Migraine late pregnancy

Pregnancy and Headaches: When Should I Worry?

Pregnancy is a beautiful thing to be celebrated, but few people fill you in on the not-so-great symptoms that may occur during the journey. Namely, heartburn, gas, constipation and, for some pregnant mamas, headaches.

While headaches can be just another normal symptom of pregnancy, should they ever be a cause for concern?

“Headaches are common in women both in and outside of pregnancy,” said Kelley Saunders, MD, an OBGYN with Banner – University Medicine Women’s Institute. “But whether they are normal or not should always be discussed with your doctor."

Here is some insight into what causes headaches during pregnancy, some remedies to treat them and why your doctor should be kept in the loop.

Is it a headache or something else?

It isn’t always easy to tell what kind of headache you’re having, but the most common types of headaches during pregnancy are tension-type headaches, migraines and cluster headaches.

Tension headaches are the most common kind of headache in pregnant women. It can feel like someone is trying to squish your head like a watermelon. If you carry your stress in your shoulders and neck, you may be more susceptible to this kind of headache.

Migraines are a particular type of headache that occur on one side of the head. For some women, migraine headaches can get worse the first few months and then improve in later stages of pregnancy. For others, they may experience no change, decrease or difference in their migraines.

Cluster headaches are less common but can occur during pregnancy. You’ll suddenly have severe pain around your eyes or temples usually about the same time every day.

The good news is that there are plenty of pregnancy-safe things you can do to prevent and relieve the most common pregnancy headaches.

Tips for relieving mild headaches

Get plenty of rest. Sleep is especially hard later in your pregnancy but is so important to physical and mental health. Find yourself a comfy prenatal pillow and snuggle away.
Drink plenty of water. Pregnant moms require more water than the average person. While you may want to avoid extra trips to the bathroom, adequate fluid intake is important for you and baby.
Eat regular, well-balanced meals. To prevent low blood sugar, eat small meals throughout the day. Avoid sugar, like soda and candy.
Get a prenatal massage. A full-body massage can release tension in the muscles of your neck, shoulders and back.
Use warm or cool compresses on head, neck and shoulders.
Avoid triggers. Keep a journal to help identify specific triggers so you can learn what to avoid. Some common headache triggers include strong odors and nitrites or nitrates.
Try exercise and relaxation techniques. There’s evidence that regular exercise can reduce stress and boost overall mood. Check with your doctor first before starting any new fitness routines.
Take acetaminophen to relieve symptoms (as approved by doctor).
Take caffeine in doses less than 200mg in a day (as approved by doctor).

If you have a history of migraines, however, your doctor may treat them differently during pregnancy. Discuss with your doctor what medications are safe to take during pregnancy.

Is my headache a cause for concern?

Sometimes. Headaches tend to be more common in the first and third trimesters, but they can occur in the second trimester as well. While there are common causes for headaches during pregnancy, it’s important to note that headaches during the second and third trimester can also be due to high blood pressure, called preeclampsia.

“Preeclampsia is a pregnancy-related condition that requires prompt evaluation and management with an obstetrician or maternal fetal medicine specialist,” Dr. Saunders said. “Elevated blood pressure prior to pregnancy puts a woman at increased risk for preeclampsia.”

When should I call my doctor?

Whether you experience headaches or not, it’s always important to discuss your pre-pregnancy history, obstetrical history and concerns with your doctor for an individualized assessment and management plan. However, if none of the above treatments resolve your mild headache or your headaches become more frequent and severe, talk to your doctor to determine the cause.

“This includes new headaches that present after 20 weeks, a sudden onset of severe headaches, headaches associated with a fever, mental health changes, elevated blood pressure and vision changes,” Dr. Saunders said. “It’s important to keep an open line of communication with your physician and let them know about any changes in your health so they can rule out anything serious."

Got questions? We can help!

If a headache is keeping you up at night and your doctor isn’t available, call the Banner Nurse Now line, a free health care service that offers advice 24-hours a day, seven days a week. Call 844-259-9494.

Check out other pregnancy articles on our Banner Health blog

Pregnancy is an exciting, but also a bit scary time (especially if this is your first baby). Here are some other reads to help guide you through the trimesters and welcoming baby:

5 Tips for Having a Happy, Healthy Pregnancy
Expect the Unexpected: How Your Body Changes During Pregnancy
What To Expect In The Second Trimester
Understanding Pulmonary Embolism Risk During Pregnancy

Women's Health Pregnancy

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Migraines & Headaches During Pregnancy: Causes and Treatment

Written by Rebecca Buffum Taylor

If you're pregnant, you're no doubt experiencing new aches and pains. If you're also one of the millions of pregnant women who experience migraines, you might be glad to know that pregnancy eases migraine headache symptoms for many women. But even if it doesn't work for you, the information in this article can help you cope.

Causes of Migraine Headaches

Exactly what causes migraine headaches isn't known. But migraines appear to involve changes in nerve pathways, neurochemicals, and blood flow in the brain.

Researchers believe that overly excited brain cells stimulate a release of chemicals. These chemicals irritate blood vessels on the brain's surface. That, in turn, causes blood vessels to swell and stimulate the pain response.

Estrogen is thought to play a role in migraines. That's why pregnancy, menstruation, and menopause often change a woman's pattern of migraine headaches.

The neurotransmitter serotonin also appears to have a key role in migraines.

Tracking Triggers With a Migraine Diary

Hormone changes during pregnancy are not the only thing that can trigger migraine headaches. Most women have a combination of triggers. For instance, stress, skipped meals, and lack of sleep may all trigger a migraine. And something that triggers a migraine one day may not bother you at all the next.

Some migraines last a few hours. Others, if left untreated, could last a couple of days. Migraines are quite unpredictable. So while pregnancy may make them worse for one woman, they might completely disappear for another.

A headache diary can let you track your particular triggers. This will help your doctor decide on what treatment will work best to relieve your specific symptoms. It may also help you recognize a pattern that tells you which triggers to avoid while you're pregnant.

Each time you have a headache, write down:

Your specific symptoms: where you feel the pain, what the pain feels like, and any other symptoms such as vomiting or sensitivity to noise, smells, or bright light
The time your headache started and ended
Food and beverages you had during the 24 hours before the migraine
Any change in your environment, such as traveling to a new place, a change in weather, or trying new kinds of food
Any treatment you tried, and whether it helped or made the headache worse

Common headache triggers include:

Chocolate
Caffeine
Foods that contain the preservatives MSG (monosodium glutamate) and nitrates
Aspartame, the sweetener in NutraSweet and Equal

Tests for Migraines

Headaches can be caused by a pregnancy complication called preeclampsia. So your doctor may evaluate you for that condition before making a diagnosis of migraine. Be sure to tell your doctor about all the medications you're taking, including over-the-counter products and natural supplements. Also let your doctor know whether anyone in your family has had migraines.

The doctor often can diagnose migraine from a headache diary and your medical history. CT scans and other radiology tests to rule out other causes of your headaches aren't usually advised in pregnancy. That's because of the potential risks to the fetus.

Self-Care of Migraines

Your first line of defense against migraine headaches is a healthy lifestyle and self-care. Here are some tips to help you manage migraines during pregnancy:

Avoid your known triggers, such as specific foods, as much as possible.
Keep a predictable schedule of meals and snacks.
Drink plenty of water.
Get plenty of rest.
Consider taking a class in biofeedback or other relaxation techniques.
When pain strikes, try ice packs, massage, and resting in a quiet, darkened room.

Medications for Migraines

If you're pregnant -- or planning to get pregnant soon -- your doctor will generally advise you to stay off medications unless they're absolutely needed. Together, you'll have to weigh the potential effects of a drug on your unborn baby. In some cases, a decision will need to be made based on scant or inconclusive research into a particular drug.

Many of the anti-migraine medications to treat or prevent migraine headache and its symptoms should be avoided during pregnancy. Some have been linked to birth defects in babies. Other medications are associated with pregnancy complications. For instance, some have been associated with bleeding, miscarriage, or intrauterine growth restriction (IUGR), a condition in which the uterus and fetus don't grow normally.

Acute Migraine Treatment

Acute treatment aims to stop a migraine attack after its first signs appear.

Pain relievers, also called analgesics, may help ease the intense pain of migraines. These general pain-relieving drugs, though, aren't specific to the migraine pain pathway:

Acetaminophen is generally considered low-risk during pregnancy.
Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, may carry a risk of bleeding and miscarriage if taken in early pregnancy. There is also a possible risk of heart complications in the baby if they are taken in the third trimester. Aspirin taken near delivery may lead to excess blood loss in mothers during birth.
Most NSAIDs, including ibuprofen -- sold over the counter under the brand names Advil and Motrin -- and naproxen -- sold as Aleve, Naprosyn and other brands -- don't have enough controlled human research studies to assess all their risks in pregnancy.
Narcotic pain relievers should generally be avoided. There is a dual risk of addiction in both mothers and babies if they are used for prolonged periods of time.

Ergotamines work specifically for migraine pain. But doctors advise against taking these drugs during pregnancy. They carry a risk of birth defects, especially if taken in the first trimester. These drugs may also stimulate labor contractions and premature birth.

Triptans work specifically on the migraine pain pathway. Triptans aren't known to cause birth defects. But most research to date has focused on animals, not humans. Your doctor can help you decide is it is safe for you and your unborn baby.

Other medications may be prescribed for relief of specific symptoms of a migraine during pregnancy. For instance, antiemetics help soothe the vomiting and nausea that can accompany a migraine. But many of the drugs typically used for migraine haven't been adequately studied in pregnancy, so their safety or risk to the fetus has not been determined.

Preventive Migraine Treatment

If you have severe, recurring attacks, preventive treatment may stop future attacks or reduce their severity. Many of the drugs used for prevention were originally used for other conditions, such as high blood pressure.

See a neurologist experienced with treating pregnant women. They'll prescribe a medicine in the lowest dose needed to help you and likely recommend some kind of talk therapy. Relatively safe medications for migraines include beta-blockers, such as metoprolol (Lopressor, Toprol XL) and propranolol (Inderal LA, Inderal XL, InnoPran XL)

When you're pregnant, always talk with your doctor before taking any drug, herbal product, or natural medicine.

If you can't take medications or wish not to, there are some devices which might be worth considering. Cefaly is a portable headband-like device that gives electrical impulses on the skin at the forehead. This stimulates a nerve associated with migraine headaches. Cefaly is used once a day for 20 minutes, and when it's on you'll feel a tingling or massaging sensation.

SpringTMS is a magnet placed on the back of the head at the first sign of a headache. It gives off a split-second magnetic pulse that stimulates part of the brain. It usually has no side effects. Also, gammaCore is a hand-held portable device which is a noninvasive vagus nerve stimulator (nVS). When placed over the vagus nerve in the neck, it releases a mild electrical stimulation to the nerve's fibers to relieve pain.

If you're seeing a headache specialist, double-check with your obstetrician or certified midwife about the safety of any medications or devices during pregnancy. While migraine pain may be excruciating, taking a risk with your baby's health could cause lifelong health problems for your child.

Migraine during pregnancy: description of the disease, causes, symptoms, cost of treatment in Moscow

Migraine during pregnancy is a fairly common phenomenon that should not be ignored and treated. There are many reasons for the appearance of the problem during this period. After childbirth, the disease usually disappears completely. In the next pregnancy, there is a risk of recurrence of the violation, but it will not necessarily appear again. Since the pain negatively affects not only the condition of the woman, but also the child, it is necessary to take drugs to eliminate the attack, but only those that are allowed for pregnant women. nine0003

Migraine in pregnant women occurs not infrequently, since, in addition to hormonal changes in the body, there are also changes in the psycho-emotional state, which often also act as a trigger for the development of pathology. Depending on the duration of pregnancy, a woman's well-being may improve or worsen. The peak of migraines in most cases occurs in the first trimester of pregnancy, when a woman's body undergoes especially rapid hormonal changes. In the later stages, headaches may begin to disturb due to changes in the spine that appear against the background of a shift in the center of gravity. nine0003

Causes

Migraine attacks during pregnancy are usually triggered by specific factors. Migraines during early pregnancy can be caused by the following reasons:

specific stresses for the body, which are associated with the process of implantation of the egg and the beginning of the development of the embryo;
a sharp change in hormonal levels;
dehydration due to changes in metabolic processes in the body and a woman's lack of attention to herself; nine0003
emergence of food intolerance against the background of early toxicosis.

Also, a number of women in the first trimester of pregnancy often experience migraine-provoking nervous strain due to constant concern about their condition, the development of the child and the upcoming birth.

In the second trimester, a woman has a significant improvement in her condition. The frequency of seizures is reduced, and because of the ability to use more drugs, they become less painful. The main provocateurs of the appearance of headaches in this period are the following factors: nine0003

physical overload - it occurs if a woman does not reduce physical activity, continuing to lead the same lifestyle as before pregnancy. As a result, an attack occurs as a protest of the body against what is happening;
strong emotional experience;
abrupt weather changes - they affect a woman if she suffered from meteorological dependence before pregnancy; nine0003
inhalation of very sweet heavy odours.

In the third trimester of pregnancy, the intensity of migraine increases. Due to the ongoing changes in the spine, blood circulation begins to deteriorate to a large extent, due to which even a slight vascular spasm is enough for a migraine attack. The main reasons that can cause it are:

drinking a large amount of liquid at once - in order not to provoke an attack, you need to drink often, but little by little, thereby not causing a sharp influx of water into the blood; nine0003
staying in an uncomfortable position, which significantly worsens blood circulation in the lower extremities;
prolonged stay in the supine position, which also worsens blood circulation;
eating spicy or spicy foods;
great excitement or prolonged nervous tension. nine0003

Migraines may persist for some time after childbirth due to hormonal changes in the body. However, this phenomenon is not always the case and is considered the exception rather than the rule for migraine during pregnancy.

Is an aura possible

Migraine with aura occurs in pregnant women with the same frequency as the classical one. In a quarter of cases, a few minutes before an attack or a maximum of an hour before it, a woman develops previous neurological disorders. If they do not appear strongly, then the patient has time to take medications, thereby relieving an attack, or to return home. When the symptoms of the aura are strong, they can cause no less torment than the pain attack itself. nine0003

You can talk about the presence of an aura in a woman if any of the following symptoms are present before a migraine attack:

visual disturbances - with them, loss of visual fields, temporary loss of vision in one or both eyes, flickering flies before the eyes or flashes of light;
severe weakness - it can spread to the whole body, but more often it is felt only in the limbs of the side from which the head will hurt in the future. The opposite side of the body suffers much less often; nine0003
tingling in the limbs and upper half of the body, even affecting the tongue and lips;
goosebumps;
complete loss or significant reduction in the sensation of limbs;
various speech disorders such as confusion or slurring.

Quite often, in pregnant women with migraine with aura, such a phenomenon is noted that if during this period the effect of the negative factor is eliminated, a further attack does not develop, even if medications are not taken. Because of this, in such a situation, a woman needs to fix as accurately as possible what caused the deterioration. nine0003

Is an attack dangerous for the fetus

Today, thanks to numerous studies, doctors have been able to find out whether a migraine attack affects the fetus. The unborn child is able to feel the emotions of the mother and her pain, which is why there is a negative change in his condition at the time of the attack. Also, against the background of pain, a spasm of the vessels supplying the placenta often occurs. As a result, the fetus begins to receive significantly less oxygen, which causes hypoxia in it, which, with frequent repetitions of migraine attacks, can cause mental development disorders against the background of brain damage. nine0003

Medicines prescribed for pregnant women must be taken during an attack without fail. They will not harm the child, as they do not penetrate the placental barrier and effectively relieve pain, eliminating its negative impact. It is unacceptable to prescribe such funds on your own, since mistakes can be too dangerous for the fetus. All drugs are correctly selected taking into account the duration of pregnancy only by a doctor.

Prophylaxis

Preventive measures against migraine during pregnancy greatly help to reduce the risk of this problem. Additionally, it will help improve well-being and a proper lifestyle. The main preventive measures during pregnancy include: nine0003

full sleep at least 9 hours a day;
taking light sedatives when nervous tension appears;
providing a comfortable temperature in the room;
drinking frequently and in small amounts;
eating food that does not cause a burning sensation in the mouth. nine0003

With frequent migraines, the doctor may also advise taking certain medications for prophylactic purposes, and these prescriptions must be strictly observed.

Migraine during pregnancy: what to do

Migraine is a benign disease, it does not affect the course of pregnancy and fetal development. However, migraine and pregnancy is a combination that requires a responsible attitude. Especially with frequent migraines (more than 2 times a week) and migraines with aura, since:

medicines approved for use, few,
and the approach to the treatment and prevention of migraine during this period is extremely individual: it depends on the frequency, severity and duration of headache, the degree of impact on life.

Our neurologist Darya Korobkova conducted a live broadcast on the clinic's Instagram account, where she told how migraine and pregnancy are connected, why attacks become more frequent or disappear, and answered subscribers' questions. The ether was saved, see “Air recording: migraine during pregnancy and GV. nine0003

We will tell about migraine during breastfeeding separately.

The statistics of clinical observations of migraine during pregnancy looks like this:

In 60-70% of pregnant women with migraine, headache attacks become less frequent, milder, or even completely disappear in the second and third trimesters. This is due to the stabilization of estrogen levels. By the beginning of the second trimester, it rises 6 times and its fluctuations stop.

In other women, migraine during pregnancy either remains unchanged or worsens. But as the duration of pregnancy increases, the proportion of such women gradually decreases:

If at the end of the first trimester the frequency and intensity of attacks persist, then it is most likely that migraine will disturb the woman during the entire period of pregnancy and after childbirth too.

How to manage migraines during pregnancy?

The main thing here is to learn how to control seizures and, if necessary, seek medical help.

Follow lifestyle advice:

get enough sleep; nine0003
drink plenty of fluids;
eat fractionally and without long breaks;
rest;
avoid stressful situations. This is one of the main provocateurs of migraine. Psychotherapy, relaxation and stress management are here to help you.

Keep a headache diary. This will help you take control of migraine triggers.
nine0014

Yes, these simple recommendations are sometimes enough to make attacks less frequent! Pregnancy is a special state of a woman. If in other periods of life we do not take such recommendations so seriously, then in this situation it is worth trying to change the philosophy of life and attitude towards ourselves =)

How to relieve an attack?

Favor non-drug methods. Sometimes, in order to relieve an attack, it is enough to eliminate an unfavorable factor:

dry biscuits, ginger, or applesauce may help with nausea;
for dehydration - diluted juice or other liquid;
sleep, walking or breathing exercises can also help to cope;

If the attacks are severe, interfere with your life, then under the supervision of a specialist, you can resort to drug therapy.

PARACETAMOL is considered the safest and can be taken throughout pregnancy. nine0003

All other drugs have nuances. For example:

ibuprofen can be taken in the second trimester, and in the first trimester it is better to limit, in the third trimester the drug is contraindicated for use;
aspirin is prohibited in the 3rd trimester and is undesirable for taking in the first two, as it can cause extremely undesirable consequences;
It is strictly forbidden to use ergotamine and opioid analgesics;

triptans are not officially approved for use during pregnancy as no controlled studies have been conducted.