Migraines During Pregnancy
The short answer
Migraines affect about 25% of women of reproductive age. Many people with migraines find they improve during pregnancy, especially in the second and third trimesters, due to stable estrogen levels. However, some experience worsening or new-onset migraines. Management during pregnancy requires careful medication selection under your provider's guidance.
Parents everywhere have the same worry. You are doing the right thing by looking into it.
By Age
What to expect by age
Migraines may worsen or remain unchanged in the first trimester due to hormonal fluctuations. Many migraine medications (triptans, ergotamines, some preventives) are not recommended during pregnancy. Acetaminophen is the safest first-line treatment. Non-medication approaches like cold compresses, dark rooms, adequate sleep, hydration, and stress management are important.
Many migraine sufferers experience significant improvement starting in the second trimester as estrogen levels stabilize at higher levels. Continue non-pharmacologic strategies. If migraines persist and are disabling, your provider can discuss safer medication options that may be appropriate.
Improvement in migraines often continues in the third trimester. However, new-onset migraines or migraines with aura in the third trimester must be carefully evaluated. Migraine with aura symptoms (visual disturbances, numbness) can mimic preeclampsia warning signs. Always report new neurological symptoms to your provider promptly.
Migraines may return or worsen after delivery as hormone levels drop dramatically. If you are breastfeeding, discuss safe medication options with your provider. Many migraine treatments are compatible with breastfeeding.
What Should You Do?
When to take action
- Migraines similar to your pre-pregnancy pattern that respond to acetaminophen and rest
- Improvement in migraines as pregnancy progresses
- Known migraine triggers (stress, sleep changes, certain foods) producing familiar symptoms
- Migraines are frequent and significantly impacting your quality of life
- You need migraine medication and want to discuss safe options
- Migraine patterns have changed compared to your pre-pregnancy experience
- New-onset migraine with aura (visual disturbances, numbness, weakness) especially in the third trimester - must be evaluated to rule out preeclampsia or stroke
- Worst headache of your life or headache unlike any previous migraine
- Migraine with confusion, difficulty speaking, high blood pressure, or fever
Sources
Related Resources
Trust your instincts. If something feels wrong, reach out to your pediatrician.
Worrying about your baby means you care. That is a good thing.
Related Maternal Concerns
Headaches During Pregnancy
Headaches are common during pregnancy, especially in the first and third trimesters. They are often caused by hormonal changes, increased blood volume, stress, fatigue, caffeine withdrawal, or dehydration. Most pregnancy headaches are tension-type and harmless, but severe or persistent headaches, especially in the third trimester, should be evaluated to rule out preeclampsia.
Preeclampsia Warning Signs
Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of organ damage, usually after 20 weeks of pregnancy. It affects about 5-8% of pregnancies and can range from mild to severe. With regular prenatal monitoring, preeclampsia can be detected early and managed to protect both you and your baby.
Which Medications Are Safe During Pregnancy
Many medications are safe during pregnancy, but some should be avoided. Acetaminophen (Tylenol) is generally considered the safest pain reliever. NSAIDs (ibuprofen, naproxen) should generally be avoided, especially after 20 weeks. Always check with your provider before taking any medication, including over-the-counter and herbal supplements. Never stop prescribed medications without consulting your provider first.
Dealing with Abnormal Prenatal Screening Results
An abnormal prenatal screening result can be terrifying, but it is important to understand that screening tests are designed to cast a wide net and have significant false-positive rates. Most people with abnormal screening results go on to have healthy babies after further testing confirms the baby is fine. An abnormal screening is a reason for more information, not a diagnosis.
Pregnancy Over 35 (Advanced Maternal Age)
While pregnancy after 35 carries some increased risks (including chromosomal abnormalities, gestational diabetes, and hypertension), the vast majority of people over 35 have healthy pregnancies and healthy babies. The term "geriatric pregnancy" is outdated and does not reflect reality. With appropriate prenatal care and monitoring, outcomes are excellent.
Amniocentesis Questions and Fears
Amniocentesis is a diagnostic test performed between 15-20 weeks that analyzes amniotic fluid to detect chromosomal conditions and genetic disorders with over 99% accuracy. The risk of pregnancy loss from the procedure is approximately 1 in 500-1,000 when performed by an experienced provider. Understanding the actual risks can help you make an informed decision.