Treatment for headache during pregnancy
Headache and migraine remedies that are safe during pregnancy | Your Pregnancy Matters
Occasional, mild headaches during pregnancy usually are nothing to worry about.Most women deal with headaches at some point in their lives. Data from the Centers for Disease Control and Prevention suggest that one in five women had a severe acute headache or migraine in the previous three months. Additionally, migraines are more common in women than men – approximately 18 percent of women have them compared to 6.5 percent of men.
Because headaches and migraines are so common, it’s probably no surprise that many women deal with them during pregnancy. For the majority of pregnant women, occasional headaches or migraines are no cause for alarm, and most standard treatments are safe. However, suffering a severe headache at key times during or after pregnancy can indicate a serious medical emergency.
Common types of headaches and treatment options
Primary headaches
Primary or acute headaches arise once in a while and typically pass after a few hours. Tension headaches are the most common type and are characterized by muscle tightness and localized pain in the head and neck.
Primary headaches in pregnant women usually can be treated at home. Rest, a neck or scalp massage, hot or cold packs, and over-the-counter anti-inflammatory drugs such as Tylenol, aspirin, or ibuprofen can reduce the pain. However, if you start to have frequent or severe headaches, talk to your doctor to determine the cause.
Migraines
Migraines tend to be episodic (frequent and long-lasting) and typically cause additional neurological symptoms, such as:
● Blurred or tunnel vision
● Hallucinations
● Light sensitivity
● Nausea and vomiting
Studies have shown that migraines can be triggered by hormonal changes, including right before your period or as a result of taking oral contraceptives.
Interestingly, some women who have migraines find that the frequency or intensity of their symptoms decreases during pregnancy. Research does not suggest, however, that pregnancy triggers the onset of migraines – if you have your first migraine during pregnancy, it’s likely coincidental.
Treatment during pregnancy is fairly similar to standard treatment. Anti-inflammatory drugs are generally safe and effective during pregnancy when used in a limited manner. Midrin is a commonly prescribed headache medication that contains acetaminophen along with a mild sedative. Midrin also has vasoconstrictive properties, which means it narrows the blood vessels, thereby reducing blood flow and pain.
Sumatriptan, commonly known as Imitrex, is another medication that reduces blood flow to the brain. It works best to stop a migraine if it’s taken as soon as symptoms present. Most nausea medications prescribed to women with migraines are safe to use during pregnancy, but I suggest reviewing the medications you take for migraine relief with your obstetrician at your first prenatal visit, just to be safe.
Certain drugs called ergotamines have a stronger vasoconstrictive effect and can adversely affect fetal growth. They also can stimulate uterine activity. Because of this, they absolutely should not be used during pregnancy.
Severe migraines might require hospitalization so you can receive fluids, pain medication, or anti-nausea medication through an IV if you are unable to keep medications down.
"Most women don’t require special care for headaches and migraines during pregnancy, and most standard remedies are safe. However, certain types of headaches require immediate medical attention to avoid potentially harmful health issues."
– Robyn Horsager-Boehrer, M.D.
When headaches are secondary to other problems
Headaches can result from other conditions, some of which are life-threatening:
● Stroke: Sudden and severe headaches might be a sign of a stroke.
Women who have strokes during pregnancy or after delivery typically describe the pain as the worst headache of their lives. They also might report other symptoms, such as speech problems, vision issues, or functional problems on one side of the face or body. At the emergency room, the doctor will evaluate you for stroke symptoms, such as visual changes, facial drooping, and arm or leg weakness. If you are having or had a stroke, we will get you emergency treatment at our Advanced Comprehensive Stroke Center.
● Preeclampsia: A headache with preeclampsia (a pregnancy complication characterized by high blood pressure) can indicate a dangerous spike in blood pressure. The doctor will assess you and might admit you to the hospital for management of blood pressure and treatment to prevent seizures.
● Spinal fluid leak: A headache after an epidural or spinal block can indicate a spinal fluid leak, especially if it worsens when you sit or stand up. The most effective treatment is an epidural blood patch, in which the doctor injects a sample of your blood into the leaking area, essentially plugging the hole.
This therapy provides dramatic relief right away.
Occasional mild headaches are common in women. The vast majority are no cause for alarm and can be treated at home, with guidance from your doctor. However, if your symptoms are severe or something just doesn’t seem right, it’s much better to seek care and be safe rather than sorry.
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Treating Migraine During Pregnancy | American Headache Society
How to treat patients for migraine during pregnancy
It’s important for providers who treat women during their reproductive years to be aware of treatment options that are safe during pregnancy. Many women with migraine who are pregnant or considering pregnancy stop taking their migraine medications and assume they don’t have safe treatment options available—but this is simply not true.
Women typically start to experience migraine attacks during adolescence, which aligns with when menstruation begins.
The highest incidence of migraine is between ages 18 and 44, which are also the year many women experience pregnancy. The rate of migraine among women is three times higher than it is for men. Because of these figures, it is believed that fluctuations in estrogen levels play a role in migraine development.
Dr. Tracy Grossman, an obstetrician-gynecologist who has completed a fellowship in maternal-fetal medicine and earned a master’s in neuroscience, shares the range of treatment options available for pregnant patients with migraine.
Treatment Options During Pregnancy
Certain medications used for migraine treatment and prevention are contraindicated for pregnancy, due to safety concerns for the developing fetus. For patients who use oral contraceptives to regulate their hormone levels and manage migraine, having a conversation about migraine treatment options may happen when they want to go off of birth control and start trying to conceive. The good news is there are safe options for migraine prior to and during pregnancy.
“I’m always telling my patients, either preconception or patients that are pregnant, that we recommend in general to use the [fewest] number of different medications for anything that we’re treating,” Dr. Grossman says. “And also, of course, the lowest dose possible that we can use in pregnancy and preconception is what we recommend.” Her first-line treatment is non-medication options, and she then layers in other treatments as needed.
Non-medication options
- Hydration: Staying hydrated is important for all pregnant women, but especially for those with migraine. “Typically a lot of patients are dehydrated and don’t even realize it,” says Dr. Grossman.
- Caffeine: Many women decide to cut out caffeine completely when they become pregnant, but a low level of caffeine is considered safe and can help prevent migraine. Dr. Grossman suggests about a cup to a cup and a half of coffee per day, with a daily maximum of 200 milligrams of caffeine.
- Magnesium: Magnesium is a supplement commonly used for migraine prevention. With its low risk of side effects, it is safe to use during pregnancy.
Over-the-counter medications
Over-the-counter medications, like acetaminophen, are safe during pregnancy. In combination with non-medication options, it can be effective in preventing and managing migraine symptoms.
Non-steroidal anti-inflammatories are another option for relieving migraine. “These are things like naproxen, Toradol, ibuprofen, which we don’t recommend use in the first trimester or in the third trimester, but in the mid-second trimester are considered safe to use for a limited amount of time,” says Dr. Grossman. “I would have a patient be on one of these medications for about 48 hours, no more than that.”
Prescription medications
Many women with migraine take triptans prior to pregnancy, but then decide to discontinue the prescription medication when they become pregnant or their provider recommends that they stop taking it.
Despite older studies that cited concern for fetal growth restriction and increased blood loss at delivery, new research shows that it’s not necessary to stop using triptans while pregnant. “More recent studies have shown that sumatriptans or triptans are actually very safe in pregnancy and have not been associated with any congenital defects or pregnancy complications,” Dr. Grossman says.
Some anti-nausea medications, including prochlorperazine, metoclopramide and diphenhydramine can also relieve migraine symptoms. Though they’re typically not used for prolonged amounts of time, these medications are safe in pregnancy.
Procedures/Devices
Nerve blocks can give patients relief from migraine during pregnancy. These local injections of a substance like lidocaine or bupivacaine are injected into the scalp to target specific nerves. The location of the injection depends on the type and location of the patient’s migraine. “These are considered safe in pregnancy because it’s a local injection, the medication, not a systemic administration,” says Dr.
Grossman, who did a study on peripheral nerve blocks during her residency. The nerve blocks can be used repeatedly throughout pregnancy as a prevention or treatment measure.
Liquid lidocaine 4% can also be administered as a nasal spray. It is safe for patients to use as often as a couple of times a day. Patients may also benefit from a wearable neuromodulation device that emits a mild electrical current for migraine relief or prevention. You can learn more about device options and how to select the best one for your patient here.
Recommending one type or a combination of prevention and treatment options can help your migraine patients safely manage their symptoms throughout pregnancy.
Primary care practitioners are essential to identifying and treating headache disorders. The American Headache Society’s First Contact – Headache in Primary Care program provides educational resources to empower healthcare professionals and improve headache and migraine care.
Learn more about the program here.
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, because:
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medicines approved for use, few,
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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. nine0003
Our neurologist Daria 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.
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. nine0003
In other women, migraines during pregnancy either remain unchanged or worsen. 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 throughout the entire period of pregnancy and after childbirth too.
How to manage migraine during pregnancy?
The main thing here is to learn how to control seizures and, if necessary, seek medical help.
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Follow lifestyle advice:
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get enough sleep;
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drink enough fluids;
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eat fractionally and without long breaks;
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rest;
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avoid stressful situations. This is one of the main provocateurs of migraine. Psychotherapy, relaxation and stress management are here to help you.
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Keep a headache diary. This will help you take control of migraine triggers.
Yes, these simple recommendations are sometimes enough to make seizures 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?
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Favor non-drug methods.
Sometimes, in order to relieve an attack, it is enough to eliminate an unfavorable factor:
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dry biscuits, ginger, or applesauce may help with nausea;
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for dehydration - diluted juice or other liquid;
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sleep, walking or breathing exercises can also help to cope;
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If the attacks are severe, interfere with your life, then under the supervision of a specialist, you can resort to drug therapy. nine0003
PARACETAMOL is considered the safest and can be taken throughout pregnancy.
All other drugs have nuances. For example:
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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;
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aspirin is prohibited in the 3rd trimester and is undesirable for taking in the first two, as it can cause extremely undesirable consequences; nine0003
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It is strictly forbidden to use ergotamine and opioid analgesics;
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triptans are not officially approved for use during pregnancy as no controlled studies have been conducted.
However, clinical observations of women around the world who took them on their own showed no adverse effects on the fetus. We discussed this issue in more detail on the air.
!Other than paracetamol, we do not recommend the use of any drug without a doctor's prescription. nine0003
When to see a doctor:
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migraine occurred for the first time during pregnancy;
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if migraine attacks suddenly become more frequent and stronger;
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if the aura became longer or appeared for the first time;
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if the headache is rapidly increasing and has an unusual character;
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if the pressure rises during the headache.
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How do doctors diagnose headaches? If you are pregnant and suffer from migraines Anxiety headache nine0003
Which doctor should I contact and how to treat correctly?
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Of course, migraine or chronic tension headache is not a contraindication to pregnancy.
And almost every woman, regardless of the presence of any chronic diseases, wants to become a mother. However, in order to survive the most comfortable period of pregnancy in the presence of chronic migraine or headache, it is necessary to prepare for this period in advance. The better your preparation is, the easier it will be for pregnancy, childbirth and postpartum feeding of the baby. Women with migraines are advised to stop all medications at least two weeks before conception and prepare to avoid severe attacks. Ideally, this stage of preparation takes from 6 to 12 months. Clinic of headache and vegetative disorders. Veina in Moscow specializes in the treatment of migraines, headaches and other types of pain syndrome. For a long time of work under the supervision of our doctors, many pregnancies have come and gone successfully, even in difficult patients. Effective assistance was provided to expectant mothers with such diseases as:
- migraine,
- headache,
- panic attacks and anxiety during pregnancy,
- insomnia,
- attacks of vegetovascular dystonia during pregnancy,
- pain in the neck, back, lower back during pregnancy,
- diseases during pregnancy.
Pregnancy and breastfeeding has many restrictions in taking medicines. However, some schemes for taking drugs to relieve headaches and migraines during pregnancy still exist. It is better to clarify and select them in advance together with the attending physician, and also to develop a clear algorithm of actions in case of an impending attack. Enduring pain during pregnancy with migraine is still not recommended, with the exception of the first trimester and the last weeks of the third trimester. But most importantly, non-drug methods of relieving headaches come to the aid of pregnant women, such as:
- biofeedback therapy,
- manual therapy,
- massage,
- acupuncture,
- psychotherapy.
botulinum therapy - prevention of migraine and headache during pregnancy
The most interesting and promising method of treating headache during pregnancy and migraine is botulinum therapy. The essence of this method is prevention.
Before becoming pregnant, a woman is given injections of one of the botulinum toxin preparations (multiple injections during the year are possible). Such prophylactic treatment can significantly reduce the frequency and intensity of migraine attacks for up to six months. Thus, it is possible to minimize the frequency and severity of attacks in the most important first trimester. Then, when the laying of the organs and systems of the baby occurs, it is risky to take painkillers. To select the optimal timing and methods of treating your type of headache, it is best to contact a headache specialist a year, six months before the planned pregnancy. nine0003
Authorized medicines for migraine and headache
Still, migraine and headache often take pregnant women by surprise. What painkillers are still allowed for pregnant women? During the entire period of pregnancy, you can take paracetamol at a dose of 325-500 mg up to 4 times a day. Caffeine is also allowed. So, you can drink migraine, panadol extra or solpadein fast.
Of course, these painkillers are not very strong. And at the usual time, taking them to relieve a migraine attack is not recommended. But during pregnancy, they can be drunk absolutely fearlessly. It is effective to take aspirin, naproxen and ibuprofen during pregnancy for migraine. But they can be drunk without fear only during the first and second trimesters. When planning a pregnancy, they are undesirable. And in the third trimester it is generally prohibited. nine0003
DRUGS FOR MIGRAINES AND HEADACHES IN PREGNANCY
There are drugs that are strictly prohibited during pregnancy. These are painkillers with phenobarbital, codeine, old tranquilizers like phenazepam and ergotamines.
Headache and migraine treatment during pregnancy
Dear expectant mothers! If you suffer from migraines, chronic headaches or other types of pain syndrome, experience a feeling of constant anxiety, panic attacks, we invite you to spend your pregnancy under the supervision of our specialists! Our doctors have harmless, but effective methods of treatment.
