When we were planning for my pregnancy with my daughter, one of the biggest concerns I had was how to manage my migraine headaches. Normally when I'm experiencing migraines, I treat the pain with over the counter medicine Excedrine Migraine, and it extreme cases prescription pain killers prescribed by my doctor. But when you are pregnant, the only doctor recommended pain killer is Tylenol, which often doesn't help much with my migraine pain. Believe it or not, some women's migraines actually decrease during pregnancy. If your migraines tend to circulate around your monthly hormone cycles, pregnancy eliminates your period and reduces the hormone yo-yo effect (the rising and dropping of estrogen). Over the next 9 months of pregnancy, I devised my own treatment plan to help me navigate through migraine pain while maintaining a healthy pregnancy.
Know Your Body - Whether you’re pregnant or not, it’s important to figure out what your migraine triggers are so you can manage your lifestyle in a way to minimize the frequency of your migraines. When you begin to feel a migraine coming on, try to recall what happened in the last 24 hours. In the beginning when you’re trying to figure the cause of your migraines, keep a headache diary so you can discuss it with your neurologist.
Common migraine triggers for women are:
Hormone fluctuations during menstrual cycles.
Irregular sleep cycles, including sleeping too much and too little.
Alcoholic beverages and wine.
Coffee and caffeine. These can both be triggers and/or help with prevention and treatment. Confusing I know, but it’s different for every person.
Certain foods such as cheese, processed and salty foods, chocolate, nuts, food containing aspartame and several others.
Stress and tension build-up in the neck and shoulders.
Sex and orgasms.
Perfumes and strong scents.
Keeping a Consistent Sleep Routine - This is great advice for anyone, but especially relevant for any pregnant women suffering from migraines. You already need excess sleep when you’re growing your little human in your body, but keeping a regular sleep schedule will help prevent migraines. Many triggers are out of our control, but this is an easy one to take ownership of.
Prenatal Massage - Beginning in second trimester, you can get prenatal massages to help relieve the tension that builds up in your neck and shoulders. For safety and liability reasons, more massage spas will require you to wait until your second trimester before you can get a massage. I will admit that I had a hard time finding a spa that would do a prenatal massage with firm tension to really work out the knots. Therapists tend to take extra precautions with pregnant women, but I do think it’s worth it to find someone who’s really willing to take the time to work out the knots and tension in your body. For myself, having a lot of muscle knots in my neck will actually lead to more headaches until it gets worked out. If you live in the San Francisco Bay Area, I really loved my prenatal massage from In-Symmetry Spa in the Mission in San Francisco.
Drinking Plenty of Water - Pregnant women should always be making an effort to drink plenty of water for a healthy pregnancy. Even a slight amount of dehydration can be the cause of a migraine headache, low energy and even swelling during pregnancy. It may be tough on your already strained bladder, but a pregnant woman should be drinking around 10 cups of water (2.5 liters) daily.
Aromatherapy - Essential oils are often used as a substitute for drugs, and they can especially be helpful with headaches. There are multiple ways you can apply essential oils topically to the body and use the scents to reduce stress and tension. Click here to read a full guide to which scents to use for headaches and migraines. You can also make custom blends by mix-n-matching your own scents that work well for you.
Pillow Talk - It may seem insignificant, but the type of pillow you use to sleep at night can make a difference in the frequency of your migraines. I have found that if I’m sleeping on a pillow that is too hard or too flat, it affects the angle of my neck and can lead to tension building up. Do some tests to find the ideal pillow type for yourself, and maybe even bring it with you when you travel.
Changing Your Environment - If you begin to feel the beginnings of a migraine, try to switch up your surroundings. My go-to is going for a walk outside, something about the fresh air tends to help. Sometimes there are smells in the area or poor air quality which can be the cause of the beginning of a migraine. Noises can also be a culprit, particularly loud and sharp or pounding noises like construction sites, dogs barking and even music.
Screen Free - Avoid screens when you feel the beginnings of a migraine coming on. When I was pregnant, I had dedicated time away from my computer, phone and TV just to make sure I wasn't aggravating my eyes. I would usually use this time to cook and food prep, which ended up being awesome because I had so many prepped meals in my freezer when I had a newborn.
If you absolutely have to be on the computer, turn down the brightness on your screen. You can also try installing f.lux on your computer so that the lighting on your screen is less harsh on your eyes.
Audio Therapy - A friend recommended binaural beats as a way to treat migraines, and my first reaction was to say that I’m sensitive to sound when I have a migraine. So I was hesitant to try it out at first. But I was pleasantly surprised to find that it did help. To try it out, put some headphones on and listen to any of these YouTube videos in a dark room without looking at the phone or computer screen.
Avoid Tight Hairstyles - This piece of advice seems so simple but it can make or break the difference between a migraine increasing or subsiding. The slow but steady pressure on your scalp will build up the pressure in your head until before you know it, you've got a full-blown migraine. I have long hair and often times a loose braid is my go-to when I need to have my hair up without being too tight.
Tea Time - Daily doses of caffeine can help prevent migraines, are safe for pregnancy and can easily be incorporated into your routine. You can try black and green teas, both work well for me. It can be a bit confusing because caffeine is also a migraine trigger, it just depends on the person and the timing of when you take it. Finding the right kind of caffeine and the best time of day to drink caffeine can make a huge difference. For myself I can’t drink coffee at all or else I’m guaranteed a migraine, but I can drink tea just fine.
Heavy Load - Just this past week I attended a conference and I had to schlep heavy bags all over Palm Springs. I can feel the tension in my neck and shoulders caused by the pressure of my bag straps. A smarter thing for me to do would’ve been to have a bag with wheels that I can roll around. My advice is to avoid carrying heavy bags whenever possible to spare your neck and shoulders more stress. If you’re a mom, use your stroller to transport bags whenever possible. I use my stroller to grocery shop all the time!
An Eye on the Weather - Certain weather conditions can make migraines much more likely to occur, depending on the individual. Cloudy and overcast weather paired with bright high reflections from the clouds creates a perfect storm for migraine weather. While we have no control over the weather, AccuWeather has a very handy “Migraine Headache Weather Predictor”. This tool predicts weather conditions and tells you how likely it is that you could have a migraine caused by barometric pressure changes. You can use this information to take extra precautions and avoid other possible triggers on the days of migraine weather.
Tylenol and Caffeine - As mentioned earlier, Tylenol is the only doctor approved pain medication for pregnant women. The best way to take Tylenol for a migraine is to pair it with caffeine. Always take it with food, even tea alone on an empty stomach can make you nauseous.
You Gotta Do What You Gotta Do - If all else in your prevention plan has failed and you're still experiencing increasing migraine pain, you can call your doctor to discuss taking Excedrine or possibly even stronger medication. There were a few times during my pregnancy when my head pain was to the point where I could barely function and it was causing me incredible stress. So I called my doctor and she said: "Just go ahead and take the Excedrine." And within 30 minutes of taking the medication, I could feel the pain subsiding and I was finally feeling relief. Of course I had feelings of guilt for increasing my risk for birth defects, but the reality is that if you take medication very sparingly during your pregnancy, your risk still remains very small.
Occipital Nerve Block - I have heard that procedure of occipital nerve blocking is safe for pregnant women. I have never tried this myself but it may be a good question to bring up with your healthcare providers.
Preeclampsia - If you are experiencing severe headaches during pregnancy and you have no history of migraines, be sure to get your blood pressure checked. Preeclampsia is a serious condition for pregnant women with high blood pressure and one of the symptoms are headaches.
Find Simple Things that Give You Comfort - It sounds oversimplified but when all else fails, you will need to ride out the storm. If you have a mental list of things that bring you to a peaceful place, it will help to mentally prepare you. Have a stash of these goodies available, and save them for when you really need it.
Try to Relax - Sometimes worrying about getting a migraine can psychologically give you migraines. Having a game plan for how to handle migraines will give you confidence and hopefully peace of mind.
Full disclosure: I am not a doctor or health care provider, just a mom who has been battling migraines for many years. You should definitely have a conversation with your doctor if you’re experiencing headaches, and if you’re pregnant you should be sharing this information with your OBGYN.
When you’re experiencing a migraine and you need advise from a health care provider on what migraine medications to take, your doctor will provide you with pamphlets with a helpline number to call. They can give you information from studies done in the past on what the risks are for pregnancy complications when taking certain medications. During the first trimester you generally have the highest amount of risk because your baby is still developing its vital organs, so better to play it safe and ask whenever you have questions.
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