Pregnancy is a transformative journey—but for many women, it also brings the challenge of managing debilitating migraines and headaches.
I’m David McCawley, Migraine Clinician with a Bachelor of Biomedical Science and a Bachelor of Physiotherapy (Honours), and nearly a decade of experience helping people reclaim their lives from the grip of chronic headache disorders.
Through my clinical work, I’ve witnessed how significantly migraines can impact individuals—especially during vulnerable times like pregnancy.
In this blog, I’ll explore how headaches and migraines present during pregnancy, their potential risks and complications, and the vital role physiotherapy can play in safe, effective management.
Understanding Headaches and Migraines in Pregnancy
Migraines are more prevalent in women, particularly during their reproductive years. Hormonal changes, especially fluctuations in oestrogen levels, can influence migraine patterns.
During pregnancy, these hormonal shifts can lead to changes in migraine frequency and intensity. Some women may experience improvement, while others might face increased episodes, particularly in the first trimester.
Risk Factors and Potential Complications
Recent research indicates that migraines, especially those with aura, are associated with increased risks during pregnancy. A study analysing data from the Nurses’ Health Study II found that women with a history of migraines had higher risks of pregnancy complications, including:
- 17% increased risk of preterm delivery
- 28% higher rate of gestational hypertension
- 40% higher rate of preeclampsia
The study also noted that migraines with aura were linked to a somewhat higher risk of preeclampsia compared to migraines without aura
Additionally, migraines with aura have been identified as a significant non-traditional risk factor for ischaemic strokes in adults under 50. This risk is particularly elevated in individuals with a heart defect known as patent foramen ovale (PFO), which is present in about 25% of the population.
Safe and Effective Treatment Options 
Physiotherapy and Non-Pharmacological Approaches
Physiotherapy, structured exercise, and relaxation techniques have been shown to be effective, safe, and non-invasive interventions for managing acute migraines during pregnancy. These methods provide evidence-based alternatives to pharmacological treatments and highlight the importance of holistic approaches to migraine management during pregnancy.
Medication Considerations
Many medications commonly used to treat migraines are contraindicated during pregnancy due to potential risks to the developing foetus. For instance:
- Ergot alkaloids, such as dihydroergotamine (DHE), are contraindicated in pregnancy because they can cause uterine vasoconstriction, leading to low birth weight and preterm birth.
- Sodium valproate is contraindicated in women of childbearing potential due to its teratogenic effects.
- Opioids are generally not recommended for migraine treatment during pregnancy, except in refractory cases, due to risks of neonatal opioid withdrawal and potential neurodevelopmental effects.
However, some medications may be considered safer:
- Triptans, particularly sumatriptan, have been reviewed extensively in pregnancy registries, with no major congenital malformations identified, suggesting they may be safe for use during pregnancy.
It’s crucial to consult with a healthcare provider before starting or continuing any medication during pregnancy.
Warning Signs: When to Seek Immediate Medical Attention
While many headaches during pregnancy are benign, certain symptoms warrant immediate medical evaluation:
- Sudden or severe headache onset
- Headache accompanied by fever, visual disturbances, or neurological deficits
- Persistent headache that doesn’t respond to usual treatments
- Headache in the third trimester, which could indicate preeclampsia
These signs could indicate serious conditions such as preeclampsia, stroke, or other neurological disorders.
Conclusion
Managing headaches and migraines during pregnancy requires a careful balance between effective relief and safety for both mother and baby.
Non-pharmacological treatments, including physiotherapy and relaxation techniques, are recommended as first-line therapies. When medications are necessary, they should be chosen cautiously, considering the potential risks and benefits. Always consult with a healthcare provider to develop a personalised treatment plan.
By staying informed and proactive, expectant mothers can navigate the challenges of migraines during pregnancy and ensure the best outcomes for themselves and their babies.
Written by:
References
American Migraine Foundation. (n.d.). Pregnancy and Migraine Medications. Retrieved from https://www.migrainedisorders.org/pregnancy-and-migraine-medications/
Frontiers in Neurology. (2023). Management of Headache in Pregnant Women. Retrieved from https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1239078/full
Ghosh, R., & Choudhury, A. (2023). Non-Pharmacological Management of Migraine: Emerging Evidence. Medicina, 61(1), 28. https://doi.org/10.3390/medicina6100028
Practical Neurology. (2023). Management of Headache in Pregnant Women. Retrieved from https://practicalneurology.com/diseases-diagnoses/headache-pain/management-of-headache-in-pregnant-women/31998/
ScienceDaily. (2023, January 31). Migraine linked to increased risk of pregnancy complications. Retrieved from https://www.sciencedaily.com/releases/2023/01/230131124422.htm
GP Notebook. (n.d.). Migraine and Pregnancy. Retrieved from https://gpnotebook.com/en-GB/pages/neurology/migraine-and-pregnancy
