Migraines Linked to Pregnancy Complications, Study Says

A history of migraines is associated with higher risks of pregnancy complications, according to researcher Alexandra Purdue-Smithe, Ph.D., who discussed her findings from a large prospective study based on the Nurses Health Study II during the 2022 American Academy of Neurology annual meeting in Seattle.

Research indicates that individuals suffering from migraine headaches have an increased risk of coronary artery disease and stroke, said Kecia Gaither, M.D., board-certified in OB-GYN and maternal-fetal medicine and director of perinatal services/maternal-fetal medicine at NYC Health + Hospitals/Lincoln in the Bronx in New York City.

Migraines are common among women, with reproductive-age women being two to three times more likely than men of similar age to suffer them.

Previously, extensive studies on migraine and adverse pregnancy outcomes have been lacking. Therefore, researchers set out to investigate links between prepregnancy migraine and adverse pregnancy outcomes in this large prospective study, said Monte Swarup, M.D., a board-certified OB-GYN in Chandler, Arizona, and founder of the HPV Hub information site.

An overview of the study

Purdue-Smithe, an instructor in medicine at Harvard Medical School in Boston, and her colleagues analyzed data from the Nurses' Health Study II, which ran from 1989 to 2009 and included more than 100,000 women ages 25 to 42. The Nurses' Health Studies are among the largest prospective investigations into the risk factors for major chronic diseases in women in the United States. A prospective study means the participants are followed over time.

Researchers utilize data from the Nurses' Health Studies to investigate areas such as diet, smoking, physical activity, oral contraceptive use, hormone therapy, sleep, genetics and other characteristics in connection with various diseases.

The study led by Purdue-Smith investigated associations of self-reported, physician-diagnosed prepregnancy migraine with:

• Preterm delivery (earlier than 37 weeks)
• Gestational diabetes mellitus
• Gestational hypertension
• Preeclampsia
• Low birth weight

"The results of the study show prepregnancy migraine was associated with higher risks of preterm delivery and gestational hypertension," Gaither explained. "The risk of preeclampsia was especially high among women who had migraine with aura."

"Preeclampsia is a potentially dangerous pregnancy complication characterized by high blood pressure," Swarup said. It's essential to diagnose and monitor preeclampsia as early as possible to offer the best outlook for mother and baby.

The study also suggested that prepregnancy migraine was not associated with low birth weight or gestational diabetes mellitus.

Mitigating the risks

The researchers advised that migraine history and phenotype (characteristics) are important to consider during obstetric assessments.

"At present, there are no recommendations on what to do in higher-risk situations," Swarup said. "Perhaps baby aspirin could help as this decreases recurrent preeclampsia, but this would need further research in this scenario."

Gaither said it could be useful to adopt closer surveillance of patients with a history of migraines.

"It's also helpful to identify the phenotype of migraine that the patient presents with as these patients appear to have an increased incidence of developing hypertensive disorders in the perinatal period," she said.

If you have a history of migraines and are pregnant, you should mention this to your healthcare provider. Providing a full medical history can assist your doctor in providing the best care to both you and your baby.