A migraine is more than just a headache; it's a neurological condition that involves much more severe pain. Of the 30 million migraine sufferers in the U.S., about 80 percent are women. But there's good news: 58 percent of women find that their migraines go away (or at least become milder) during pregnancy. For others, they disappear after the first trimester. That's because, for many women, migraines are triggered by the hormonal fluctuations around their periods. But once they get pregnant and pass the first trimester, their hormones remain at a steady level.
That's what happened to Brandy Surber, of Stanaford, West Virginia. "Since becoming pregnant, I've had fewer migraines," she says. "During my first trimester, though, I experienced three or four." When she contacted her doctor, she learned that her regular medication was off-limits during pregnancy.
In fact, the most popular migraine painkillers are considered category C, which means we don't know if they're safe or not, says Merle Diamond, MD, associate director of the Diamond Headache Center, in Chicago. She adds, however, that in certain cases, a doctor might determine that an NSAID (non-steroidal anti-inflammatory drug) is in her patient's best interest. Another class of migraine drugs, ergotamine derivatives (like Cafergot), is category X. "Never use them, ever," Dr. Diamond says. This lack of options frustrated Surber, who says that prior to becoming pregnant, "I'd gotten used to treating my migraines instead of riding them out."
The problem is even more difficult for those women (an unlucky minority) whose migraines become more intense and frequent during pregnancy. So what can a migraine sufferer do? "Focus on trying to prevent them," says Dr. Aurora. She suggests nonpharmacological options like biofeedback, physical therapy, massage, or acupuncture. And, obviously, avoid your personal migraine triggers. Gradually, Surber has found natural ways to manage her pain. "It's lessened by elevating my legs, drinking more water, and taking a 30-minute nap," she says. "I'm going to do my best to try to stay medicine free while breastfeeding!"
If "medicine free" just isn't for you, ask your doctor for viable drug options. "We use Tylenol with codeine pretty comfortably," says Dr. Diamond. Beta-blockers, which are used to lower blood pressure, can also prevent migraines and are considered relatively safe during pregnancy. If the pain is accompanied by vomiting, your doctor might prescribe an anti-nausea medication like Zofran. Chances are, she is aware of other safe medications as well, and there's nothing wrong with asking.
They may be painful, but keep in mind that most headaches are harmless. Even migraines haven't been shown to pose a risk to your baby. Here's an encouraging reminder: "Once you break a headache," says Dr. Schapiro, "it usually stops [for good]." So you can focus on your other pregnancy complaints. Constipation, anyone? Aching back?