Tuesday, April 19, 2016

Migraine linked to increase in pregnancy, labor and neonatal complications!


The occurrence and frequency of migraine attacks in women is influenced by hormonal changes throughout the lifecycle. More than 50% of women report an improvement in attacks, especially during the second and third trimester irrespective of the type of migraine.

If migraines do occur, they do so most often during the first three months of pregnancy due to the rise in estrogen level. The other triggers for attacks in pregnancy are possibly from lack of sleep, additional stresses, or other headache causes.

Women who have migraine during pregnancy end up having higher rates of preeclampsia, preterm delivery, and low-birthweight babies that far exceed national statistics, a new study suggests.  In Women older than 35years of age, it is an independent risk factor for adverse pregnancy outcome.


"Over half the patients experienced some type of adverse birth outcome, which suggests that pregnancies in such patients should be considered high risk, especially in older women," said lead author Matthew S. Robbins, MD, associate professor, clinical neurology, Albert Einstein College of Medicine, chief of neurology, Jack D. Weiler Hospital, Montefiore Medical Center, and director of inpatient services, Montefiore Headache Center, Bronx, New York.

Researchers at Montefiore Medical Center reviewed 5 years of data between July 1, 2009, to June 30, 2014 and identified 90 women, who had severe attack during pregnancy.

The findings included:

  • About 38.8% of women were African American, 76.7% were obese with body mass index of 30 kg/m2 or more and a third of the group (30%) was nulliparous.
  • More than half of these women (54 percent) had at least one complication.  
  • About 30 percent of the women had a preterm delivery, as compared to nearly 10 percent in general population.
  • About 20 percent of the women with migraine had preeclampsia, compared to between 5 and 8 percent in the general population.
  • 19 percent of the women with migraine delivered babies with low birthweight, compared to 8 percent in the general population.
  • Researchers do not know the cause for these increased incidences of co-morbidities, but is possibly linked to increased cardiovascular complications in these women, or changes in   the endothelium leading to preecclampsia.


Dr. Robbins caution against generalizing these findings to other population, as the study involved a small inner city population but does suggest a close follow up of women with migraine and treating them as high risk.

The study had many limitations, notable lack of control group of women who had migraine but did not report to physician for care. Also, Sixty-two percent of the women in the study received treatment for their migraine, which also could have played a part in the pregnancy and birth complications.

David J. Dickoff, MD, a general community neurologist in Yonkers, New York summed it well saying "The importance of the migraine study is to alert all doctors, especially obstetricians, that history of migraine headaches is a risk factor for pre-eclampsia," Dr Dickoff said. "These patients may need to be considered high risk and followed more closely for BP [blood pressure] elevations and proteinuria."

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