Migraines During Pregnancy
Medically reviewed by Dr. Lisa Okafor, MD, FACOG · Board-Certified OB-GYN
Content reviewed against published ACOG, NIH, March of Dimes guidelines
Last reviewed:
Your health matters just as much as your baby's. If you are dealing with migraines during pregnancy, here is what you need to know.
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.
Key takeaways
- 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.
- Usually normal when: Migraines similar to your pre-pregnancy pattern that respond to acetaminophen and rest
- Call your doctor if: New-onset migraine with aura (visual disturbances, numbness, weakness) especially in the third trimester - must be evaluated to rule out preeclampsia or stroke
- Varies by age — see the age-by-age breakdown below
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What Parents Should Know
According to ACOG, NIH, March of Dimes guidelines, 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. At First trimester, 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. It is generally considered normal when migraines similar to your pre-pregnancy pattern that respond to acetaminophen and rest. However, you should contact your pediatrician promptly if new-onset migraine with aura (visual disturbances, numbness, weakness) especially in the third trimester - must be evaluated to rule out preeclampsia or stroke.
Normal vs. Concerning
By Age
What to expect by age
First trimester
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.
Second trimester
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.
Third trimester
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.
Postpartum
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 to Tell Your Pediatrician
- Describe when you first noticed migraines during pregnancy and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if migraines are frequent and significantly impacting your quality of life.
- Mention if you need migraine medication and want to discuss safe options.
- Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
- Bring a list of any questions or observations you want to discuss at the appointment.
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
What You Can Do at Home
- Keep track of when you notice migraines during pregnancy — noting the time of day, duration, and any triggers can help your pediatrician.
- Remember that migraines similar to your pre-pregnancy pattern that respond to acetaminophen and rest — this is generally within the range of normal.
- At First trimester, focus on observation rather than intervention unless your pediatrician advises otherwise.
- Prioritize your own rest and nutrition. Accept help when offered, and do not hesitate to reach out to your healthcare provider.
- While monitoring at home, seek immediate care if new-onset migraine with aura (visual disturbances, numbness, weakness) especially in the third trimester - must be evaluated to rule out preeclampsia or stroke.
Related Conditions
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.
Related Resources
Postpartum Recovery Guide
Week-by-week postpartum recovery timeline and warning signs.
Month-by-Month Development
Detailed monthly development guides from birth through 24 months.
When to Call the Doctor
General guide on when to call the pediatrician, visit urgent care, or go to the ER.
Frequently asked questions
Is migraines during pregnancy normal?
When should I call the doctor about migraines during pregnancy?
When is migraines during pregnancy normal?
What causes migraines during pregnancy?
What should I mention to my pediatrician about migraines during pregnancy?
Is migraines during pregnancy normal at First trimester?
Is migraines during pregnancy normal at Second trimester?
Should I go to the ER for migraines during pregnancy?
Does migraines during pregnancy go away on its own?
References
- [1]American College of Obstetricians and Gynecologists. Headaches in Pregnancy. ACOG, 2022. ACOG
- [2]National Library of Medicine. Migraine in Pregnancy. StatPearls, 2023. NIH
- [3]March of Dimes. Headaches During Pregnancy. March of Dimes, 2023. March of Dimes
Doctor Visit Checklist
Bring this checklist to your next pediatrician visit to discuss Migraines During Pregnancy.
Things to mention
- Describe when you first noticed migraines during pregnancy and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if migraines are frequent and significantly impacting your quality of life.
- Mention if you need migraine medication and want to discuss safe options.
- Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
- Bring a list of any questions or observations you want to discuss at the appointment.
Observations to share
- 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
Urgent signs to report immediately
- 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
My notes
From ismybabyalright.com — free, evidence-based baby health guides
All content follows our editorial policy and is reviewed against published clinical guidelines.
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Related Resources
Bottom line
Most cases of migraines during pregnancy are normal. Talk to your pediatrician if new-onset migraine with aura (visual disturbances, numbness, weakness) especially in the third trimester - must be evaluated to rule out preeclampsia or stroke.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.
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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.