Migraines & Pregnancy

Migraines during pregnancy can be incredibly challenging. How can you manage them, and what gentle treatment options are available?

Reading time: 11 minutes

Last updated: February 6, 2024

It was supposed to be just another ordinary Thursday, like any other. But when I took a pregnancy test that day, my life changed in an instant. The second line appeared within seconds. In fact, I had taken the test just to be sure I wasn’t pregnant—after all, how likely could a pregnancy be despite hormonal contraception? Practically impossible, or so we thought. But guess what? WRONG!

At that moment, I was home alone. My boyfriend was at work. I called him once. Twice. Three times. No answer. Tears streamed down my face, my whole body trembled and sweated, my heart was racing. When I finally reached him, he immediately rushed home. The moment he walked through the door, I collapsed into his arms, sobbing, and whispered, “The test was positive!”

Thankfully, he managed to calm me down. And so, that life-changing Thursday ended with tears, uncertainty, shock, confusion—and an early evening in bed with a migraine.

Excitement, tension, and stress are major triggers for my migraines. Normally, I would have taken pain medication right away, but it suddenly hit me: that was no longer an option during pregnancy. So, I lay in a dark room with a cold washcloth on my neck and peppermint oil on my forehead. But sleep was out of the question—my mind was racing, and the pain was unbearable.

Was I really pregnant?

My gynecologist confirmed my pregnancy the next day through an ultrasound, and that was when I started to truly process this massive life change. Telling our family and seeing their reactions helped us grasp and accept the reality. Everyone reacted similarly—initial shock, brief speechlessness, but ultimately joy and excitement.

As days and weeks passed, the first clear signs of pregnancy appeared. The initial shock gradually transformed into confidence, acceptance, and happiness.

A Migraine-Free Pregnancy?

My mother also had migraines before her pregnancies—though not as frequently or intensely as I do. However, after giving birth to my older sister, her migraines completely disappeared, except for one or two attacks per year. For someone with chronic migraines, that sounds like a dream!

Pregnancy changes a lot. The entire body shifts its focus to creating and nurturing new life. Over 70% of women with migraines experience fewer or no attacks at all during pregnancy, especially in the last two trimesters. Many women report significantly fewer or no migraine attacks at all during this time.

Women who suffer from hormonal migraines—those linked to their menstrual cycle—often benefit from pregnancy due to the absence of menstruation and the stable, high levels of female hormones. However, this high level of estrogen and progesterone drops sharply after birth, leading to a resurgence of frequent and intense migraine attacks for about half of affected women. Some even experience worsening migraines postpartum and during breastfeeding due to the increased production of prolactin, the hormone responsible for milk production.

Additionally, neurotransmitters like serotonin and endorphins can help prevent pain signals from reaching the brain during pregnancy. A healthier lifestyle, avoidance of alcohol and nicotine, and better self-care can also contribute to fewer migraine attacks. However, a small percentage of women, especially those with migraines with aura, may experience worsening symptoms during pregnancy.

Unfortunately, I am one of the 30% whose migraines did not improve during pregnancy. In fact, my attacks became more frequent. UGH!

Migraines & Pregnancy: Medication for Pain Relief

I quickly realized that migraines during pregnancy are even more exhausting and debilitating than before. There is also the overwhelming feeling of helplessness—having to endure the pain without relief, just waiting for it to pass on its own. Any medication taken during pregnancy must be considered carefully due to potential risks to the fetus, especially during the critical first trimester when the baby’s development is most vulnerable.

Warning About Acetaminophen (Paracetamol) in Pregnancy

Most effective migraine treatments, such as triptans, should only be considered with caution and after a thorough discussion with a gynecologist or neurologist.

As a general rule, it is advisable to avoid pain medication completely, especially in the first trimester. However, in severe cases, acute medication can be considered under medical supervision. According to migraine treatment guidelines:

Mild migraine attacks should be managed without medication through sensory shielding and rest.
Metoclopramide (MCP) can be taken for nausea and vomiting during pregnancy.
In the 1st and 2nd trimesters, aspirin, ibuprofen, or metamizole can be used, but not in the 3rd trimester!
Acetaminophen (paracetamol) should only be used if no other options are available, as studies suggest potential risks for neurological developmental disorders, allergies, and reproductive issues in the unborn child.
There is no strong epidemiological evidence linking triptans to birth defects or pregnancy complications. The most extensive data exist for sumatriptan, making it the preferred choice for severe migraine attacks during pregnancy. If ineffective, other triptans may be considered when absolutely necessary.

Migraine Relief through Personalized Nutrition

Medication Free
Side Effect Free
Based on Science

Natural Treatments for Acute Migraines

Both my midwife and gynecologist recommended high-dose magnesium at the first sign of a migraine attack. Magnesium relaxes muscles, reduces inflammation, stabilizes blood pressure, and calms the nervous system. It also helps prevent uterine contractions and reduces the risk of preterm labor or miscarriage.

Other natural remedies include:

Cold compresses

Gentle facial massages

Soothing essential oils (such as peppermint or lavender)

Acupuncture, which is safe and effective during pregnancy and breastfeeding

⚠️ Warning! Even small amounts of undiluted essential oils in a baby’s mouth or nose can irritate the airways, cause severe laryngeal spasms, or even lead to life-threatening respiratory failure.

Aside from hormonal changes, headaches in pregnancy can have many other causes, such as stress, food sensitivities, sleep deprivation, low blood sugar, or iron deficiency.

For general headaches, maintaining good sleep (at least 7.5 hours), adequate hydration (at least 2 liters), fresh air, daily movement (at least 15 minutes), and regular small meals can help prevent them. Caffeine (200-300mg or 2-3 cups of coffee per day) is not strictly prohibited during pregnancy and can sometimes help with circulation.

Now More Important Than Ever: Natural Migraine Prevention

Migraine prevention is particularly crucial during pregnancy. Relaxation techniques such as progressive muscle relaxation, autogenic training, breathing meditation, and yoga can help relieve muscle tension, reduce stress hormones, and activate the body’s natural pain defense systems. Studies show that regular use of these techniques can significantly reduce migraine frequency over time.

Another safe and natural migraine prevention method is Ebby. Research has shown that blood sugar metabolism, particularly blood sugar fluctuations, play a role in migraine onset. A diet that keeps blood sugar levels stable and low can help prevent attacks.

With Ebby, you can track your blood sugar response to different meals using a sensor and receive personalized dietary recommendations to help manage migraines. The app is available by prescription, fully covered by health insurance, and can be renewed every three months.

Migraines & Pregnancy: Enduring the Pain Together

I am now six months pregnant. More than half of the journey is behind me, but my migraines remain unchanged. The attacks have not necessarily worsened, but enduring them without medication is incredibly difficult.

One evening, during a particularly excruciating migraine attack, I lay in bed crying, feeling completely overwhelmed. Then, suddenly—a little kick from inside my belly.

Once. Twice. Three times.

For a brief moment, I forgot the pain and smiled.

And in that moment, I knew—it was all worth it.

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„CHARISMHA – Chancen und Risiken von Gesundheits-Apps“, In: http://www.charismha.de/. Letzter Zugang: 05.10.2020

About the Author

Mona Kattwinkel

Mona is a student, a young mother and, last but not least, a migraine expert. She has had migraines since she was 8 years old and is a member of a self-help group within the MigräneLiga e.V. Germany.