Migraine during pregnancy: is it more than a headache?

ABSTRACT Migraine headaches have a female predominance with a peak in prevalence in the third and fourth decades of life. Women of reproductive age are liable to develop their first migraine

while pregnant or exhibit changes in the character, frequency or severity of their headaches during pregnancy and the puerperium. The purpose of this Review is to examine the

pathophysiology underlying the development of migraine headaches and the association of this pathophysiology with pregnancy-related complications. We also discuss the diagnosis and

management of migraine headaches that precede pregnancy or develop _de novo_ during pregnancy, placing an emphasis on the distinction between primary migraine headache and headache secondary

to pre-eclampsia—a relatively frequent complication of pregnancy and the puerperium. We present the case of a woman with a history of migraine headaches before pregnancy, whose symptoms

progressed during pregnancy in part because of increasing exposure to narcotic medications. We also review the options for migraine evaluation and treatment, and provide an overview of the

risks associated with the different treatment options. KEY POINTS * Migraines affect up to 18% of pregnant women * In most cases, migraine has been diagnosed before pregnancy * Migraines

need to be differentiated from other complications associated with or resulting from pregnancy and the puerperium * Differentiation of migraine from pre-eclampsia-associated headache is

important because migraine does not necessitate emergent delivery * Persistent headache in the context of pre-eclampsia can be an indication for emergent delivery to prevent further maternal

complications * The main precept for the management of migraines during pregnancy is to use the smallest amount of medication necessary for adequate pain prevention and control Access

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SIMILAR CONTENT BEING VIEWED BY OTHERS THE CHILDHOOD MIGRAINE SYNDROME Article 26 May 2021 INVESTIGATING RISK FACTORS FOR MIGRAINE IN SYRIAN WOMEN: A CROSS-SECTIONAL CASE-CONTROL STUDY

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author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this

article. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, NC, USA Stephen A. Contag & 

Heather L. Mertz * Department of Neurology, Wake Forest University Health Sciences, Winston-Salem, NC, USA Cheryl D. Bushnell Authors * Stephen A. Contag View author publications You can

also search for this author inPubMed Google Scholar * Heather L. Mertz View author publications You can also search for this author inPubMed Google Scholar * Cheryl D. Bushnell View author

publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to Cheryl D. Bushnell. ETHICS DECLARATIONS COMPETING INTERESTS The authors

declare no competing financial interests. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Contag, S., Mertz, H. & Bushnell, C. Migraine during

pregnancy: is it more than a headache?. _Nat Rev Neurol_ 5, 449–456 (2009). https://doi.org/10.1038/nrneurol.2009.100 Download citation * Published: 14 July 2009 * Issue Date: August 2009 *

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