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Nearly 33 million Americans suffer
from migraine, and the majority of those are women. It stands to
reason that many women in their childbearing years will suffer from
migraine disease. What does a pregnant mother-to-be do to treat her
disease? An automatic and immediate response may be to reach for some
medication, but expectant mothers and their doctors should do careful
research of any medication used for migraine in order to protect the
developing baby.
Migraine
attacks can change during pregnancy, and there is some good news
right from the start; 60 to 80 percent of expectant mothers will see
an improvement in their migraine patterns during their pregnancies.
Hormonal changes in pregnancy
probably account for the relief many pregnant women realize.
Migraine relief will usually last until shortly after the birth of
the baby, unless the mother chooses to breastfeed; then her relief
may last until the baby weans. There are some women who will have
worsening symptoms of their migraines, especially during the first
trimester.
If
an expectant mother does not get relief from migraine attacks during
her pregnancy or the migraine attacks worsen, with careful
consideration, there are several ways to address the situation.
Migraine
management during pregnancy presents special problems because of
limitation on medication use. Female patients are encouraged to
postpone their pregnancy until their migraines are stable and
manageable. Then, preventive medications can be slowly
discontinued prior to pregnancy.
In
the ideal situation, the pregnant mother would not require
medications of any kind. Non-pharmacologic measures should be
encouraged as a first-line treatment for migraine in pregnant women –
measures such as trigger identification, lifestyle change, ice, rest,
biofeedback and relaxation.
But,
if a pregnant mother needs medication, the doctor should use
medications with a high degree of safety and avoid one with a known
risk or unknown risk. Depending on the severity and frequency of
the expectant mother’s migraines, medications would be used for
relief or for preventive measures.
(Timothy R. Smith, MD, RPh. Smith is
the director of the Ryan Headache Center in St. Louis, Missouri.
Deborah Wirtel (La
Leche League International) January 2004).
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