Migraine is a neurological condition that affects nearly three times more women than men. Hormones — and their fluctuations each month around menstruation — are one explanation for this trend. The effect of hormones on migraine is also observed during pregnancy.

If you are pregnant, you may notice changes in your migraine attacks. You may even experience a migraine attack for the first time during pregnancy. However, about 50 percent to 80 percent of pregnant people with migraine actually experience a reduction in their migraine attacks during pregnancy, particularly in the second and third trimesters. An increase in estrogen levels may explain why this can happen. However, some people may experience more frequent or more severe migraine symptoms during pregnancy.

Migraine attacks during pregnancy themselves are not dangerous for the developing fetus. However, certain migraine treatments and medications may affect the safety of a pregnancy and increase the risk of birth defects. Some people with migraine are also at an increased risk of pregnancy complications.

There are many factors to consider if you live with migraine and are pregnant or want to become pregnant. If you see a neurologist or migraine specialist, it’s important to have them communicate with your obstetrician before, during, and after your pregnancy. This way, they can be on the same page about how to manage your migraine symptoms and pregnancy.

Migraine Symptoms and Pregnancy

The type of migraine symptoms you experience and their severity may vary depending on which trimester of pregnancy you’re in.

The First Trimester

Pregnancy may potentially make migraine symptoms worse in the first trimester. During the first three months of pregnancy, hormone changes and symptoms like morning sickness can make migraine symptoms worse. Morning sickness, including nausea and vomiting, may cause you to eat and drink less. This could lead to low blood sugar, dehydration, headaches, and migraine attacks.

The Second and Third Trimesters

In the second and third trimesters of pregnancy, more than half of pregnant people experience fewer migraine symptoms. This is thought to be caused by higher levels of estrogen and endorphins, hormones that are natural painkillers.

“I am 19 weeks pregnant, and ever since I got pregnant, my migraines have stopped,” wrote a member of MyMigraineTeam. Another member said, “My migraines were 100 percent gone while I was pregnant and breastfeeding. My doctor actually said it is very common.”

First Migraine in Pregnancy

Unfortunately, some people will experience migraine attacks for the first time during pregnancy. “My migraines first started when I was pregnant 18 years ago,” wrote one member.

Experiencing a migraine attack for the first time during pregnancy could be a sign of a more serious underlying health issue. You should tell your doctor if you experience your first migraine attack while pregnant. It could be an indication of dangerous conditions like bleeding in the brain, a tumor, or meningitis (an inflammatory brain infection).

According to the American Migraine Foundation, studies show that worsening migraine symptoms and high blood pressure during pregnancy can increase the risk of preeclampsia, a serious pregnancy complication characterized by high blood pressure.

It’s important to work with your health care providers — both your neurologist and obstetrician — to monitor your migraine symptoms during pregnancy.

Migraine Medications and Pregnancy

Many people who live with migraine take medications to manage their symptoms. But how do these medications affect people who are trying to get pregnant, are already pregnant, or are breastfeeding?

Using Medications During Pregnancy

Health care providers usually advise avoiding migraine medications during pregnancy and breastfeeding if possible. Medications can pass through the placenta (the organ that provides oxygen and nutrients to the fetus during pregnancy) and breast milk. They may pose risks to the fetus or newborn.

If you are pregnant, you should discuss any medications you take for migraine with your doctor. Decisions about migraine medication during pregnancy are unique to each individual. Doctors will weigh the risks and benefits of each medication. Sometimes, they may prescribe small amounts of medication if other nondrug treatments do not work and your migraine attacks lead to sleep deprivation, stress, malnutrition, severe pain, or depression.

General Recommendations

Low doses of acetaminophen (Tylenol), caffeine, propranolol (Inderal and InnoPran XL), and amitriptyline are generally safe for pregnant people, with a doctor’s guidance. Do not take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) during pregnancy.

Several vitamins and supplements may help reduce how often you experience migraine flare-ups. Folic acid may also reduce the harmful effects of some other medications on your developing baby. It is important to talk to your doctor to see if vitamins may help you.

Because drugs cannot be tested on pregnant or breastfeeding people, there isn’t valuable research on the safety of drugs during pregnancy. Doctors recommend medications with caution based on each person’s individual circumstances. The U.S. Food and Drug Administration (FDA) has some guidelines for taking medications during pregnancy.

It is very important to work with your doctors to determine the best treatment for your migraine symptoms during pregnancy. Never take over-the-counter or prescription pain medications without your doctor’s advice, as they may harm you or your developing baby.

Managing Migraine During Pregnancy

Managing migraine symptoms during pregnancy can be difficult, especially since pregnancy often comes with its own challenging symptoms.

“Just getting over 24 hours of migraine. It’s really hard while pregnant and trying not to take my meds,” wrote one MyMigraineTeam member.

Most medications should be avoided during pregnancy, but nondrug treatment options can help you manage migraine symptoms. These include:

• Maximizing your comfort during a migraine attack with a cold compress, darkened room, and sleep
• Avoiding known migraine and headache triggers, like specific foods and stress
• Trying complementary and alternative treatments like massage, acupuncture, relaxation techniques, and biofeedback, with your doctor’s approval
• Staying hydrated
• Trying physical therapy for poor posture, which can lead to headaches
• Getting eight hours of sleep every night

“Acupuncture, massage therapy, and yoga are really great even when not pregnant,” wrote one member.

Always consult your doctor before trying any natural or homeopathic remedies. In addition, talk to your health care team about your migraine symptoms during pregnancy. They may have other ideas for nondrug treatments and resources that may help your migraine symptoms (plus other types of head pain, like tension headaches) during pregnancy.

Migraine After Childbirth

While migraine symptoms typically improve in the second and third trimesters of pregnancy, they may come back shortly after giving birth. Some people experience migraine attacks several days after giving birth. Others get them once their period returns. The reemergence of migraine attack is thought to be caused by a drop in estrogen levels and factors like exhaustion, dehydration, and low blood sugar after giving birth.

Managing Migraine Attacks

During this period, you should still avoid medications for migraine, as they can be passed on to the baby through breast milk. Talk to your doctor, obstetrician, and lactation specialist about your options while breastfeeding. They will help determine a treatment plan so you can safely manage your migraine pain.

Caring for a newborn baby can often result in exhaustion, lack of sleep, and stress, which may trigger migraine flares. Likewise, pain from a migraine attack may make it difficult to care for a newborn. Do not be afraid to ask for help from your partner, family, or close friends in caring for your baby if you are struggling with migraine attacks. They should be able to sympathize with what you’re going through and offer support.

Talk With Others Who Understand

MyMigraineTeam is the social network for people with migraine and their loved ones. On MyMigraineTeam, more than 77,000 members come together to ask questions, give advice, and share their stories with others who understand life with migraine.

Have you dealt with migraine symptoms during pregnancy? Share your experience in the comments below, or start a conversation by posting on your Activities page.