Headaches and migraines in pregnancy
Sep 08 • 2014

Migraines during pregnancy account for a third of all neurological problems; Dr Nicopoullos comments in this blog on the link between the two

Migraine Awareness Week (1-7 September 2014), is an event aimed at raising awareness of the debilitating condition that affects over eight million people in the UK, including the likes of Hugh Jackman, Janet Jackson, Serena Williams and Ben Affleck. A migraine is characterised by an intense headache occurring at the front or side of the head, resulting in a severe throbbing sensation.

Headache is a common symptom that affects 20 per cent of all women, but a growing number are now suffering migraines during pregnancy. Dr James Nicopoullos, Consultant Gynaecologist and Subspecialist in Reproductive Medicine & Surgery at The Lister Hospital, London, comments on the link between migraines and pregnancy: “Migraine and headache are common problems in pregnancy and account for about a third of all neurological problems encountered. Many women who already suffer from migraines find their symptoms worsen during pregnancy.”

Mr Nitish Narvekar, Consultant Obstetrician & Gynaecologist at The Lister Hospital, London comments on the prevalence of headaches and the impact of having children later in life: “Migraine headaches are most prevalent in third and fourth decades of life, and with increasingly delayed childbearing, the incidence of migraines during pregnancy is on the rise.”

Dr Guy Leschziner, Consultant Neurologist at The Lister Hospital, London comments onthe main causes of migraines: “The cause of migraine is likely to be genetic, in that it often runs in families, and that changes in certain genes have been found to cause migraine. However, a variety of factors may trigger migraine attacks – some people link attacks with foodstuffs such as cheese, red wine or citrus fruit, hormonal changes (migraine associated with periods is common in women), sleep (either too much or too little) or stress.”

Dr Nicopoullos comments on the key contributors: “Some tension headaches may occur in pregnancy as a consequence of muscle contraction, often during periods of stress. Migraines are thought to be a consequence of dilated blood vessels in the brain that can stimulate pain receptors, often precipitated by various dietary factors, stress and hormones (including the oral contraceptive pill or pre-menstruation).”

Mr Nitish Narvekar comments: “An abrupt change in oestrogen levels is a trigger for migraines. Therefore, most women, except those with focal migraines, experience either an improvement or no change in migraine frequency, whereas, falling oestrogen levels may trigger migraines during the post-natal period. Most women with headaches, including migraine, have a pre-existing history, and therefore, any presentation for the first time in pregnancy including a significant change in the nature or frequency of previous headaches, or, associated medical problems such as raised blood pressure, needs immediate medical review. It is extremely safe both for the woman and her baby to have a non-contrast CT or MRI scan of the head to establish a clinical diagnosis if they are worried.”

Dr Nicopoullos continues: “The majority of women with previous migraines actually see an improvement in pregnancy, which is most marked in the second and third trimesters. This may be as a consequence of the relative hormonal stability in pregnancy. In those that do worsen, it is often in the first trimester but can be expected to decrease later in pregnancy. It is important to note that in the absence of any other complications simple cases of headaches/migraines do not negatively affect the pregnancy outcome.

“Although the majority of headaches in pregnancy are tension-related, on occasion these can be a presenting feature of other pregnancy–related problems such as pre-eclampsia (usually characterised by a severe headache, associated with flashing lights and high blood pressure) or other neurological problems, so it would be advisable to always seek a medical review.”

Dr Nicopoullos comments on which pain relief is and isn’t recommended during pregnancy: “Paracetamol-based pain relief is recommended for attacks in pregnancy, often in conjunction with one of a number of safe anti-sickness medications. Codeine based drugs are also safe. Non-steroidal anti-inflammatory drugs such as ibuprofen are not recommended in pregnancy due to possible negative effects on the foetus.

“In those with frequent attacks, low-dose aspirin can be safe and effective and on occasion beta-blockers are recommended if they persist. However the latter has been associated with a possible effect on foetal growth so should only be used in resistant cases and after discussion with the obstetrician and neurologist. Some of the commonly used drugs to treat migraines (Sumatriptan) and prevent migraines (Pizotifen) remain poorly studied in pregnancy so should be avoided unless other options do not work and should only to be used after discussion with the obstetrician and neurologist.”