Migraine Headache in Pregnancy: Managing Pain for Two

#MigraineDuringPregnancy #PregnancyHealth #HeadacheManagement #MigraineTreatment

Introduction Pregnancy is a beautiful journey filled with excitement, anticipation, and joy. However, it can also bring along some not-so-pleasant companions, like headaches and back pain. As a mom-to-be, you might wonder if it’s safe to treat migraine attacks during pregnancy. The good news is that you can manage migraine headaches while expecting, but it requires careful planning and guidance from a healthcare professional like Dr. Anurag Aggarwal, the Head of Emergency Medicine & Pain Medicine. In this blog, we’ll delve into essential insights and strategies for dealing with migraine headaches during pregnancy.

Plan with Your Doctor Before you start the exciting journey of pregnancy, it’s crucial to consult your doctor if you are currently taking medications for migraines. Not all medications are safe for the developing fetus, and some need to be discontinued months before conception. For instance, nonsteroidal anti-inflammatory drugs like ibuprofen are not recommended during the first and third trimesters. Certain migraine preventive therapies, such as topiramate and CGRP monoclonal antibodies, also need to be reconsidered.

Hope on the Horizon If you’re already a migraine sufferer, there’s good news: your migraines might improve during pregnancy. Research shows that approximately 50% of women with migraines experience improvement by the first trimester, and about 87% see an improvement by the third trimester. However, hormonal changes, nausea, sleep disturbances, and other factors can still contribute to headaches. To mitigate these triggers, consider these self-care tips:

• Stay hydrated. 
• Maintain a healthy diet. 
• Prioritize good sleep hygiene. 
• Incorporate gentle exercise when possible.
• Perform daily neck stretches, especially during baths or showers.

Distinguishing Migraines from Secondary Headaches When dealing with headaches during pregnancy, it’s essential to distinguish primary headaches (where pain is the condition itself) from secondary headaches (where pain is a symptom of another underlying issue). This differentiation is especially crucial for expectant mothers. There are three possible scenarios:

A woman with a primary headache continues to experience her usual migraine. A woman without a history of primary headaches suddenly develops a severe headache during pregnancy.

A woman with a primary headache experiences different pain characteristics, intensity, or associated symptoms.

In the second and third scenarios, a headache should be considered a symptom of an underlying condition until a proper diagnostic evaluation is performed. Some common secondary headaches during pregnancy include cerebral venous thrombosis, subarachnoid hemorrhage, and preeclampsia.

Red Flags for Headaches in Pregnancy Certain “red flags” can help healthcare providers determine if a headache is a primary concern or a potential symptom of a more serious underlying issue. These red flags include:

Safe Migraine Medications in Pregnancy Once red flags are ruled out, and the diagnosis is confirmed as migraine, it’s crucial to know which medications are safe to use during pregnancy. While non-pharmacological interventions should be the primary approach, treatment should not be delayed as poorly managed headaches can negatively impact both the mother and the baby. Here are some safe medication options:

Acute Migraine Treatment in Pregnancy:

• Paracetamol (PCM) at doses of 650-1000 mg with caffeine less than 200 mg/day. • Naproxen, Ibuprofen, and ketorolac are generally safe before 30 weeks of pregnancy. Their use in the first trimester may slightly increase the risk of early pregnancy loss and congenital anomalies, but the evidence is weak. They should be used for less than 48 hours. After 30 weeks of pregnancy, their use should be avoided due to potential risks like PDA closure and pulmonary artery hypertension in newborns. • Triptans, such as sumatriptan and rizatriptan, can be used for moderate to severe headaches that do not respond to other medications. • Ergotamine is strictly contraindicated in pregnancy due to the risk of hypertonic uterine contractions. • Glucocorticoids may be considered in intractable cases. Prednisone and methylprednisolone are preferred because they are metabolized into inactive forms by the placenta, minimizing fetal effects.

Migraine Prophylaxis in Pregnancy: • First-line preventive therapies include beta-blockers like propranolol, metoprolol, and atenolol. These are not teratogenic, but prolonged use can lead to mild fetal growth restriction and mild transient neonatal effects. • Calcium channel blockers, especially verapamil, are commonly used and have minimal adverse effects during pregnancy. • Second-line preventive therapies may include low-dose antidepressants like venlafaxine or tricyclic antidepressants. These should be used cautiously, especially in the third trimester. • Gabapentin is an option for refractory cases, but valproate and certain other anticonvulsants should be avoided due to their teratogenic potential.

Conclusion In summary, if you experience migraines during pregnancy, remember that you don’t have to suffer in silence. With proper planning and the guidance of a healthcare professional, you can manage your migraines safely and effectively. Being pregnant does not mean you cannot treat your migraine attacks; it simply requires careful consideration of the best approach for you and your baby’s health. Always consult your healthcare provider for personalized advice and treatment options tailored to your specific situation. Your well-being and the health of your little one are top priorities during this exciting journey.

#PregnancyWellness #MigraineRelief