Should migraine factor into family planning?

Migraine disproportionately affects women, often during the period in their lives when they’re most likely to become pregnant. For many women living with migraine, uncertainty about how pregnancy may affect their migraine treatment plan is a source of anxiety. Will they have to stop taking medication? If so, how will they manage their symptoms—and will those symptoms worsen or improve?

Pregnancy can impact migraine symptoms, and certain medicines are not safe for babies during pregnancy. But luckily for the 25% of women who experience migraine during their lifetime, pregnancy often has positive effects on migraine, and doctors say there are no reasons to not get pregnant if you have migraine.

Migraine Pain and Pregnancy Hormones

Between 50 and 80% of pregnant migraine patients actually experience a reduction in migraine attacks during their pregnancy. Migraine and estrogen have a complicated relationship, Robbins says, but in general higher estrogen levels result in reduced migraine.

“Most women report improvement in migraine: in how frequent the attacks are, and how severe the attacks are,” says Dr. Matthew Robbins, an associate professor of neurology at the Albert Einstein College of Medicine in New York and a neurologist at the Montefiore Headache Center. “This improvement usually continues through pregnancy to the end, and often even after delivery if a woman is breastfeeding.”

Breastfeeding can prevent estrogen levels from dropping after a woman gives birth—which can help lower the frequency of migraine attacks in women. Just as higher estrogen levels can decrease the frequency and severity of migraine during pregnancy, Robbins said, the high estrogen levels maintained while babies are nursing can maintain that pain-suppressing effect.

“We always encourage our patients to breastfeed, especially if they have migraine, because it might confer an added benefit,” Robbins said. As breastfeeding tapers off, Robbins said, migraine frequency may start to increase again.

Migraine Medication and Pregnancy

Some migraine medications can be harmful to developing babies, which is why doctors recommend speaking to them early on in the family planning stage.

“Much of the injury that can be done to a developing baby by medications that are taken by a mother who is newly pregnant can occur early on, often before a mother even knows she’s pregnant,” says Robbins. “So it’s very important to have time to talk about what the plans are because there could be medicine exposures that could place a developing baby at risk.”

While a doctor can talk to patients more about specific cases—and in some instances can recommend medication that will be safe during specific trimesters—non-medical approaches to migraine are often emphasized during pregnancy. Things like avoiding triggers, minimizing stress as much as possible, and non-medicine therapies like prenatal yoga and acupuncture are often recommended. Acetaminophen is usually considered safe for acute attacks, but pregnant women should always consult their doctor before taking medication.

Migraine and Postpartum Depression

Because migraine is often linked with depression, women sometimes assume postpartum depression will also be linked. Robbins says that is not the case.

“Although migraine is associated with depression in general, and depression can make migraine worse, women with migraine should not specifically worry about postpartum depression,” he says. There is no known link between migraine and postpartum depression. Although migraine is associated with depression, and depression can make migraine worse, women with migraine should not specifically worry about postpartum depression, Robbins said. Medicines that are off limits during pregnancy are often fine to take shortly after pregnancy, so Robbins says women who are suffering from migraine or postpartum depression should seek care.

“Women with migraine should definitely not be afraid of becoming pregnant,” Dr. Robbins said. “There’s no evidence or experience that suggests that having children is in any way harmful to women with migraine overall.”

Migraine and pregnancy are distinct medical experiences, and each require specialized care. If you don’t already have a headache doctor and you’re considering becoming pregnant, connect with a specialist who can help you manage your migraine symptoms and treatment safely. The American Migraine Foundation’s searchable doctor database can make it easy to find a doctor or headache center near you.

Still, women with migraine should not let concerns about migraine interfere with their family planning, and can hope that their migraine frequency will decrease during pregnancy.