Migraine Often a Deciding Factor in Pregnancy Planning

Erik Greb

July 01, 2020

Migraine can significantly influence a woman's decision to have children, new research shows.

Results from a multicenter study of more than 600 women showed that among participants with migraine, those who were younger, had menstrual migraine, or had chronic migraine were more likely to decide not to become pregnant.

Although women with migraine who avoided pregnancy believed their migraines would worsen during pregnancy or make their pregnancy difficult, previous observational research indicates that migraine often improves during pregnancy.

Dr Ryotaro Ishii

"Women who avoided pregnancy due to migraine were most concerned that migraine would make raising a child difficult, that the migraine medications they take would have a negative impact on their child's development, and that their migraine pattern would worsen during or just after pregnancy," study investigator Ryotaro Ishii, MD, PhD, a visiting scientist at Mayo Clinic in Phoenix, Arizona, told Medscape Medical News.

The findings were presented at the American Headache Society (AHS) Annual Meeting 2020, which was conducted virtually this year because of the COVID-19 pandemic.

Future Plans

There is a paucity of research on the impact of migraine on pregnancy planning, the researchers note. The few studies that have investigated this issue have focused on women's previous family planning decisions and experience, rather than on future plans, the researchers note.

To evaluate how migraine in women influences pregnancy planning, the investigators analyzed data from the American Registry for Migraine Research (ARMR). The registry, which was established by the American Migraine Foundation, collects clinical data about individuals with migraine and other headache disorders from multiple centers.

Participants eligible for the current analysis were women who had been diagnosed with migraine on the basis of the International Classification of Headache Disorders–3 criteria. All completed the ARMR questionnaire between February 2016 and September 2019.

The investigators excluded patients with trigeminal autonomic cephalalgia, secondary headache, painful cranial neuropathies, other facial pain, and other headaches.

They identified 895 eligible women with migraine. Of these, 607 completed the pregnancy question.

Among those participants, 121 women (19.9%) reported that migraine was a factor in their decision not to become pregnant. Of this group, 70 (11.5%) reported that migraine was a "significant" factor in deciding not to have children, and 8.4% said it was "somewhat" of a factor.

The remainder of the cohort (479) reported that migraine had no influence on their pregnancy plans.

There were no between-group differences by race, marital status, employment, or income. This finding suggests that sociodemographic differences "have less impact on pregnancy planning than migraine-specific characteristics like headache frequency and experience with having migraine attacks triggered by menstruation," Ishii said.

"Substantial Burden"

Not surprisingly, women who avoided pregnancy had fewer children than the rest of the sample. About 60% of those who made the decision not to become pregnant had no children, and 72% had not been pregnant since they began experiencing migraine.

Compared to women who reported that migraine had no influence on their pregnancy plans, those who avoided pregnancy were more likely to have chronic migraine, at 81.8% vs 70.2%. They were also more likely to have menstrual migraine, at 4.1% vs 1%. In addition, women who decided not to have children because of migraine were significantly younger, at an average age of 37.5 vs 47.2 years.

The number of days with headache per 3-month interval was 53.9 among women who avoided pregnancy, vs 42.5 among the other women. The Migraine Disability Assessment score was also higher for women who avoided pregnancy (132.5) than for the other women (91.7), indicating more severe disability.

In addition, more of the women who avoided pregnancy had a history of depression (48.8%) compared to the other women (37.7%). The average score on the Patient Health Questionnaire–4 was higher among women who avoided pregnancy (4.0) than among other women (3.1), indicating greater anxiety or depression.

Among women who avoided pregnancy, 72.5% believed their migraine would worsen during pregnancy, and 68.3% believed that migraine would make pregnancy very difficult.

"Clinicians need to recognize that migraine often has a substantial burden on multiple aspects of life, including one's plans for having children," Ishii said.

"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," he added.

More Education Needed

Commenting on the study for Medscape Medical News, Susan Hutchinson, MD, director of the Orange County Migraine and Headache Center, Irvine, California, said not knowing how pregnancy is going to affect patients' migraines can be "very scary" for women.

In addition, patients often wonder what migraine treatments they can safely take once they do become pregnant, said Hutchinson, who was not involved in the research.

She noted that advantages of the ARMR data are that they are derived from a multicenter study and that migraine diagnoses were made by a headache specialist. A potential limitation of the study is that the population may not reflect outcomes of the millions of women who have migraine and become pregnant but never see a specialist.

"These findings show that more education is needed," Hutchinson said.

Most women, especially those who have migraine without aura, note improvement with migraine during pregnancy, primarily due to the high, steady levels of estradiol, especially in the second and third trimesters, she said.

In light of this, neurologists should reassure women that migraine is not a contraindication to pregnancy, she added.

There is also a need for additional research to assess how past experience with migraine and pregnancy influences a woman's comfort level with additional pregnancies. Studies as to which treatments are safest for acute and preventive treatment of migraine during prepregnancy, pregnancy, and lactation are also needed, Hutchinson noted.

"If women knew they had treatment options that were evidence-based, they might be much more comfortable contemplating a pregnancy," she said.

Ishii and Hutchinson have disclosed no relevant financial relationships.

American Headache Society (AHS) Annual Meeting 2020: Abstract 829749, presented June 13, 2020.

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