Course of Migraine During Pregnancy and Postpartum: A Prospective Study

Abstract

The aim of this study was to investigate prospectively the course of migraine during pregnancy and postpartum. Of all the pregnant women consecutively attending an obstetrics and gynaecology department for a routine first-trimester antenatal check-up, 49 migraine sufferers - two were affected by migraine with aura (MA) and 47 by migraine without aura (MO) - who had experienced at least one attack during the 3 months preceding pregnancy were identified, enrolled in the study and given a headache diary. Subsequent examinations were performed at the end of the second and third trimesters and 1 month after delivery. Migraine was seen to improve in 46.8% of the 47 MO sufferers during the first trimester, in 83.0% during the second and in 87.2% during the third, while complete remission was attained by 10.6%, 53.2%, and 78.7% of the women, respectively. Migraine recurred during the first week after childbirth in 34.0% of the women and during the first month in 55.3%. Certain risk factors for lack of improvement of migraine during pregnancy were identified: the presence of menstrually related migraine before pregnancy was associated with a lack of headache improvement in the first and third trimesters, while second-trimester hyperemesis, and a pathological pregnancy course were associated with a lack of headache improvement in the second trimester. Breast feeding seemed to protect from migraine recurrence during postpartum.

Migraine and pregnancy: an internet survey

“…The figure for the significant improvement in headache during lactation, which emerged from the answers to our survey, is substantially in line with that in the literature [9].…”

Exclusive breastfeeding protects against postpartum migraine recurrence attacks?

“…However, a protective association between breastfeeding and migraine recurrence in the postnatal period was previously observed 7 .…”

“…The most accepted hypothesis for the physiopathology of attacks during menstruation lies in the sharp decrease of estrogens durestrogens dur-during the premenstrual period 1,5,6 . However, the majority of the pregnant women that are migraine sufferers before pregnancy show migraine improvement or even disappearance during pregnancy 7,8 . Absence of cyclical hormonal fluctuations during pregnancy, mainly estrogens that rise during this period, is pointed as one of the most important causes of such behavior 4,8 .…”

“…The protective effect of the gestational period ceases rapidly in the postpartum period and migraine returns to its normal course 7 . However, a protective association between breastfeeding and migraine recurrence in the postnatal period was previously observed 7 .…”

“…The sample was calculated taking into account information from a study by Sances et al 7 . In this study, the recurrence of the migraine attacks in the first postpartum week was 21.6% (95%CI 9.8-38.2), among women who breastfeed exclusively, and 80.0% (95%CI 44.4-97.0%), among those who used infant formula.…”