Tiredness, morning sickness and swollen ankles are all things that are expected during pregnancy, but what many women do not expect are migraines.
The hormonal and physical changes can have an impact on the frequency and severity of headaches and migraines during your pregnancy. Dr Daniel Fenton, Clinical Director at the Private GP Clinic, London Doctors Clinic is here to explain exactly why these changes occur, when to expect them and your best options should you experience painful migraines.
When are migraines most common during pregnancy?
Migraines can occur at any time during pregnancy. Some women may experience their first ever migraine during pregnancy, which can understandably cause a great deal of anxiety. However, rest assured, up to as many as 60-70% of women experience improvement in their migraine, 20% of whom experience complete resolution of symptoms. Some women will unfortunately experience an increase in frequency and severity.
If there is a time where it is most common, why do they occur at this time?
The hormonal changes that occur throughout pregnancy and are thought to contribute to migraines make it is impossible to predict whether they will be worse in the first, second or third trimester.
That said, we know that women who note improvement towards the end of the first trimester are more likely to have continued improvement in their migraines throughout pregnancy. If improvement has not occurred by the end of the first trimester, migraine is likely to continue throughout pregnancy and after delivery.
Women with a history of migraines specifically related to the menstrual cycle are highly likely to have reduced frequency in pregnancy. Similarly, women with migraines without associated aura (often characterised by zig zags and flashing light), are also likely to notice an improvement.
Breastfeeding has also be found to sustain the beneficial effects of pregnancy on migraine.
What can you do if you are experiencing these migraines? What are the best ways to relieve the symptoms and is there anything you should avoid?
In general, drug treatment should be limited in pregnancy, but this does not mean treatment options are not available.
We aim to keep treatment simple, and stick to medications recognised as safe in pregnancy.
If pain relief is required, start with paracetamol – this is safe for both mother and baby and may be enough to help.
If this fails and the migraine is truly unbearable , then Sumatriptan may be used. This is a well-recognised treatment for migraines and can be used in pregnancy if necessary, under the advice of a doctor.
As a general rule of thumb, I would avoid aspirin at all costs and non-steroidal anti-inflammatories such as Ibuprofen and Naproxen.
The medications used to prevent migraines such as propranolol, amitriptyline and topiramate should all be stopped/avoided during pregnancy as they can potentially cause harm to the baby.
If you wish to avoid medication altogether, consider using a headache diary to identify triggers. Write a list of potential known triggers and a record them each day, regardless of whether you have a migraine or not. This will help to identify the true triggers, and makes it much easier to avoid them. Stress, chocolate, cheese, strenuous exercise and poor sleep have been found to be triggers in some individuals, try to minimise these where possible.
Dr Daniel Fenton, Clinical Director at the Private GP Clinic, London Doctors Clinic