Migraines in pregnancy

Migraine is an extremely common disorder, affecting about 18% of women. Because of the various factors influencing the condition, the diagnosis and treatment of migraine is not a simple matter. During pregnancy, these problems are further complicated because of the additional precautions that are necessary.

The frequency of migraine attacks has actually been shown to decrease during pregnancy. In a study carried out by researchers at the Institute of Nervous Diseases at the University of Rome, the results confirmed previous studies, that during pregnancy, migraine sufferers had fewer attacks than before their pregnancy. As the pregnancy progressed, the attacks became fewer and fewer, so that during the last three months, 80% of the patients in the study experienced no attacks at all. Not only did the frequency of attacks decrease, but also, the intensity of the pain was not as severe.

Those migraine sufferers who experienced an aura before the attacks, showed no improvement during pregnancy. The aura consists of seeing flashing lights, or patchy loss of vision, or in some people inability to speak properly. In fact in migraine with aura, the attacks may even worsen during the pregnancy.

After birth
Unfortunately in most cases, the migraine returned after the birth of the baby. What emerged from the study, however, was that the rate of recurrence of the migraine following the birth was strongly influenced by the type of feeding. With breastfeeding, 43% of patients reported the recurrence of their migraines within a month.

With bottlefeeding however, there was a 100% recurrence in the first month. Once breastfeeding stops though, the migraines usually resume their old pattern.

The migraine was also twice as likely to return in women having their first child, as in those having their second or third child. Women below the age of thirty were also twice as likely to experience a recurrence.

With regard to treatment options during pregnancy, medication is discouraged due to the potential harmful effects on the foetus. Even common over-the-counter drugs such as aspirin must be avoided, as it may increase the chances of bleeding. The only headache medication that is considered to be safe during pregnancy is paracetamol (Panado), but in most cases this is inadequate for the intense pain of migraine.

Some medications commonly used in migraine contain ergotamine. This drug can stimulate the muscles of the uterus, and lead to abortion. Often, the “migraine kits” obtainable from pharmacies without a prescription, contain ergotamine. Even codeine, an ingredient of many painkillers, has been associated with congenital malformations.

One of the biggest problems with regard to headache medications is the lack of information on their possible effects on the unborn child. The reason for this is that pregnant women are usually excluded, for obvious reasons, from drug trials. So when a new drug comes on the market, pregnant women are advised not to use it, because it hasn’t been adequately tested during pregnancy.

Herbal remedies
Many people today look to herbal or “natural” remedies. These must under no circumstances be taken during pregnancy. The therapeutic effect of even the most natural of substances is due to the active chemicals they contain. A number of easily obtainable herbal preparations can be harmful to the pregnant woman or to the foetus.

Treatment of migraine during pregnancy has to focus on non-drug therapies. The best way to approach the problem is to diagnose from which structure the pain originates, so that one can treat the source of the pain. This is a highly specialised diagnosis, and must include an assessment of the amount of tension in the muscles of the head and neck, which are often the main source of the pain. If muscle tension is present, there are a number of non-drug treatment options available.

The first choice is a specially constructed intra-oral appliance, that sits comfortably in the palate, and relaxes the muscles of the head and neck. In most patients, no further treatment is necessary. The other treatment options are physiotherapy, postural training, and appropriate exercise. It may be necessary in some cases to inject a little local anaesthetic into the muscle trigger points – this can be safely performed at any stage of the pregnancy.

The other structures that must be assessed are the arteries of the scalp. This can only be done while the pain is present, and, as it is a highly specialised diagnosis, can only be done by doctors who have received special training.

The aim of treatment is prevention of the migraine, so that potentially harmful medication is no longer necessary.

Simple rules
It may, however, be possible to reduce the frequency and intensity of attacks by observing a few simple rules. Scrupulous avoidance of known headache triggers can greatly reduce the number of attacks. Not everyone has the same triggers though, and this will only help if you have identified your particular triggers. Alcohol should be avoided, and skipping meals is discouraged, as a drop in blood sugar levels can sometimes trigger a migraine attack. Some migraine sufferers benefit from simply increasing their water intake, a healthy alternative to drugs.

This information has been supplied and checked by the multidisciplinary team of specialists at The Headache Clinic, in association with The International Headache Society and the South African Institute of Headache and Migraine Science. For consultation with these specialists, call The Headache Clinic on 0861 678 911 (Johannesburg, Cape Town, Durban).

(Joanne Hart, Health24, June 2007)

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