of headaches can also change during pregnancy. Studies have shown that the frequency and duration of all headaches, including migraine, decrease during pregnancy (6,7). Contrary to the general belief, we found the opposite to be true in our study population.…”

Headaches During Pregnancy

“…Moreover, the migraine course was assessed only very roughly: all that was established at each antenatal check-up was whether or not there had been a headache since the last antenatal check-up. At variance with all the previous studies, Marcus et al [24], using a headache diary, prospectively monitored a highly-selected sample of 49 women with primary headache (women experiencing headache at least twice a month, recruited through advertisements placed in obstetricians' surgeries and local newspapers), only 18 of whom were pure Table 1 Take-home messages on the relationship of migraine with pregnancy • Migraine has been extensively studied in relationship with reproductive milestones (menarche, pregnancy and menopause) • Migraine without aura (MO) benefits from the hyperestrogenic state of pregnancy and the lack of hormonal fluctuations • A very strong improvement of MO has been documented across gestation, and only a minority of pregnant women still suffers during the third trimester • Less women with migraine with aura (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 • Recent evidences have linked migraine with hypertension and vascular complications during gestation • There is a higher risk of developing either gestational hypertension or preeclampsia in migrainous women compared to nonmigrainous women (adjusted OR 2.85; 95% CI, 1.40-5.81) • In those women not showing remission or amelioration during gestation, migraine is associated with an increased risk of developing hypertension and other vascular complications during pregnancy and later in life • The positive association between migraine and the onset of hypertension in pregnancy remained unchanged after adjusting for other well-known risk factors such as age, family history of hypertension, and smoking habits • 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 migraineurs, from the second trimester and found an improvement in only 41% of the women. The study also revealed a nonsignificant trend toward a greater improvement in migraineurs than in patients with tension-type headache.…”

“…Indeed, Marcus et al [24] found that the headache index during the first 3 postpartum months was similar for women who were breastfeeding to that obtained during the second trimester of pregnancy. No conclusive data are available on MA and lactation.…”

“…The correlation between migraine and pregnancy-related hypertension was hypothesized as early as 1959 [39], and since then, some studies have shown weak evidence of a positive association [12,23,24,36,[40][41][42][43]. However, these clinical observations were retrospective, and in most studies, the diagnosis of migraine was not done according to the IHS criteria for primary headaches and the criteria for the diagnosis of hypertensive disorders were not homogeneous.…”

Acute headache diagnosis in pregnant women

“…2 Migraine is the most common disabling primary headache disorder, and, in pregnancy, retrospective and prospective studies consistently demonstrate that by the second trimester, migraine frequency typically improves, although attacks of migraine with aura and aura without headache may not reflect this pattern. [3][4][5][6][7][8][9][10] Acute, severe headache in pregnancy is generally regarded as a "red flag" and a cause for further investigation, particularly when new onset. [11][12][13] Various secondary headache disorders are more likely to occur during this time period, 12 possibly related to hypercoagulability, hormonal factors, anesthesia for labor, and other mechanisms.…”