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Treating Migraine During Pregnancy

February 07, 2023

The experience of having migraine can be brutal and many pregnant women struggle without treatment because of the risk some medications pose to their pregnancy.

To better understand how migraine is – and can be – treated during pregnancy, a group of researchers with the Hartford HealthCare Ayer Neuroscience Institute Headache Center explored current practices to chart a course for future care. The results were published in Headache: The Journal of Head and Face Pain.

“Migraine treatment during pregnancy can be challenging for many reasons. We know some women receive all aspects of care – including primary care, obstetrical/gynecological and migraine care – from their women’s healthcare provider, but we know very little about how these providers approach migraine treatment during pregnancy,” notes Allison Verhaak, PhD, a clinical health psychologist with the Headache Center and part of a research team that included Headache Center Director Brian Grosberg, MD.

Migraine in pregnancy

Migraines are most common during women’s reproductive years, affecting about 25% of those ages 30 to 39. Of those who are affected by migraine, 80% will continue to have them at some point during their pregnancy, Dr. Verhaak says.

“While many women report improvements in migraine during pregnancy, particularly by the second trimester, up to 60% may not see improvement so treatment during this time is very important,” she explains.

Survey says

The Hartford HealthCare research team sent an online survey to more than 400 women’s healthcare providers across the state, receiving about 100 responses. Most responses came from providers practicing obstetrics and gynecology.

They fielded questions about what, if any, acute and preventive migraine treatments they prescribe to pregnant patients. Some results include:

  • 26% reported counseling women on migraine treatment in pregnancy as early as before conception
  • 35% counseled patients after they become pregnant
  • 63% felt comfortable recommending or continuing some acute treatments for a patient’s migraine, although they were less comfortable with treatments such as triptans
  • 40% felt less comfortable recommending preventive migraine treatments during pregnancy
  • 70% were comfortable with non-medication approaches to addressing migraine
  • 40% report referring pregnant patients to neurologists or headache specialists for migraine care

“Our women’s healthcare providers reported feeling largely uncomfortable prescribing or recommending use of nerve block injections or neuromodulation devices for migraine treatment during pregnancy,” Dr. Verhaak says, noting that another study showed that headache specialists are comfortable with these treatments.

In addition, she says the use of triptans during pregnancy has been debated, with the American College of Obstetrics and Gynecology recently addressing the issue in new headache treatment guidelines, advising “cautious use” for persistent headache in pregnancy.

“This highlights the complexity of migraine treatment during pregnancy, including differing comfort levels across specialties and challenges of relying on safety data that show no adverse effect in pregnancy,” she says.

Looking ahead

The survey results, she continues, highlight the different comfort levels between medical specialists who may be treating pregnant women with migraine and highlight the importance of consulting and collaborating on care or providing cross-specialty education on migraine treatment guidelines.

“We are hoping to help bridge the knowledge, comfort and treatment gaps between different medical specialties who may care for patients with migraine during pregnancy. The ultimate goal is to increase cross-disciplinary conversations and standardized care for this important patient population,” Dr. Verhaak says.

In addition to Drs. Verhaak and Grosberg, co-authors of the study included maternal fetal medicine specialist Stephanie Bakaysa, MD; obstetrician/gynecologist Amy Johnson, MD; Maria Veronesi, MA; and Anne Williamson, PhD.