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  • Review Article
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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

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Acknowledgements

Charles P. Vega, University of California, Irvine, CA, is the 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.

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Correspondence to Cheryl D. Bushnell.

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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

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