Pregnancy & Migraine
by Lauren Doyle Strauss, DO
While over half of women with migraine report improvement of headaches during pregnancy, having a history of migraine may increase the chance of negative health outcomes. The state of pregnancy increases the risk of several other causes of headache, especially those associated with hypertensive disorders of pregnancy, and providers need to diagnose and treat emergently. It has been reported in two large studies one based in Taiwan and another in Hungary, that delivery complications may be increased in a patient with prior diagnosis of migraine including increased risk of risk of nausea and vomiting, low birthweight babies, preterm delivery, preeclampsia, and cesarean delivery in women with migraine.[ There is a recent study published in Headache by Dr. Tracy Grossman and colleagues from Montefiore Medical Center that studied the effects of severe migraine requiring urgent care on delivery outcomes. They reviewed records over a 5 year period of pregnant patients that received a neurology evaluation for headache that met criteria for migraine. Comparing the percentage of adverse delivery outcomes to local and national averages, patients that experience a severe migraine during pregnancy that required an urgent headache evaluation during their pregnancy had a two fold increase of preterm labor and five fold increase in having a low birthweight infant. Although this was a smaller study of 86 patients, it suggests that pregnancies in migraine patients presenting to an acute care setting may benefit from more intense surveillance for potential pregnancy and delivery complications.