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Migraine and pregnancy

Although migraine is less active for many women during pregnancy when hormonal levels are high and more stable, migraine may begin for the first time during pregnancy, especially in the first trimester.

Many women with menstrually related migraine without aura or migraine with aura have little headache during pregnancy, only to have the attacks return with resumption of the menstrual cycle. During pregnancy usually migraine with aura is seen.Uknis and Silberstein writing in Headache in 1991 on “Migraine and Pregnancy” presented a case: A 27-year-old woman with no family or personal history of migraine presented with headache associated with unilateral paresthesias and blurred vision. This was her first, and so far only, attack of migraine with aura and led to the diagnosis of her pregnancy and to this review.

Uknis and Silberstein also stated: Preexisting migraine usually improves with pregnancy, particularly if it was associated with menstrual migraine. Headache occurs frequently in the post-partum period, particularly in known migraineurs. Migraineurs have no increased risk of complications during pregnancy and their children have no increased incidence of birth defects. Silberstein and Merriam writing in 1991 in Neurology on “Estrogens, progestins, and headache” stated: Migraine may worsen in the first trimester of pregnancy; many women become headache-free during later pregnancy, but 25% have no change. Menstrual migraine typically improves with pregnancy, perhaps due to sustained high estrogen levels. Migraine frequency decreases with advancing age, but may either regress of worsen at the menopause. For pregnant migraineurs there may be an increase in complicated migraine and pre-eclamptic toxemia. f40l The triptan drugs are not indicated during pregnancy and so most patients use simple, supportive treatment like bed rest, cold rags, acetaminophen, and occasional Vicodin (hydrocodone).

At the American Academy of Neurology Annual Meeting in 2007, Cheryl Bushnell, M.D. from Duke University reported “a very close association between migraine and vascular disease” during pregnancy. This study found that women who suffer migraine attacks while

pregnant have an increased risk of stroke, heart attack, blood clots, preeclampsia, and other vascular problems. Dr. Bushnell said:

Women with persistent migraine during pregnancy should be aware of their risk factors, such as high blood pressure, high cholesterol, diabetes, history of blood clots, heart disease, and prior stroke. Good prenatal care is essential.

In general a clinical neurologic examination but no imaging is performed on the pregnant patient with migraine, although CAT and MRI scans have been performed occasionally for special situations with no untoward results.