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.
The study was presented on April 17,
2016 at the American Academy of Neurology (AAN) 68th Annual Meeting in Vancouver, Canada.
"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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