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Migraines and Pregnancy
Being pregnant can be a wonderful time for many women, but it does also include some unexpected realities and changes to your body. Listen as neurologist Dr. Laura Dresser discusses migraines and pregnancy, what causes them, how you know the difference between that and a regular headache, remedies and more.
Featured Speaker:
Dr. Dresser uses her expertise to help patients establish a rigorous diagnostic plan and appropriate management options that fit their lifestyle and personal goals.
Learn more about Dr. Laura Dresser
Laura P. Dresser, MD
Dr. Laura Dresser is a Board-Certified neurologist with additional fellowship training in Multiple Sclerosis and Neuroimmunology, as well as Women’s Neurology. Her main areas of interest and expertise include multiple sclerosis, neuromyelitis optica, autoimmune encephalitis, neurosarcoidosis, among other autoimmune diseases that affect the central nervous system. She also specializes in neurological complications of pregnancy, postpartum and menopause.Dr. Dresser uses her expertise to help patients establish a rigorous diagnostic plan and appropriate management options that fit their lifestyle and personal goals.
Learn more about Dr. Laura Dresser
Transcription:
Migraines and Pregnancy
Intro: This is BayCare Health Chat, another podcast from BayCare Health System.
Maggie McKay (Host): Being pregnant is a wonderful time for many women, but it does also include some unexpected realities and changes to your body. In this episode, we'll talk about one of those possibilities, migraines and pregnancy, what causes them, how do you know the difference between that and a regular headache, remedies and more. My guest today is neurologist, Dr. Laura Dresser, at BayCare specializing in women's neurology.
Welcome, Dr. Dresser. Thank you so much for being here today to talk about this important topic.
Dr Laura Dresser: Thank you for having me.
Maggie McKay (Host): Absolutely. So to begin, what is a migraine? Because I've never even heard of pregnancy migraines before.
Dr Laura Dresser: Sure. So, migraines are a type of headache syndrome and, usually, they cause very severe pain. They can be disabling and sometimes they can present with other neurological symptoms beyond headache. Migraine attacks are typically described as a pulsating or throbbing pain, and they can be associated with nausea and vomiting, sensitivity to light or sounds. These typical features are not always present, and headaches really can vary a lot from person to person. And even within the same person, one attack can look and feel quite similar to another.
Maggie McKay (Host): And so when you are pregnant, how common are these migraines?
Dr Laura Dresser: So, headaches in general are common during pregnancy, about 15% to 20% of pregnant women have migraines. And the percentage in the severity and the frequency of the headaches change a little bit during pregnancy.
Maggie McKay (Host): What causes migraines when we're pregnant? Because again, I didn't know that they went hand in hand with pregnancy. I've never ever heard of that.
Dr Laura Dresser: Sure. So to be honest, the exact cause of migraine in general is not fully understood. What we know is that migraine attacks involve changes in nerve pathways, in brain chemicals, and also blood flow of the brain. During pregnancy, hormonal changes play a pretty big role in how headaches behave. We believe that when you're pregnant, your estrogen levels are stable as compared to when you're not pregnant, and that can actually make headaches better. But for some pregnant women, there are other changes that are occurring in your body that can change the frequency of your headaches. For example, lack of sleep, changing eating patterns, as well as dehydration and stress.
Maggie McKay (Host): So, you talked a little bit about this, but can you expand on when somebody's pregnant, how does that affect migraine frequency and the severity? Is it worse when you're pregnant?
Dr Laura Dresser: So, that's a very good question. Over half of women that had migraines prior to pregnancy will experience an improvement in both the frequency and severity. And this is especially true during the second and the third trimester, and more so for women that had a history of migraine without aura. On the other hand, about 20% of women that had migraines prior to pregnancy will feel slightly worse or significantly worse. There are some women that just don't see any changes during pregnancy. And what is important to know is that, even though headaches can be worse during pregnancy, they're not affecting the baby or the fetus and their development.
Maggie McKay (Host): That's good news. Does stress play a part at all?
Dr Laura Dresser: For sure. What we see is that both physiological and social stress can affect migraine severity and frequency. So like I said before, if you are not sleeping well, eating well, or your general stress about bringing a new life into your home, that's going to affect how frequent you're having headaches.
Maggie McKay (Host): And can a woman who has never had migraines in her life get them when she's pregnant?
Dr Laura Dresser: Yes, you can experience your first ever headache and migraine during pregnancy. That is not uncommon. We still worry, especially if you're further along in your pregnancy and want to make sure we're not missing out on other causes of headache. So, your provider may want to pursue additional testing such as MRIs of the brain and the blood vessels.
Maggie McKay (Host): And so now that we know a little bit more about it, I know you mentioned in the beginning a few of the ways that we can tell the difference between a regular headache and a migraine, but can you just go over maybe the one or two main ways you can tell.
Dr Laura Dresser: Sure. So, it's basically a clinical diagnosis and, therefore, it's going to be how you feel. Migraine attacks are typically described as severe pain for most patients, and they can also be moderate attacks. They usually present as a throbbing or pulsating pain, and the pain tends to affect one side of the head. Some people do feel it all over the head though. And severe attacks can be associated with nausea, vomiting, a very typical feature of migraine is sensitivity to light and sounds. So if you have a headache and feel like sounds and noise and light make it significantly worse, it's possible that this is a migraine.
Maggie McKay (Host): Dr. Dresser, I always think when we are talking about pregnancy and all the things that come with it, it's so unfair. You're going through so many other things and then we can add migraines to the list, possibly. But it doesn't mean we're definitely going to have them. At least, we do know that for now. But seriously, they can be dangerous when you're pregnant. So, tell us about the risks of maternal stroke.
Dr Laura Dresser: For sure. So, outside of pregnancy, even women who have migraines, especially those who have migraine with aura, have an increased risk of stroke. What we know is that if you become pregnant and have a history of headaches, that risk increases slightly. Overall, the risk is low. You shouldn't avoid pregnancy if you have a history of migraine. But what we do know is that women that have migraines can also develop hypertensive disorders in pregnancy. For example, pre-eclampsia has a much higher risk. It's important that those women are followed closely because control of blood pressure and other cardiovascular risk factors can decrease the risk of stroke.
Maggie McKay (Host): How common is that, maternal strokes?
Dr Laura Dresser: The percentage is low. It's usually under 1% for the majority of women. The percentage increases slightly when you have a history of hypertension or when you develop hypertension in pregnancy, and that can be as high as 5%.
Maggie McKay (Host): So, the big question, is remedies. What are the remedies for migraines? Because during pregnancy, a lot of women don't want to take any kind of medicine. So, what do you do to get rid of them or to prevent them?
Dr Laura Dresser: So, I think key will be hydration. For any pregnant women, hydration is important whether you have headaches or not. But if you have a history of migraine, that's going to become even more important. Staying well hydrated is going to be key and can either be helpful for a headache that's happening or also to prevent headaches in general.
Caffeine is another thing that women avoid during pregnancy because they think it may be unsafe for baby, especially early on. But we know that caffeine can be helpful for migraine and it's been shown to be safe if you take it in moderation, to up to maximum of 200 milligrams per day. So, that's something that you can use as a treatment of headaches, not necessarily prevention.
And another very common thing that we do for pregnant women is magnesium. It can actually be helpful beyond migraines for muscle spasms, for mood, but it is shown to reduce the frequency and severity of migraines in both pregnant and non-pregnant women. You can pick magnesium over-the-counter and take it every day during pregnancy.
Now, there are obviously over-the-counter medications that you can take as needed. Everything that is a medication, whether it's over-the-counter or prescription, you want to make sure it's safe during pregnancy and consult with your OB-GYN. But you can continue some of these medications during pregnancy as well.
Maggie McKay (Host): And what would you like listeners to take away from our conversation?
Dr Laura Dresser: That migraines are common outside of pregnancy, but pregnancy can be a significant factor for increased frequency of migraine. For the majority of women though, migraines improve during pregnancy, so you have a bit of a honeymoon there. We didn't touch this during our story, but postpartum can also be an important risk factor for migraine worsening.
So if you have a history of migraine and are planning to become pregnant or are recently pregnant, make sure you touch base with your provider. And if your headaches are getting worse, there are treatments and neurologists and OB-GYNs can help you figure out a way to get your headaches under better control.
Maggie McKay (Host): All useful information. Thank you so much. We know so much more about migraines now and I'm sure it will be very helpful to people who are planning to become pregnant or who already are. So, thank you for sharing your expertise, Dr. Dresser.
Dr Laura Dresser: For sure. Thank you for having me.
Maggie McKay (Host): Again, that's Dr. Laura Dresser, neurologist at BayCare specializing in women's neurology. And that wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. For more health tips and updates, follow us on your social channels. If you found this podcast informative, please share it on your social media and be sure to check out all the other interesting podcasts in our library. I'm Maggie McKay. Thanks for joining us and be well.
Migraines and Pregnancy
Intro: This is BayCare Health Chat, another podcast from BayCare Health System.
Maggie McKay (Host): Being pregnant is a wonderful time for many women, but it does also include some unexpected realities and changes to your body. In this episode, we'll talk about one of those possibilities, migraines and pregnancy, what causes them, how do you know the difference between that and a regular headache, remedies and more. My guest today is neurologist, Dr. Laura Dresser, at BayCare specializing in women's neurology.
Welcome, Dr. Dresser. Thank you so much for being here today to talk about this important topic.
Dr Laura Dresser: Thank you for having me.
Maggie McKay (Host): Absolutely. So to begin, what is a migraine? Because I've never even heard of pregnancy migraines before.
Dr Laura Dresser: Sure. So, migraines are a type of headache syndrome and, usually, they cause very severe pain. They can be disabling and sometimes they can present with other neurological symptoms beyond headache. Migraine attacks are typically described as a pulsating or throbbing pain, and they can be associated with nausea and vomiting, sensitivity to light or sounds. These typical features are not always present, and headaches really can vary a lot from person to person. And even within the same person, one attack can look and feel quite similar to another.
Maggie McKay (Host): And so when you are pregnant, how common are these migraines?
Dr Laura Dresser: So, headaches in general are common during pregnancy, about 15% to 20% of pregnant women have migraines. And the percentage in the severity and the frequency of the headaches change a little bit during pregnancy.
Maggie McKay (Host): What causes migraines when we're pregnant? Because again, I didn't know that they went hand in hand with pregnancy. I've never ever heard of that.
Dr Laura Dresser: Sure. So to be honest, the exact cause of migraine in general is not fully understood. What we know is that migraine attacks involve changes in nerve pathways, in brain chemicals, and also blood flow of the brain. During pregnancy, hormonal changes play a pretty big role in how headaches behave. We believe that when you're pregnant, your estrogen levels are stable as compared to when you're not pregnant, and that can actually make headaches better. But for some pregnant women, there are other changes that are occurring in your body that can change the frequency of your headaches. For example, lack of sleep, changing eating patterns, as well as dehydration and stress.
Maggie McKay (Host): So, you talked a little bit about this, but can you expand on when somebody's pregnant, how does that affect migraine frequency and the severity? Is it worse when you're pregnant?
Dr Laura Dresser: So, that's a very good question. Over half of women that had migraines prior to pregnancy will experience an improvement in both the frequency and severity. And this is especially true during the second and the third trimester, and more so for women that had a history of migraine without aura. On the other hand, about 20% of women that had migraines prior to pregnancy will feel slightly worse or significantly worse. There are some women that just don't see any changes during pregnancy. And what is important to know is that, even though headaches can be worse during pregnancy, they're not affecting the baby or the fetus and their development.
Maggie McKay (Host): That's good news. Does stress play a part at all?
Dr Laura Dresser: For sure. What we see is that both physiological and social stress can affect migraine severity and frequency. So like I said before, if you are not sleeping well, eating well, or your general stress about bringing a new life into your home, that's going to affect how frequent you're having headaches.
Maggie McKay (Host): And can a woman who has never had migraines in her life get them when she's pregnant?
Dr Laura Dresser: Yes, you can experience your first ever headache and migraine during pregnancy. That is not uncommon. We still worry, especially if you're further along in your pregnancy and want to make sure we're not missing out on other causes of headache. So, your provider may want to pursue additional testing such as MRIs of the brain and the blood vessels.
Maggie McKay (Host): And so now that we know a little bit more about it, I know you mentioned in the beginning a few of the ways that we can tell the difference between a regular headache and a migraine, but can you just go over maybe the one or two main ways you can tell.
Dr Laura Dresser: Sure. So, it's basically a clinical diagnosis and, therefore, it's going to be how you feel. Migraine attacks are typically described as severe pain for most patients, and they can also be moderate attacks. They usually present as a throbbing or pulsating pain, and the pain tends to affect one side of the head. Some people do feel it all over the head though. And severe attacks can be associated with nausea, vomiting, a very typical feature of migraine is sensitivity to light and sounds. So if you have a headache and feel like sounds and noise and light make it significantly worse, it's possible that this is a migraine.
Maggie McKay (Host): Dr. Dresser, I always think when we are talking about pregnancy and all the things that come with it, it's so unfair. You're going through so many other things and then we can add migraines to the list, possibly. But it doesn't mean we're definitely going to have them. At least, we do know that for now. But seriously, they can be dangerous when you're pregnant. So, tell us about the risks of maternal stroke.
Dr Laura Dresser: For sure. So, outside of pregnancy, even women who have migraines, especially those who have migraine with aura, have an increased risk of stroke. What we know is that if you become pregnant and have a history of headaches, that risk increases slightly. Overall, the risk is low. You shouldn't avoid pregnancy if you have a history of migraine. But what we do know is that women that have migraines can also develop hypertensive disorders in pregnancy. For example, pre-eclampsia has a much higher risk. It's important that those women are followed closely because control of blood pressure and other cardiovascular risk factors can decrease the risk of stroke.
Maggie McKay (Host): How common is that, maternal strokes?
Dr Laura Dresser: The percentage is low. It's usually under 1% for the majority of women. The percentage increases slightly when you have a history of hypertension or when you develop hypertension in pregnancy, and that can be as high as 5%.
Maggie McKay (Host): So, the big question, is remedies. What are the remedies for migraines? Because during pregnancy, a lot of women don't want to take any kind of medicine. So, what do you do to get rid of them or to prevent them?
Dr Laura Dresser: So, I think key will be hydration. For any pregnant women, hydration is important whether you have headaches or not. But if you have a history of migraine, that's going to become even more important. Staying well hydrated is going to be key and can either be helpful for a headache that's happening or also to prevent headaches in general.
Caffeine is another thing that women avoid during pregnancy because they think it may be unsafe for baby, especially early on. But we know that caffeine can be helpful for migraine and it's been shown to be safe if you take it in moderation, to up to maximum of 200 milligrams per day. So, that's something that you can use as a treatment of headaches, not necessarily prevention.
And another very common thing that we do for pregnant women is magnesium. It can actually be helpful beyond migraines for muscle spasms, for mood, but it is shown to reduce the frequency and severity of migraines in both pregnant and non-pregnant women. You can pick magnesium over-the-counter and take it every day during pregnancy.
Now, there are obviously over-the-counter medications that you can take as needed. Everything that is a medication, whether it's over-the-counter or prescription, you want to make sure it's safe during pregnancy and consult with your OB-GYN. But you can continue some of these medications during pregnancy as well.
Maggie McKay (Host): And what would you like listeners to take away from our conversation?
Dr Laura Dresser: That migraines are common outside of pregnancy, but pregnancy can be a significant factor for increased frequency of migraine. For the majority of women though, migraines improve during pregnancy, so you have a bit of a honeymoon there. We didn't touch this during our story, but postpartum can also be an important risk factor for migraine worsening.
So if you have a history of migraine and are planning to become pregnant or are recently pregnant, make sure you touch base with your provider. And if your headaches are getting worse, there are treatments and neurologists and OB-GYNs can help you figure out a way to get your headaches under better control.
Maggie McKay (Host): All useful information. Thank you so much. We know so much more about migraines now and I'm sure it will be very helpful to people who are planning to become pregnant or who already are. So, thank you for sharing your expertise, Dr. Dresser.
Dr Laura Dresser: For sure. Thank you for having me.
Maggie McKay (Host): Again, that's Dr. Laura Dresser, neurologist at BayCare specializing in women's neurology. And that wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. For more health tips and updates, follow us on your social channels. If you found this podcast informative, please share it on your social media and be sure to check out all the other interesting podcasts in our library. I'm Maggie McKay. Thanks for joining us and be well.