September 29, 2020
2 min read
Ishii reports no relevant financial disclosures. Schwedt reports serving as a consultant for Alder, Allergan, Amgen, Avanir, Biohaven, Cipla, Click Therapeutics, Dr. Reddy’s, Eli Lilly, Equinox, Ipsen Bioscience, Nocira, Novartis, Salvia, Teva, Xoc Pharmaceuticals, Weber and Weber; having stock options in Aural Analytics, Nocira and Second Opinion; and receiving research funding from Amgen, American Migraine Foundation, Arizona State University, Henry Jackson Foundation, National Institutes of Health, Patient Centered Outcomes Research Institute, and U.S. Department of Defense. Schwedt also reports serving on the Board of Directors for the American Headache Society and the International Headache Society.
Nearly 20% of women with migraine reported avoiding pregnancy because of the condition, according to research published in Mayo Clinic Proceedings.
Researchers evaluated responses on family planning from women with migraine who participated in the American Registry for Migraine Research, an observational study that recruited participants at headache specialty clinics in the United States.
The analysis included 607 women with migraine who completed questionnaires from February 2016 to September 2019. Among them, 19.9% reported that they avoided pregnancy. Researchers determined that women who avoided pregnancy were younger, had fewer children and were more likely to have chronic migraine compared with those who did not avoid pregnancy.
Among women who avoided pregnancy due to migraine, 72.5% thought their migraine would worsen during pregnancy, 68.3% believed that disability caused by migraine would make their pregnancy difficult and 76% thought that migraine medications would affect their child’s development. In addition, 72.7% of those who avoided pregnancy were concerned that they would pass genes to their children that could cause them to have an increased risk for migraine.
Healio Primary Care spoke with Ryotaro Ishii, MD, PhD, a visiting scientist at Mayo Clinic, Phoenix, and Todd J. Schwedt, MD, chair of neurology research at Mayo Clinic, to learn more about how pregnancy affects migraine and what primary care physicians should tell women with migraine who are concerned about pregnancy.
Q: Do migraines worsen during pregnancy?
Ishii: Migraine usually improves during pregnancy, especially among patients who have migraine without aura, migraine that started with menarche, or menstrual migraine. According to the previous literature, about one-half to three-fourths of those with migraine experience a marked improvement in migraine during pregnancy, with a significant reduction in the frequency and intensity of their attacks, in particular during the second and the third trimesters.
Q: Many women expressed concerns about migraine medications harming their child’s development. What migraine treatments should PCPs and patients be aware of that are safe to use during pregnancy?
Ishii: The prognosis of migraine during pregnancy is generally good. So, the use of acute treatments can typically be limited and used in a stepwise or stratified way, while prophylactic medications are often unnecessary during pregnancy. When acute and preventive migraine medications are necessary, safety must be considered.
Schwedt: Fortunately, the majority of women have substantial improvements in their migraine patterns during pregnancy, limiting the need for medication. When treatment is needed, there are certain medications and non-medication options that are associated with less risk. It is essential that women who are planning pregnancy or who are pregnant discuss treatment options with their clinician.
Q: What can physicians do to help educate women about the impact of pregnancy on migraine?
Ishii: Clinicians need to recognize that migraine often has a substantial burden on multiple aspects of life, including one’s plans for having children. Clinicians should educate their patients who are considering pregnancy about the most likely course of migraine during pregnancy, migraine treatment during pregnancy, and the potential impacts of migraine and its treatment on pregnancy outcomes.
Q: When should PCPs refer pregnant patients with migraine to a specialist?
Schwedt: It is difficult to specify thresholds for exactly when referral is indicated since the answer depends largely on the primary care provider’s level of expertise. The primary care provider will be successful in helping the majority of their migraine patients through their pregnancies. Patients who have worsening or difficult-to-manage migraine during pregnancy need to be evaluated for possible underlying causes and potentially referred to a neurologist or headache specialist.