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Many women who have migraines and headaches seem to watch their head pain disappear during pregnancy. Almost 70% of women with a history of migraine headaches improve during this time. Unfortunately, 30% don't improve. They stay the same or get worse. Let's be clear..I am talking about moderate to severe headaches that are not relieved by Tylenol.
The headache in pregnancy may become more frequent and more severe as estrogen levels rise in the first trimester. If you are one of these women, you might improve if under the care of both your OB/GYN and a neurologist.
If this is a new onset of headaches or migraines then this could be an emergency. Please call your doctor and tell them if you have headaches you've never had before. A moderate to severe headache in pregnancy should be taken seriously. High blood pressure during pregnancy can be serious and could cause a bad headache. Conditions such as this are bad for the mother and the baby.
Treatment of Migraine in Pregnancy
As mentioned, these headaches can be severe. If accompanied by nausea and vomiting that should be treated too to avoid stress on the baby. Tylenol with codeine is the drug of choice during the first trimester, to be used at the onset of the migraine. Additionally, you can be on daily medication during this time. We usually place our patients on Inderal (propranolol) low dose, 10-20mg per day to start. Usually a low dose like this is sufficient. Rarely, we do use low doses of an anti-seizure drug and although these medications are not recommended for pregnancy, once again the risk to the both the mother and baby must be weighed.
Can you have triptans, like Imitrex, while you are pregnant? We get this question alot and generally speaking NO you cannot take your triptan during this time. Most OB/GYN's and primary care physicians would agree.
HOWEVER...if your headaches are so severe the Tylenol with codeine, or even Lortab, is not working, then you should see a headache specialist. ONLY A NEUROLOGIST, working with your OB/GYN should determine if you can have a triptan during pregnancy.
Although medication should be avoided during pregnancy, if the risk to you is greater then the condition should be treated. Severe pain of chronic headache increases adrenaline levels. This increases the baby's heart rate and your blood pressure rises.
Occasionally, we do prescribe daily medication for mothers who have severe pain with nausea and vomiting. This should be guided by both your OB/GYN and your headache specialist.
MRI and CT Scans During Pregnancy
Many people ask me about MRI's, CT scans and being pregnant. You should not have a CT of the brain while pregnant. This is a form of X-Ray and is not good for the forming fetus.
But, if a doctor deems it is necessary you can have an MRI or MRA of the brain. MRI's use magnetic fields. MRA's are similar but only look at the arteries in the brain, not the brain itself, like MRI's. MRI's are not generally done when you are pregnant and we do not do them if the diagnosis is clear cut..such as a recurrence of migraines. But if needed, we do them right away. Rarely, I have seen brain tumors and aneurysms (out pouching of arteries) in pregnancy. Remember, medical intervention is warranted if the health of the mother is at risk. If you are in trouble, the baby is in trouble.
Speak to your provider about your headaches. Headaches and pregnancy is not something to just be endured. This should be one of the happiest times of your life, not one of the most miserable.
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