February 03, 2023
Women who get migraines have a higher likelihood of preeclampsia, gestational hypertension and other pregnancy complications, new research shows.
Women are 2-3 times more likely to experience migraines than men, particularly during their reproductive years. But the relationship between migraines and pregnancy complications is not completely understood.
The new study, from Brigham and Women's Hospital in Boston, suggest migraine may be an important risk factor for pregnancy complications. The risk of gestational hypertension was 28% higher among women who experienced migraines prior to pregnancy. The risk of preeclampsia was 40% higher and the risk of preterm delivery was 17% higher.
Migraine with aura – recurring headaches accompanied by sensory disturbances – was linked to a slightly higher risk of preeclampsia than migraine without aura. However, no relationship was observed between migraine and low birth weight or gestational diabetes.
Previous research has suggested that the high blood pressure that often accompanies migraine increases the risk of preeclampsia and other vascular complications.
The latest study found that women with migraine who took low-dose aspirin more than twice per week prior to pregnancy had a 45% lower risk of preterm delivery.
The U.S. Preventive Services Task Force recommends low-dose aspirin for pregnant women who are at high risk of preeclampsia or have more than one moderate risk factor for preeclampsia. Migraine, however, is not included among the indications for aspirin use in pregnancy.
“Our findings of reduced risk of preterm delivery among women with migraine who reported regular aspirin use prior to pregnancy suggests that aspirin may also be beneficial for women with migraine," said Dr. Alexandra Purdue-Smithe, an associate epidemiologist at Brigham and Women's Hospital. "Given the observational nature of our study, and the lack of detailed information on aspirin dosage available in the cohort, clinical trials will be needed to definitively answer this question."
The study analyzed data from 19,694 U.S. nurses who experienced 30,555 pregnancies.
A migraine is a type of headache of moderate or severe intensity that can last up to three days. Symptoms include a throbbing pain that typically starts on one side of the head, sensitivity to light and sound, and nausea or vomiting. Physical activity also tends to worsen the pain. The condition is often hereditary.
Migraine with aura may cause numbness, speech difficulty or one's vision to be distorted by black dots or zig-zag lines. These symptoms often occur as a precursor to the head pain.
The hormonal changes that women experience during pregnancy can impact the symptoms of migraine. Between 50% to 80% of pregnant migraine patients actually experience a reduction in migraine attacks during pregnancy. However, some women experience an increase in symptoms, especially during the first trimester.
Women who experience migraines during pregnancy are advised to develop a safe treatment plan with their obstetrician and headache doctors. Identifying and avoiding migraine triggers, getting sufficient sleep and staying hydrated are among the non-pharmacological ways to manage migraine during pregnancy.
The American Academy of Family Physicians lists acetaminophen and metoclopramide as drugs safe to use for migraine during pregnancy. Studies have not been able to determine if migraine medicine and not just migraine itself contributes to increased risk of pregnancy complications.
"Preterm delivery and hypertensive disorders are some of the primary drivers of maternal and infant morbidity and mortality," Purdue-Smithe said. "Our findings suggest that a history of migraine warrants consideration as an important risk factor for these complications and could be useful in flagging women who may benefit from enhanced monitoring during pregnancy."
Prior studies have reported a link between adverse pregnancy outcomes and migraine, particularly migraine with aura, and higher risk of coronary heart disease and ischemic stroke.
A 2019 Danish study linked migraine in pregnancy to an increased risk of pregnancy-associated hypertension disorders, miscarriage, low birth weight, preterm birth and Cesarean delivery. Children exposed to maternal migraine in utero also had higher risks of respiratory distress syndrome, febrile seizures and the need for hospitalization and admission to an intensive care unit.