Pregnancy migraines: how to cope and when to call your doctor

The mind-numbing pain, the nausea and the sensitivity to light and sound that come along with migraines can make you miserable. But when you’re pregnant, it can amp up the normal aches and pains you’re already dealing with.

Although pregnancy migraines are usually nothing to worry about, they could be an early warning sign of pregnancy complications that could put you and your baby at risk.

Here’s what you need to know about migraines, how to find relief and when you should call your doctor.

Pregnancy migraines are common, but the causes are unclear

Approximately four out of 10 women will experience migraines throughout their lives and most will have them before age 35, right around the same time many women get pregnant, a study in the journal Cephalalgia found.

“Women who had migraines before they were pregnant should anticipate a change in their migraines when they are pregnant,” said Dr. Kelly Kasper, a board-certified OB-GYN at Indiana University Health in Indianapolis.

Migraines can happen more frequently, increase in intensity or be accompanied with new symptoms that you didn’t have before getting pregnant.

For example, you might have a migraine with aura, neurological changes like visual disturbances and flashes of light or nausea and vomiting. These changes are likely triggered by higher levels of estrogen, said Dr. Matthew S. Robbins, chief of neurology at the Jack D. Weiler Hospital of Montefiore Health System and director of inpatient services for the Montefiore Headache Center in New York City.

Yet estrogen also seems to help some women who notice that their migraines disappear when they’re pregnant. This is likely due to the fact that estrogen surges during pregnancy and there’s no dip in the hormone that often triggers migraines before menstruation.

Surprisingly, some women can also have migraines even if they never had them before. For them, the migraines will usually start in the first trimester and subside as their pregnancies progress. Although it’s not clear why this happens, it could simply be that they’re common in women of childbearing age, Robbins said.

Migraines may also be triggered by things like sleep deprivation and stress, which most pregnant women deal with at some point during pregnancy.

When migraines are serious

Although migraines seem like just a pain, new research found that pregnancy migraines can be associated with serious pregnancy complications.

One study published in the journal Neurology found  that women who had high blood pressure and experienced a severe headache were 17 times more likely to experience pregnancy complications, like preeclampsia.

Preeclampsia, which affects between 5 and 8 percent of pregnancies, can lead to preterm birth and delivering a small baby. It’s also the leading cause of maternal and infant illness and death worldwide.

The study found that those who had no history of headaches also had a five-fold increased likelihood of complications.

Another study presented in April at the American Academy of Neurology's annual meeting found that women with severe migraines were more likely to have pregnancy complications including preeclampsia, preterm delivery and low birthweight babies. The study also found that women 35 and older were seven times more likely to have these complications.

Robbins, who is also an associate professor of clinical neurology at Albert Einstein College of Medicine in New York City and authored both studies, said although it’s unclear why women are at an increased risk for complications, there are several plausible reasons.

One is that migraines are associated with other cardiovascular conditions like high blood pressure and psychiatric diseases such as anxiety and depression.

“It could be that this population is just a sicker group of patients because they have active migraines,” he said.

In women over 35, the combination of age and migraines may accelerate the complications but it’s not clear why.

Migraines are also associated with something called endothelial dysfunction, or dysfunction of the blood vessels. Since preeclampsia has the same related underlying dysfunction it might magnify the risk, he said.

When to call your doctor

Call your doctor if you never experienced migraines or severe headaches in the past, if your migraines last longer than 24 hours or if they are associated with nausea and vomiting.

“Preeclampsia can develop very rapidly. We have patients who will develop it within the 24-hour time period,” Kasper said.

You should also talk to your doctor if your migraines are accompanied with aura and you have never experienced that before, or if you have numbness or tingling in your face or arms.

In addition to headaches, vision changes, and nausea and vomiting, the signs of preeclampsia can also include pain in the upper right part of your abdomen and an increase in swelling.

How to cope

There are several things you can do help manage migraines and prevent an attack from happening.

Have a plan before you get pregnant.

If migraines are currently a problem, have a plan in place before you get pregnant. Think about your triggers and what you can do manage them. Also, if you’re considering medication for severe attacks, talk to your doctor about what types of medications are safe to take during pregnancy.

Take a break.

Retreating to a dark, quite room to rest or take a catnap can help reduce your pain and other symptoms. Placing a cold washcloth over your eyes can also help.

Eat right and drink up.

Skipping meals and dehydration can trigger a migraine. Make sure you’re eating three healthy meals a day, have snacks on hand so you’re prepared when hunger strikes and drink plenty of water.

Avoid food triggers.

Coffee, tea and chocolate can all be triggers for a migraine. Yet deciding to cut out the caffeine that your body is used to when you find out your pregnant can also bring on a migraine.

“If you’re somebody that has a cup of coffee every single morning to start your day, it’s OK to still have that cup of coffee,” Kasper said.

Consider medication.

If resting isn’t an option because of work, caring for other children and other responsibilities, try acetaminophen, which is safe and effective during pregnancy, Kasper said.

Your doctor can prescribe medications for the pain and the nausea that are safe during pregnancy but they carry side effects. Ask your doctor about other therapies such as IV treatments or a nerve block with a local anesthetic.

Make sleep a priority.

Waking up in the middle of the night coupled with normal pregnancy fatigue can trigger a migraine. Although it can be challenging, try to keep a consistent sleep schedule or ask a family member to help with other children or errands so you can sleep later or rest during the day.

Manage stress.

Although pregnancy is a happy time in your life, it can also be rife with worry about things like labor and delivery, raising a baby and money.

Nevertheless, you should find ways to cope with stress to ward off migraines. Take a prenatal yoga class, plan a babymoon with your partner or simply make time each day for something that relaxes you. Going for a walk, taking a bath or reading a good novel can all do wonders for your stress.