Migraine is a common neurological disorder that affects women more than men. Clinical estimates suggest that the ratio of women to men suffering from Migraine is 4:11. This debilitating condition is prevalent in 4% women during their puberty to 25% women of reproductive age1. A gradual decrease in the frequency and intensity of pain in observed during the peri-menopause and menopausal stages. However, pregnancy is one phase, when migraine attacks are least and provides a temporary relief to the pregnant migraineur.
Hormonal influence on migraine:
It is common knowledge that there is a correlation between migraine and hormones. Fluctuation in hormones every month and a sudden decrease in levels of oestrogen is believed to play a key role in triggering migraine attack, which is also known as menstrual migraine1. It is also seen that women who take combined oral contraceptives experience a migraine attack during the weeks of hormonal suppression. This complex relationship between drop in oestrogen levels and migraine has been consistently proven by recent research; however, many questions are still unanswered regarding the mechanism and pathway through which it triggers a migraine attack.
Migraine attacks during pregnancy:
It is observed that the frequency of migraine attacks considerably declines during the second and third trimester since the course of migraine is linked with levels of oestrogen in the body. When conception occurs, the corpus luteum maintains the balance and levels between progesterone and oestrogen for the first trimester and later this role is taken over by the placenta. As the levels of both hormones are maintained during the remainder of pregnancy, prevalence of migraine attacks declines1.Additionally, an increase in the beta-endorphins (chemicals released by the central nervous system and pituitary gland) during pregnancy, which is also known to possess anti-nociceptive properties, is attributed for a decline in migraine attack during pregnancy1. Many clinical data have confirmed this theory and hence it is believed to play a key role in reduced migraine frequency during pregnancy.
However, there are many women who complain of migraine attacks during the course of their pregnancy. Here anxiety, nausea, changes in body related to pregnancy etc are thought to play a key role. Also, many women suffer from pre-eclampsia (high blood pressure) during pregnancy that can cause a headache. Hence, it is easy to confuse between a normal headache and migraine.
Treatment of migraine during pregnancy:
Pregnancy is a very sensitive phase of a woman’s life. Many medicines are contraindicated in pregnancy as they can cross the placental barrier and harm the foetus. The status of drugs used in migraine (such as triptans) is not established yet, hence to be on safer side, these medications are contraindicated in pregnancy. Therefore, doctors usually advice non-drug treatments such as massages, relaxation and sleep, icepacks etc. however, there are certain medicines such as paracetamol, ibuprofen when taken in smaller doses can provide temporary relief from headache without much side effects.2
- Arq. Neuro-Psiquiatr. vol.69 no.4 São Paulo Aug. 2011 http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2011000500008&lng=en&nrm=iso&tlng=en
- Drug Saf. 1998 Nov;19(5):383-8. http://www.ncbi.nlm.nih.gov/pubmed/9825951