What's behind an alarming report of a connection between those nasty headaches called migraines and problems at birth? Doctors solve the mystery.
As if getting migraines isn't bad enough already, a new study on them could give pregnant women an even bigger headache. The research, to be presented at the American Academy of Neurology's annual meeting next month, shows that expectant moms who had migraines severe enough to seek care were more likely to have complications toward the end of pregnancy, like preterm delivery, preeclampsia and low birth weight.
Researchers at Montefiore Health System in the Bronx, N.Y., looked at pregnancy and delivery records of 90 pregnant women who had neurology consultations for a migraine, over a five-year period. Over half of the women (54.4 percent) had at least one adverse outcome: Almost 30 percent had a preterm delivery (compared to nearly 10 percent in the general population), about 20 percent had preeclampsia (compared to five to eight percent), and 19 percent had babies with low birth weight (compared to eight percent).
Although the sample size was small, the dramatic increase in negative outcomes among expectant moms with migraines raises a red flag. "Studies in recent years have demonstrated that women with a history of migraine have an increased risk of various pregnancy complications," study author Matthew S. Robbins, M.D., chief of neurology at Jack D. Weiler Hospital of Montefiore and associate professor of clinical neurology at Albert Einstein College of Medicine, tells Fit Pregnancy. "What has not been clear from past studies is if having active, severe migraine while pregnant would impact outcomes for that very pregnancy at delivery."
Women 35 and older were seven times more likely to have these complications, which makes sense because older moms are at higher risk in general. "Migraine may independently increase that risk in this age group because it may lead to elevated inflammation or blood vessel changes," Dr. Robbins says. "This might worsen blood flow to the placenta in older women who are already susceptible to such complications."
The cause of the link between migraines and problems at birth isn't clear, but Dr. Robbins suspects it has something to do with the havoc these headaches wreak on the body. "Migraine is a brain disease that impacts cardiovascular and overall health and well-being," he says. "It is associated with many other medical problems that may increase the risk for more complicated pregnancies." This includes preeclampsia, which shares many features with migraines including headache and visual disturbance. Both also lead to inflammation and abnormal functioning of blood vessels around the brain, he says.
Most of the women in the study (62.2 percent) were treated with either acetaminophen (Tylenol) orally, or given intravenous (IV) anti-nausea drugs or antihistamines. But Dr. Robbins doesn't think the meds caused the delivery complications, instead of the migraines themselves. "Our study didn't specifically address this question," he says. "However, I don't think that it's related to the medications, since most women received medications that have a good track record for safety in pregnant women."
What to do?
A larger study is needed to confirm this research and find the potential reasons behind it. Also, outcomes for women whose migraines were not severe enough to get treatment need to be explored. But even so, Dr. Robbins says that pregnant women should definitely not ignore a migraine. "I would advise such women to be proactive and seek care—there are many available, safe treatments," Dr. Robbins says. Not wanting to receive meds could actually be worse for baby. "Frequent pain, nausea and other neurological symptoms may impact both the well-being of the pregnant mother and her baby."
Symptoms of migraines include sensitivity to light and sound, nausea, vomiting and vision problems. If you get these really bad headaches and are not yet pregnant, Dr. Robbins suggests planning ahead and talking to a specialist. If you're already pregnant and are experiencing frequent migraines, ask your OB or midwife about being followed by a high-risk doctor, he says. Hormonal changes are one trigger of migraines in pregnancy, but stress, skipping meals and lack of sleep can also bring them on. So remember to take care of yourself—that's the best way to take care of baby, too.