Migraines Before Pregnancy Are Associated With an Increased Risk of Preterm Birth and Preeclampsia

Many women suffer from migraines. These excruciating headaches can severely impact the quality of life, especially during pregnancy, which can lead to many changes. Recent research has now  found that migraines before and during pregnancy can be dangerous as they can lead to maternal health problems and negative pregnancy outcomes.

Migraines and Pregnancy Complications

Women are disproportionately affected by migraines, especially during their reproductive years. Women are two to three times more likely than men to experience migraines in their lifetime. This type of headache is most common in women between the ages of 18 and 44. For some, the migraine headache may be accompanied by an aura (5.5% of the population), which is usually a visual disturbance that occurs before the headache begins. However, the relationship between migraines and adverse pregnancy outcomes is not yet as clear. A study by researchers at Brigham and Women’s Hospital, a founding member of Mass General Brigham’s health system, analyzed data from thousands of women from the Nurses’ Health Study II to assess the relationship between migraines and pregnancy complications. In an article published in Neurology, the team reports that migraines diagnosed before pregnancy have been associated with adverse outcomes during pregnancy, including preterm birth, hypertension and preeclampsia, suggesting that migraines may be a clinical marker of increased obstetric risk .

Preterm birth and hypertensive disorders are some of the major causes of maternal and infant morbidity and mortality. The study results suggest that a history of migraine should be considered as an important risk factor for these complications and could be helpful in identifying women who might benefit from increased surveillance during pregnancy. Adverse pregnancy outcomes and migraines, particularly migraines with aura, are associated with an increased risk of coronary artery disease and ischemic stroke in women, according to previous research. The underlying biology responsible for these risks could also increase the likelihood of pregnancy complications. But so far, few small or retrospective studies have examined migraine as a risk factor for pregnancy complications. No prospective studies have examined risks by aura phenotype (migraine with versus without aura).

Migraines Before Pregnancy Increase the Risk of Preterm Birth and Preeclampsia

Purdue-Smithe and colleagues analyzed data from the large, prospective Nurses’ Health Study II, which included 30,555 pregnancies from 19,694 US nurses. Researchers examined self-reported, physician-diagnosed migraines before pregnancy and the migraine phenotype (migraines with and without aura) and the incidence of self-reported pregnancy outcomes. Because of the large size of the study population and the availability of data on other health and behavioral factors, researchers were able to control their analyzes for potential confounders such as body mass index, chronic hypertension, and smoking. They found that migraines before pregnancy were associated with a 17 percent higher risk of preterm birth, a 28 percent higher rate of gestational hypertension, and a 40 percent higher rate of preeclampsia compared to no migraines. Migraine with aura was associated with a slightly higher risk of preeclampsia than migraine without aura. However, migraines were not associated with low birth weight or gestational diabetes.

Participants with migraines who used aspirin regularly (more than twice a week) before pregnancy had a 45 percent lower risk of preterm birth. The US Preventive Services Task Force currently recommends low-dose aspirin during pregnancy for people at high risk of preeclampsia and people with more than a moderate risk factor for preeclampsia. Clinical studies have shown that low-dose aspirin during pregnancy also reduces the rate of preterm birth. However, the researchers note that migraines are not currently among the indications for the use of aspirin in pregnancy. This would require further clinical studies.

Some other limitations of the study include that participants only reported if they had a medical diagnosis of migraines, likely excluding those who did not have chronic or severe migraines. Furthermore, the aura was assessed after migraine diagnosis and after many pregnancies in the cohort, possibly leading to some degree of reverse causality in analyzes examining the migraine phenotype.

Effective Ways to Combat Migraines

Over-the-counter pain relievers can help women with migraines. There are also drugs that can prevent this type of headache. During pregnancy, however, such medicines may only be taken after consultation with your doctor! In addition, there are natural ways to counteract migraines. These include regular exercise, relaxation techniques and biofeedback. Cognitive behavioral therapy can also be useful. In addition, there are special teas (especially ginger, cowslip, willow bark) and homeopathic remedies to combat migraines. Avoiding caffeine, tyramine and histamine can also be helpful.