Pregnancy and Migraines

Pregnancy and Migraines

Pregnancy is an exciting time for many women. Unfortunately pregnant women also suffer from headaches and migraines, and tend so self-medicate with over the counter medication. 

According to Dr. Elliot Shevel, South Africa’s migraine surgery pioneer and the medical director of The Headache Clinic, “Often the migraines or headaches worsen during the first trimester (the the first three months of pregnancy), but don’t despair – in 70 % of women the migraines get better in the second and third trimesters. Unfortunately medication is not a good option during pregnancy, and the only pain medication that is safe is Panado or Paracetamol,” he says.

“Unfortunately pregnant women who suffer from migraines with aura, (a term used to refer to warning signs of migraine such as seeing zigzag lines before the pain starts), usually don’t find relief in the second half of their pregnancy and have less chance of improvement.”

Two studies show that many pregnant women rely on over the counter medication. The first study, published in the Journal of the Pakistan Medical Association, showed “a significant number of pregnant women relied on over-the-counter medication”. A descriptive cross-sectional study was conducted at Isra University Hospital in Pakistan for six months and comprised of 351 pregnant women who were interviewed face to face. Overall, 223 (63.5%) patients were using over the counter drugs before pregnancy and 128 (36.5%) had used them in a previous pregnancy. A further 133 (37.9%) were using the medications during the current pregnancy. Quite worrying is that a total of 103(77.4%) had no knowledge about the possible harmful effects of the medication they were taking.

Whilst this study highlighted the frequent use of over the counter medications in pregnant women, another study, published in Headache: The Journal of Head and Face Pain, indicates most women experience automatic relief during their 2nd and 3rd trimesters. For those not getting relief from headaches or migraines, medication needs to minimise. 

So is surgery a viable option in pregnant women?

One of the most successful treatment methods for migraine is to close off the small arteries under the skin of the scalp that cause the pain (not the arteries in the brain), by means of minimally invasive surgery. Commenting on the surgery during pregnancy, Dr Shevel says, ‘We usually wouldn’t do the surgery during the first three months of the pregnancy because the drugs used in the sedation or anaesthetic may affect the fetus and cause problems. After the first trimester the operation is safe to perform, but we prefer to wait until the baby is born to avoid any possible unforseen complications. Sometimes however, an expectant mother is just in so much pain that the operation can’t wait.” 

Other pressing issues

Expectant mothers always have a lot of questions about headaches and migraines. Here are some answered: 

  • Will the baby be affected by the trauma and pain of my headache? No, says Shevel. “There is no evidence to indicate this, but the baby can be affected by a medication the mother is using and that is why we are saying only Panado or Paracetamol is safe.” 
  • Is there an ingredient in the pill that aggravates or makes headaches worse? The short answer is yes. “The pill contains a variety of different hormones, and changes in those hormone levels can affect the headaches. It is interesting to note however, that although they can make the headaches worse, they may also sometimes make them better – it’s impossible to predict.”
  • What role does breastfeeding play? According to Shevel breastfeeding can also play a role. “If women breastfeed after birth the headaches usually stays away until the baby is weaned. “

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