Pregnancy and Migraine: What to Expect, Safe Treatments, & More
If you are newly-expecting and suffer from migraine, it’s only natural to wonder what to expect and which migraine treatments you can turn to without risk to you or your baby. In this article, we’ll answer your migraine pregnancy questions and share some of the safest ways to approach migraine treatment in pregnancy.
Will pregnancy make my migraine worse?
Actually, in most cases, it’s the opposite. Pregnancy has a positive effect on migraine for 55 to 90% of women who are pregnant, regardless of whether they experience migraine with aura, migraine without aura, or menstrual migraine. Doctors have suggested that the reduction in migraine frequency and intensity is a result of the high and stable estrogen levels during pregnancy.
That’s not to say that migraine goes away for all pregnant women. Some women who experience migraine with aura may also experience a new onset aura in the second or third trimester. In rare cases, migraine will actually appear for the first time during pregnancy.
A Timeline of Migraine During Pregnancy
Generally speaking, the further you are into your pregnancy, the more likely it is that you will see an improvement in your migraine. Most women find their migraine to be the most active in the first trimester and that symptoms will often return postpartum.
Despite the fact that you’re most likely to experience any migraine symptoms in the first trimester, there’s also a good chance you’ll see positive changes. A 2003 study tracking migraine activity through pregnancy reports that 46.8% of participants saw migraine improvement in the first trimester.
It’s worth noting that non-migraine headaches are common in the first trimester, including sinus headaches due to a runny or stuffy nose, or dehydration headaches caused by morning sickness.
The second trimester is when pregnant migraineurs — 83% according to the aforementioned study — usually begin to see notable migraine improvement. If you experience headaches into your second trimester, it’s important to let your healthcare provider know. Headaches during this period are sometimes caused by high blood pressure, which can pose potential danger for both you and your baby.
The largest number of migraineurs (87.2%) report improvement in the third trimester. Headaches in these final few months of pregnancy may also be the result of high blood pressure or changes in posture.
What are migraine symptoms in pregnancy?
If you’ve experienced migraine pain previously, you can expect a migraine attack during pregnancy to feel similar to your previous attacks. If you think you’re experiencing migraine for the first time while expecting, here are some common migraine symptoms:
- Throbbing head pain on one side, often behind an eye (although the pain can occur all over)
- Sensitivity to light, sound, smell, and motion
- Nausea and/or vomiting
About 30% of people with migraine experience disturbances in vision or sensation prior to their headaches, known as migraine aura. This may consist of:
- Blind spots in vision (scotoma)
- Temporary vision loss (scotoma)
- Flashing dots or sparkles in vision (visual aura)
- Wavy lines or patterns in vision (visual aura)
- Changes in the way you speak, including tripping over your words (dysphasic aura)
- Numb or tingling skin, usually starting in the hand and moving up the arm (sensory aura)
- Ringing in the ears
What can I take for a migraine during pregnancy?
A migraine attack is debilitating enough to make anyone reach for medication, but when it comes to migraine and pregnancy, that’s where things can get complicated. Currently, there is no migraine medicine for pregnancy that is approved by the FDA. And while most pregnant migraineurs will experience migraine improvement in the second and third trimesters, this leaves women in their first trimester - or those who continue to experience migraine attacks beyond the first trimester - unable to use their usual medications for migraine relief during pregnancy.
If you’re looking for detailed information on a specific prescription, you can search for it in the FDA Index to Drug-Specific Information. But in general, you should be aware of the following pregnancy-specific guidelines for different types of drugs that are commonly used to treat migraine and relieve pain.
Note: Regardless of these guidelines, you should still seek a thumbs-up from your healthcare provider before using any medications, supplements, or herbs while pregnant.
Infrequent use of acetaminophen (also known as paracetamol) throughout pregnancy is generally the only pain medication that doctors will green-light. Unfortunately, certain studies suggest that regular use of acetaminophen while pregnant may have links to autism and ADHD in children. So while it may not cause miscarriage or birth defects, you should still approach this class of drugs with caution.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Most of us have taken NSAIDs like ibuprofen or aspirin at some point in our lives without thinking twice about it. For pregnant women, that shouldn’t be the case. Studies have tied NSAIDs to an increased risk of miscarriage, including a 2003 study that suggests prenatal use of this class of drugs may increase the risk by 80%. NSAIDs are strongly discouraged in the third trimester especially, as they may cause fatal heart issues for unborn babies.
According to the CDC, opioid use during pregnancy is linked to adverse health effects in both expecting mothers and their babies. Babies exposed to opioids during pregnancy are more likely to be born preterm (before 37 weeks) and/or with birth defects, require longer hospital stays and rehospitalization, and have poor fetal growth. Opioid use disorder and long-term opioid use can also result in neonatal abstinence syndrome (NAS), where the newborn experiences opioid withdrawal symptoms. A recent study also suggests that babies born with NAS are at higher risk of developing educational disabilities.
Sumatriptan is widely prescribed for moderate to severe migraine and researchers have found that triptans may potentially be safe during pregnancy — but more research is still needed. In the meantime, you should consult with your physician before continuing sumatriptan, as there are still concerns that triptans could narrow blood vessels that supply the placenta. In certain severe cases, doctors may allow sporadic use of sumatriptan during pregnancy.
CGRP Monoclonal Antibodies
Calcitonin gene-related peptide-blocking monoclonal antibodies are relatively new in the grand scheme of things — the first prescription version wasn’t approved by the FDA until mid-2018. Thus, researchers simply haven’t had the time they need to execute studies and draw definitive conclusions regarding the safety of this class of drugs for pregnant women. Specifically, there’s concern that their continued use could lead to a potentially dangerous increase in blood pressure.
How do I get rid of a migraine while pregnant?
In the absence of migraine medication for pregnancy, relief can still be found for pregnant migraineurs — just perhaps not in the form of a pill. The right mix of lifestyle changes and non-pharmacological treatments can play the role of much-needed migraine remedies for pregnancy if you continue to experience headaches in the first trimester and beyond.
1. Find relief in narrow-band green light.
Thanks to novel research led by Dr. Rami Burstein, we now know that a specific, narrow band of green light can actually soothe photophobia and other common symptoms of a migraine attack. A 2020 study built on this foundational research and found that regular exposure to narrow-band green light may reduce headache days and headache intensity in migraineurs.
While exposure to just any form of green light won’t have the same effects, the good news is that the specific band of green light identified by Dr. Burstein is available to use at home, thanks to The Allay Lamp. Portable, affordable, and effective, the Allay Lamp is non-intrusive and completely safe for anyone to use on a regular basis.
Tip: In addition to using it when you feel an attack coming on, we suggest using Allay for an hour before bed every night to wind down and calm your brain.
2. Keep tabs on your triggers.
Using a migraine diary during pregnancy can help you identify your triggers and avoid them as much as possible while pregnant. Some of the most common triggers are stress, inadequate sleep, and strong smells or perfumes. Certain foods can also act as migraine triggers.
3. Make smart lifestyle changes.
Small changes and healthy habits can go a long way in managing migraine when drugs are off the table. However, before incorporating any lifestyle changes, be sure to consult with your doctor first.
- More water - Dehydration is one of the most common causes of headaches in pregnant women, simply because it takes more water to stay hydrated when you’re pregnant.
- Prenatal yoga - Studies suggest that prenatal yoga is safe and can lower stress, all the while increasing the chance of improved labor, pregnancy, and birth outcomes.
- Mindfulness meditation - A 2018 analysis of previous randomized controlled trials found that mindfulness meditation decreased headache intensity and frequency for the 350 patients across the studies.
Your little one will thank you.
Pausing prescriptions and pain medicines may seem a little daunting at first, but it’ll all be worth it when you hold your little one in your arms. Plus, narrow-band green light is here to provide relief when you need it. If you have any questions about how it works or why it’s safe, just check out the science behind The Allay Lamp — or send us your questions at firstname.lastname@example.org.
Have you used Allay while pregnant?
New and soon-to-be moms, we'd like to hear from you! Dr. Burstein is working on some exciting new research and would love to hear more about your experience with Allay. Please email us to learn more!