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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, migraines 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 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

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Dizziness during pregnancy - a dangerous symptom or the norm, why dizziness in early pregnancy

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Dizziness during pregnancy - a dangerous symptom or a norm

Dizziness (vertigo) is the second most common neurological symptom after headache. It affects up to 5% of the world's population. During pregnancy, any deviations that affect the physical and emotional state of the expectant mother are undesirable. It is difficult for women in the position and without feeling the precariousness of space or the appearance of symptoms of near loss of consciousness. Therefore, dizziness during pregnancy is monitored and blocked as soon as possible. In this case, it is important to remember that vertigo is not a disease, but a symptom provoked by a physical condition, body structure, or exacerbated pathologies. The way to deal with dizziness also depends on the provocateur of the disorder.

Symptoms of the disorder - how vertigo manifests itself in pregnant women

Women "in position" complain of the following signs of an attack of vertigo:

• Pulsation of blood in the temporal region is the first symptom that precedes an attack.
• Ringing in the ears - it is superimposed on the pulsation in the temporal region and indicates an increase in symptoms. At this stage, you should be alert and find a quiet place where you can wait until your head stops spinning.
• Loss of focus - this sign indicates the onset of dizziness, and most women complain of background darkening and white or black "midges" floating before their eyes.
• Feeling of weakness, profuse sweating, nausea, numbness of the fingers and toes - these signs of oxygen deficiency in the blood do not leave the pregnant woman until the end of the attack.

Non-pregnant women who experience spontaneous dizziness also complain of similar symptoms. Pregnant women feel dizzy much more often, and literally from the first trimester. And not all women experience this disorder painlessly. In some patients, dizziness comes to vomiting and loss of consciousness. After all, the severity of the attack is determined by the cause of the problem.

What can make you dizzy

According to WHO, dizziness and loss of stability in women are due to the following reasons:

• A sudden change in the position of the head or body - your vestibular apparatus does not have time to orient in space, which exacerbates neurological symptoms. For the same reason, the patient may have a headache or neck pain.
• Oxygen starvation of the brain - stale air in the room, a large number of people in the neighborhood, closeness, all this ends in fainting even without a history of pregnancy.
• Decreased blood pressure - against the background of hypotension, oxygen starvation of the brain develops, provoking dizziness and fainting. In this case, the head will hurt in the forehead and temples.
• Hyperventilation of the lungs - an excess of oxygen and a fall below the norm of carbon dioxide leads to metabolic disorders, vertigo and fainting.
• Anemia and glucose deficiency - a drop in hemoglobin levels during pregnancy is observed in most patients, and iron deficiency reduces the oxygen content in the blood. Against this background, the head begins to hurt, and fainting occurs.

Vertigo is one of the symptoms indicating viral diseases, brain tumors and anomalies, diseases of the cardiovascular system, osteochondrosis, vegetative dystonia. And this condition can also be provoked by a sharp change in weather due to a jump in atmospheric pressure. Therefore, pregnant women and their relatives should not panic when stability is lost.

Most serious illnesses are detected during pregnancy monitoring. Therefore, in a healthy woman, depending on the trimester, the most likely cause of vertigo is increased blood supply to the uterus, fetal pressure on internal organs, and other “profile” problems.

Vertigo in the first trimester — causes and consequences

In the first weeks of pregnancy, all systems of the future mother's body are restructured. A woman's hormonal background changes, immunity is suppressed, blood supply to the uterus increases. The pregnant woman will feel sick from toxicosis throughout the first trimester, in addition, in the early stages she will face severe attacks of vertigo. Moreover, during the starting toxicosis, the head is spinning especially strongly.

In addition to hormonal changes, the causes of vertigo in the early stages include the patient's careless behavior. After confirming the status of a future mother, women continue to live without taking into account the peculiarities of their condition. But nature prioritizes from the first days of gestation. Systems and internal organs are still designed to serve one person. Therefore, even with slight overwork or frequent lack of sleep, the vestibular apparatus breaks down literally on the go. The body is filled with heaviness, the sense of balance disappears in an unknown direction (you will be rocked, stagger and feel sick in any transport), severe shortness of breath appears.

How to deal with vertigo in the early stages? In this case, you need to reconsider your regimen. Give up night shifts, hard physical work. And be sure to sign up for a consultation - obstetricians will explain to you again why a woman in position should go to bed no later than 23:00 and sleep at least 9-10 hours a day.

Dizziness during the second trimester - a danger or a norm?

The hormonal storm will shake the body during the entire first trimester, but by the beginning of the second third, the restructuring of the immune system will be over. The fetus will finish forming organs, the blood flow will be adjusted to the needs of two people, and the expectant mother will find a long-awaited peace. At this time, vertigo does not bother patients very much. But no doctor can rule out this problem. After all, a woman's body reacts to external stimuli in a slowdown mode, and a growing uterus absorbs up to 60% of blood flow.

As a result, provocateurs of dizziness in the second trimester are:

• Prolonged immobility, followed by a sharp attempt to stand up or sit down - after such a shake, the head is spinning especially strongly.
• Oxygen starvation provoked by anemia, stuffiness or heart problems - under the weight of these problems, the patient begins to stagger even in a sitting position.
• Hypotension provoked by the weather or health condition - in this case, not only vertigo is observed, but also fainting.

At this time, vertigo is rare, so with frequent dizziness, a pregnant woman should see a doctor. He must figure out why you are dizzy in order to eliminate the causes and consequences of the disorder. The latter are extremely unpleasant, up to the threat of miscarriage and fetal arrest due to oxygen starvation.

Why can I feel dizzy in the third trimester?

In the later stages, vertigo is a normal, almost natural phenomenon. In the third trimester, a woman feels weak and dizzy for an obvious reason - the uterus, ready for childbirth, consumes most of the blood flow, provoking oxygen starvation of the brain. Because of this, the patient has a strong attack of vertigo, but without nausea and fainting. If you begin to feel sick during this period, contact your doctor immediately.

In addition, by the third trimester, the uterus grows so much that it begins to press down on the vena cava, slowing down the intensity of blood flow. Therefore, in the later stages, one can observe a relatively strong, but completely safe attack of dizziness, which disturbs a woman even in a supine position.

The main danger of the last trimester is severe nausea, and with mild vertigo you will have to live until the very birth. However, the true cause of a strong or weak attack of vertigo can only be established through laboratory and hardware diagnostics.

How to identify the causes of dizziness in a pregnant woman

Early and late vertigo is an almost natural condition of the expectant mother. And some women in labor complained of seizures from the first to the last week. But this does not mean that nothing needs to be done with patients experiencing frequent attacks of vertigo - in this case, at least monitoring of the health of the woman and the fetus is necessary.

If the seizures appear too often or disturb the pregnant woman constantly, especially in the second trimester, the obstetrician will write a referral to a neuropathologist and psychoneurologist. These doctors must decide what to do with such a patient. After all, constantly disturbing attacks of vertigo indicate the onset of serious problems with the cardiovascular, immune and neurological systems.

To confirm or refute the fears of neuropathologists and psychoneurologists, the patient is sent for hardware and laboratory diagnostics. In these circumstances, it is customary to do an MRI, radiography of the cervical vertebrae, a urine test and blood biochemistry. Based on the results of these tests, a conclusion is prepared on the condition of the pregnant woman and symptomatic or deep therapy for vertigo is prescribed.

Treatment of dizziness in pregnancy

The treatment of serious pathologies, the symptoms of which are weakness and dizziness, requires considerable effort and expense. The treatment regimen for neurological, cardiovascular and oncological diseases is prescribed by specialized doctors. Fortunately, every year among pregnant women there is a very insignificant percentage of such patients.

Most women suffer from vertigo due to natural causes - due to changes in the uterine blood supply and hormonal storm. Only childbirth can cure these problems. During gestation, doctors can relieve the symptoms of vertigo by prescribing the following drugs to the patient suffering from dizziness:

• sedative drugs - they will relieve stress;
• antiemetics - they make life easier during the first trimester;
• erythrocyte stimulants - this drug enhances blood oxygen saturation;
• vitamin B12 and folic acid - they increase hemoglobin;
• caffeine - it increases blood pressure.

Dosage and dosage regimen can only be prescribed by the attending physician. This is usually done by obstetricians-gynecologists, who observe pregnant women from the first weeks to childbirth.

Prevention of vertigo

To prevent or reduce the frequency of vertigo attacks, you must first review your routine, highlighting at least 9-10 hours for daily sleep. Secondly, allocate at least 1-2 hours for walks in the fresh air. Thirdly, you will have to master a couple of exercises that allow you to maintain the health of the spine and neck. Fourth, pregnant women should avoid stress and eat right. Eat up to six times a day, in small portions. Fifthly, the expectant mother needs to regularly visit her gynecologist and share all her health problems with him. The doctor will suggest a strategy of behavior and prescribe the necessary medications.

a particular example of the course of the disease uMEDp

Migraine is one of the most common forms of headache. There is evidence for the role of magnesium deficiency in the pathogenesis of migraine. The disease most often occurs in women of reproductive age. The frequency of migraine attacks during pregnancy tends to decrease. However, in cases where migraine attacks persist during pregnancy, difficulties arise in the selection of a drug. Magnesium preparations (Magnerot) are effective and safe drugs and can be recommended for prophylactic treatment of migraine in pregnant women.

Migraine is the second most common form of primary headache after tension headache. Epidemiological studies have confirmed the high prevalence of migraine and its socio-economic significance, negative impact on the quality of life and performance [1].

Periodically recurring migraine headache attacks are pulsating, often unilateral in nature, accompanied by nausea, vomiting, photo and sound phobia. After an attack, drowsiness and lethargy are observed. Migraine is a chronic, heterogeneous disease. There are more than 15 subtypes of migraine, but in practice migraine with aura and without aura is usually distinguished [1]. The frequency, duration, and intensity of seizures vary greatly among patients. Each patient has their own specific precipitating factors. Young women suffer from migraine three times more often than men. A change in the hormonal status associated with menarche, pregnancy, lactation or menopause is accompanied by a change in the clinical course of the disease in them. Women note a clear relationship between headache attacks and the onset of menstruation [2]. During pregnancy, approximately 70% of women with migraine, mostly without aura, improve, the frequency of headache attacks decreases as the gestational age increases. However, in migraine with aura, the frequency and intensity of attacks persist throughout pregnancy [3]. In this case, it is necessary to exclude the secondary nature of migraine, in particular, an increase or decrease in blood pressure (BP), the development of venous vascular dyscirculation, intracranial hypertension, preeclampsia / eclampsia. It is also necessary to conduct a differential diagnosis of primary headaches according to international diagnostic criteria, to determine the subtype of migraine [1].

The tactics of treating migraine in pregnant women in most cases does not differ from the traditional one and includes two directions - relief of a headache attack and preventive therapy for frequent (more than 2-3 per month) attacks. For mild or moderately intense migraine attacks, the drugs of choice are simple analgesics (paracetamol, ibuprofen), as well as their combination with caffeine. Given that during migraine attacks, many patients have pronounced atony of the stomach or intestines, which makes it difficult for the absorption of oral drugs, antiemetics (metoclopramide or domperidone) are added to therapy. For more severe migraine attacks, specific triptan preparations are used that effectively eliminate headaches. The most studied is sumatriptan, which can be used in pregnant women.

The use of small doses of beta-blockers, tricyclic antidepressants, non-steroidal anti-inflammatory drugs, and magnesium preparations is recommended as a preventive therapy for migraine in pregnant women [4]. Most drugs for the treatment of migraine are allowed to be used during pregnancy, however, before prescribing a particular drug, it is necessary to take into account factors such as the form of migraine, its intensity, gestational age, fetal condition, concomitant extragenital diseases, the benefit-risk ratio of the intended therapy.

On the example of a clinical case, let us consider the features of the course of migraine in a pregnant woman and the tactics of its management in case of a change in the nature of cephalalgia.

Patient management

Patient V., 36 years old. She was under the supervision of an obstetrician-gynecologist in the antenatal clinic from 10 weeks of pregnancy. Married. Works as a nurse.

Second birth, third pregnancy. The first birth at the age of 24, during pregnancy was observed due to the threat of termination, blood pressure during pregnancy did not increase. Term delivery, newborn boy, weight 3050 g,

height 51 cm.

From the age of 18, the patient has been suffering from attacks of unilateral throbbing headache lasting up to 24 hours with nausea and photophobia. The frequency of migraine attacks before pregnancy is 1-2 times a month. The patient was seen by a neurologist for headache. Diagnosis of migraine without aura. The secondary nature of the headache was excluded. The headache was stopped by simple analgesics or passed after rest, sleep.

History of aggravated heredity - arterial hypertension (AH) in the father, migraine in the mother.

Smoker, has not smoked for the last 10 years.

A year before the expected pregnancy, she underwent a clinical, laboratory and instrumental examination at the place of residence, including an electrocardiographic study, 24-hour blood pressure monitoring (ABPM), electroencephalography, and ultrasound duplex scanning of the vessels of the main parts of the head. AH, vascular disease of the head were not detected, there was no pathology of the kidneys.

First examination: 12 weeks pregnant

Objectively: the condition is satisfactory. Height 158 ​​cm, weight 70.3 kg (weight before pregnancy 67 kg, body mass index 26.8 kg / m², overweight). BP 110/60 mm Hg. Art. Heart rate (HR) 88 beats / min. No changes were found according to clinical blood and urine tests. Biochemical blood test: total cholesterol 3.8 mmol/l, glucose

3.86 mmol/l, uric acid 172 µmol/l. Coagulogram without deviations from the reference values.

Urinalysis: specific gravity 1012, protein negative, leukocytes 8–10 per field of view.

Electrocardiogram (ECG) - sinus rhythm, heart rate 80 bpm, vertical position of the electrical axis of the heart.

ABPM: daily average BP 110/65 mm Hg. Art., standard deviation from the mean value of blood pressure (standard deviation - STD)

14/9 mm Hg. Art.; day - BP 116/66 mm Hg. Art., STD 10/9 mm Hg. Art.; night - 94/53 mm Hg. Art., STD 10/8 mm Hg. Art.; SI (daily BP index) 18/9%, VI (time index) 0/0%. Conclusion: normal average daily BP levels are recorded, the circadian rhythm of BP for diastolic BP is disturbed - non-dipper, BP variability is within the normal range.

Echocardiography (EchoCG): morphofunctional parameters within the normal range: interventricular septal thickness (IVSD) - 0.83 cm, thickness of the posterior wall of the left ventricle (PVSLV) - 0.83 cm, end diastolic size (EDD) of the left ventricle - 4, 4 cm, end systolic size (SSR) of the left ventricle - 2.23 cm, ejection fraction (EF) - 65%, myocardial mass index (IMM) of the left ventricle - 74. 7 g / m³, total peripheral vascular resistance (OPVR) -

1212 dyn x s x cm-5.

Due to a history of headaches, the patient was referred for a consultation with a neurologist. No focal symptoms were found in the neurological status. Diagnosis: migraine without aura. Due to rare migraine attacks, prophylactic therapy is not indicated. Relief of seizures with paracetamol in combination with caffeine.

The patient is referred to the high-risk group: age, complicated obstetric anamnesis, heredity burdened by hypertension, overweight, circadian rhythm disturbances in diastolic blood pressure.

Re-examination: pregnancy 20 weeks

No active complaints at the time of examination. He notes an increase in the frequency of headaches up to 2-3 times a week. The characteristic of cephalgia is the same.

Objectively: satisfactory condition, weight 73.1 kg, blood pressure 118/68 mm Hg. Art., heart rate 76 beats / min.

No abnormalities were found in general blood and urine tests. Biochemical blood test: total cholesterol 5.7 mmol/l, glucose 4.0 mmol/l, uric acid 256 µmol/l. The coagulogram corresponds to the reference values.

ECG - sinus rhythm, heart rate 80 beats/min, vertical position of the electrical axis of the heart.

Echocardiography: TMZhP 0.8 cm, TLSLV 0.8 cm, EDR 4.8 cm, EFR 2.2 cm, EF 67%, IMM 79.1 g/m³, TPVR 1714 dyn × s × cm-5.

ABPM: daily average BP 111.7/66.5 mm Hg. Art., STD 15 / 9.6 mm Hg. Art.; day - BP 114.3 / 68.3 mm Hg. Art., STD 10.9 / 9.6 mm Hg. Art.; night - 103/62.1 mm Hg. Art., STD 11.3 / 9.1 mm Hg. Art.; SI 9.7/9.1%, CI 5/2%.

Conclusion: normal 24-hour BP levels are recorded, disturbed circadian BP rhythm with a decrease in day/night pressure drop of less than 10% - non-dipper, systolic 24-hour BP variability is increased. In comparison with the data of the previous study, there is an increase in the level of nocturnal blood pressure by 9/9 mmHg Art.

In neurological status without negative dynamics.

Despite the patient's satisfactory condition, the normal level of blood pressure, the absence of any laboratory markers of a complicated course of pregnancy, the trend towards an increase in TPVR and a change in the daily profile of blood pressure according to the non-dipper type, an increase in the frequency of cephalalgia are of concern.

It is recommended to continue monitoring, re-examination every 14 days with an assessment of weight gain, measurement of blood pressure, urinalysis. Magnesium preparations are recommended for a long time. Over the next 6 weeks, the patient took Magnerot 500 mg 3 times a day, noted an improvement in well-being. During the first 2 weeks of therapy, one mild attack of headache was noted, in the future, headache attacks did not bother.

Pregnancy 32 weeks: hospitalization

At 32 weeks, during the next visit, the patient complained of a bilateral headache of a pressure-pulsating nature of the frontotemporal localization. The pain is most pronounced in the morning, decreases somewhat with the vertical position of the body, sleep is disturbed. Objectively: the condition is satisfactory, weight is 79.1 kg, blood pressure is 150/90 mm Hg. Art., heart rate 72 beats / min.

In the general analysis of urine: specific gravity 1014, traces of protein, leukocytes up to 10–12 per field of view. Complete blood count (30 weeks): hemoglobin 109g/l, hematocrit 34.1%, the number of erythrocytes, platelets are normal, there are no deviations in the leukocyte blood count, ESR 32 mm/h. Biochemical blood test: total cholesterol 7.2 mmol/l, glucose 3.8 mmol/l , uric acid 286 µmol/l.

ECG - sinus rhythm, heart rate 76 beats/min, ventricular extrasystole was registered.

Ultrasound of the fetus: dimensions correspond to a period of 30 weeks, no signs of violation of the uteroplacental and fetoplacental blood flow were detected, the threat of termination of pregnancy.

Examination by a neurologist revealed no focal symptoms. Headache is most likely due to the manifestation of hypertensive syndrome.

Diagnosis: 32 weeks pregnant. Gestational arterial hypertension. Preeclampsia (PE)? The threat of abortion. Anemia.

Immediate hospitalization to the maternity hospital is recommended to clarify the diagnosis and conduct intensive drug treatment. Later, the patient developed PE: an increase in blood pressure up to 150/9 was recorded.0 mmHg Art., was determined protein in the urine more than 0.3 g / day. Therapy was carried out with antihypertensive drugs - Dopegyt 1500 mg / day, as well as magnesium therapy. At 34 weeks, the patient had a premature birth, the newborn was a boy, weight 2600 g, height 49 cm with an Apgar score of 7.8 points at the 1st and 5th minutes, respectively.

Summary: the development of PE in a pregnant woman with a burdened somatic and neurological history, an increased risk of vascular complications was preceded by structural and functional changes in the cardiovascular system from the beginning of pregnancy; the use of magnesium preparations (Magnerot) improved the patient's condition at the 20-26th week of pregnancy due to a decrease in headache attacks; monitoring of blood pressure levels, its circadian rhythm and laboratory data contributed to the timely detection of gestational complications, timely hospitalization and adequate complex antihypertensive and magnesium therapy.

Cephalgic syndrome in women during pregnancy is noted quite often, accompanies hypertensive disorders, vegetative-vascular dystonia syndrome, depression and is considered the leading manifestation of migraine. Frequent and intense headaches reduce performance, significantly worsen the quality of life. Difficulties in differential diagnosis dictate the need to find effective and safe methods of preventive therapy for headache in pregnant women. In our patient, a migraine headache that preceded pregnancy recurred during pregnancy, which was the basis for prophylactic treatment. Certain difficulties were caused by the choice of the drug. We preferred magnesium preparations.

Migraine is a magnesium deficiency disease

Clinical and experimental data allow us to consider migraine as a magnesium deficiency disease [5]. Patients suffering from migraine, compared with healthy people, often have lower concentrations of magnesium in serum and blood cells, saliva and cerebrospinal fluid [6]. Magnesium is the second intracellular cation after potassium; it is involved as a cofactor in more than 300 metabolic reactions in the body, including protein synthesis, intracellular energy metabolism, DNA and RNA reproduction, and stabilization of mitochondrial membranes. Magnesium plays an important role in nerve impulse transmission, cardiac excitability, neuromuscular conduction, muscle contraction, vasomotor tone, and the regulation of glucose and insulin metabolism. Low levels of magnesium in the body are associated with the development of hypertension, type 2 diabetes, Alzheimer's disease, and migraines. It is suggested that one of the mechanisms for the development of migraine headache may be a violation of the intracellular interaction of magnesium and calcium. Altered activity of ion channels plays the role of a trigger in the development of spreading cortical depression [7].

Magnesium deficiency contributes to platelet hyperaggregation, negatively affects the function of serotonin receptors, the synthesis and release of various neurotransmitters, which causes the development of vascular spasm [8]. Magnesium is involved in modulating the level of nitric oxide in the cell [9], a decrease in which is noted in migraine, especially in women with migraine pain, potentially mediated by sex hormones [10].

Magnesium deficiency in migraine sufferers may be due to genetic causes of malabsorption or increased excretion [11].

Mitochondrial Theory of Migraine: Drugs

Recent studies have shown that several subtypes of migraine are associated with mitochondrial damage to neurons and astrocytes due to intracellular calcium accumulation, free radicals, and a deficiency in oxidative phosphorylation. Markers of these disorders are low superoxide dismutase activity, activation of cytochrome oxidase and nitric oxide, high levels of lactate and pyruvate, and a low ratio of phosphocreatine-inorganic phosphates and N-acetylaspartate-choline in patients with migraine. Mitochondrial dysfunctions are genetically determined; mitochondrial DNA polymorphisms have been described in migraine with vomiting in pediatric practice [12]. The therapeutic evidence of the mitochondrial theory of migraine can be recognized as the effectiveness of a number of drugs with a positive effect on mitochondrial metabolism. These drugs include primarily magnesium preparations, as well as riboflavin, coenzyme Q10, carnitine, topiramate, lipoic acid, niacin.

Empiric magnesium therapy seems reasonable in all patients with migraine, as half of them are magnesium deficient, and routine determination of magnesium levels in the blood does not reflect its real status. At the same time, magnesium preparations are available, safe and inexpensive [11]. The effectiveness of magnesium therapy in patients with migraine has been proven in a number of clinical studies [13].

For patients with episodic migraine (headache ≤ 14 days per month), recommendations for preventive therapy have been developed based on an analysis of the results of randomized trials and Cochrane reviews. Magnesium preparations along with some other drugs (topiramate, propranolol, nadolol, metoprolol, amitriptyline, gabapentin, candesartan, butterbur, riboflavin, coenzyme Q10) were found to be effective and recommended for migraine prevention [14].

Magnerot during pregnancy

During pregnancy, the administration of magnesium preparations allows achieving a satisfactory effect without fear of embryotoxic and teratogenic effects, unlike many drugs traditionally used to treat headache [15].

For our patient, we recommended taking Magnerot in medium therapeutic doses for a long time (at least 8 weeks). Correction of magnesium deficiency during pregnancy is necessary, since magnesium deficiency is associated with a wide range of complications of pregnancy and childbirth. As is known, a decrease in the content of magnesium leads to an increase in the tone of the myometrium and underlies preterm labor [16, 17]. A low level of intracellular magnesium contributes to the development of AH in pregnant women [18, 19]. Magnesium deficiency during pregnancy can lead to intrauterine growth retardation (IUGR) [20] and poor offspring survival [21]. At the same time, experimental data on the study of IUGR treatment methods in pregnant rats demonstrate the possibility of therapy with a magnesium-enriched diet, which reduced induced fetal growth retardation by 64%, and also reduced the level of pro-inflammatory cytokines in the amniotic fluid and placenta [22].

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