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Headaches and Pregnancy

by Sarah
(Houston, Texas)

Good day: 26 yr old female, pregnant. I am aware that I am about to get a migraine because of pressure behind my right eye. If I take medication immediately it subsides, however, if I don't it turns into a migraine that throbs from my right shoulder blade up my neck to my right temple accompanied by the right eye pain.

I sleep on the left side of my head that night and the next morning the migraine has migrated to the other side of my head only difference is that it is just a regular migraine, no pressure behind the eyes but the same throbbing pain in the left temple and back of the head. Even before I became pregnant I was having these headaches although less often.

Sarah



Answer:

Hi Sarah,

Although you didn't ask a specific question I will assume you want to know about migraines in pregancy. You didn't say which trimester, but with 80 % of women and migraine, the migraines disappear during that time. About 15% of women stay the same and 5% get worse (those are the ones I see!).

Headaches and pregnancy do not have to go hand in hand. Migraines occuring during this time can be managed with tylenol with codeine which is OK to take during this time. Although we do not place women on anti-zeizure meds during pregnancy, we do prescribe a low dose of propranolol, a beta blocker, which seems to help some patients. I generally start at 10mg twice a day.

The neck and back pain can be managed with massage and moist heat to the area. I also do trigger point injections for many pregnant women and this helps not only with the neck pain but also the migraines.

Good luck,
Mary Kay Betz MS RPA-C

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Migraine Medication During Pregnancy

by Melanie
(Philippines)

Headaches And Pregnancy

Headaches And Pregnancy

I suffer from severe headache but I am not pregnant what type of medication(s) would you recommend that would be safe and not harmful to my pregnancy and yet still effective to stop the headache?

Melanie

Answer

Hi Melanie,

I am assuming that your severe headaches that you refer to are migraines. Fortunately, 70% of women who suffer from migraine, even menstrual migraine improve during pregnancy.

Since you are not pregnant yet, generally we take a wait and see attitude in terms of headaches and pregnancy.

If you do become pregnant and your headaches are still there, we start with Tylenol # 3 (with codeine) to take at the onset of a headache. Some patients are on propranolol, low dose 1-40mg per day to prevent severe headaches. I also have placed patients on Topamax during pregnancy if their headaches are severe and accompanied by nausea and vomiting. The chronic excess vomiting and elevated blood pressure during pain is worse for the baby than taking a low dose of topamax to prevent this.

Good luck!

Mary Kay Betz MS RPA-C

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Pregnant Taking Topamax

by Jen
(UK)

Pregnancy and Seizures

Pregnancy and Seizures

Hello.
Basically I was diagnosed 6 years ago with Epilepsy after having one 'Grand Mal' seizure. All scans proved inconclusive, however I have remained on Tablets since and am seizure free.
I want to have a baby and take 50mg per day. My doctor said if I stop taking it I would need to give up my driving license for 12 months, which I dont really want to, however I dont want my baby to have a defect.
Are the tests done on larger doses than my 50mg as it seems my dosage is very low compared to most?
I look forward to hearing from you.

Answer:

Hi Jen,

You don't mention whether or not your doctor is a neurologist or a primary care physician. Since you are in the UK, any advice or answer I give will be based on practice in the USA so please check with your doctor and have a frank discussion with him or her before getting pregnant. The reason I mention all this is that you are way below anti-seizure dosing for this drug and even below the doses we use for headache. Epilepsy, or seizure disorder, means ongoing seizures. Therefore, I would question your diagnosis.

Generally, if someone has been seizure free for 5 years in our clinic and tests are negative, we allow them to taper off the drug.

Ok..let's talk about the drug! Topamax does have a slightly higher incidence of birth defects that that seen in the normal population. This occurs about 1% of the time and in the presence of Topamax the incidence is 2-3% depending on various study outcomes. This is all based on US data but I would assume UK studies are about the same. I do prescribe the medication at low doses for severe migraine during pregnancy and have had patients already on the drug who became pregnant and then stopped it. So far I have not seen any problems, but every woman and every pregnancy is different.

The key here is to talk to a neurologist who specializes in seizures. Believe it or not, in the field of neurology we are all sub-specializing now! Please do not stop the drug yourself without a doctor's clearance. Co-ordinate the care with your ob/gyn doctor as we do. My doctor will not prescribe anything during pregnancy without the ob/gyn approving it first.

As for the driving, I can't comment as here in the US the laws vary state by state.

I wish you the best of luck and hope you have a healthy happy baby someday!

Mary Kay Betz, MS RPA-C
Physician Assistant

Comments:

Good post! I too am thinking of getting pregnant, and have migraines. I will discuss with my doc. Thanks..

Cindy

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Headache after Childbirth

by Anonymous

I am a 29 year old female who gave birth 3 years ago (I was 26). 4 days after delivery I was having my hair done when it literally felt like someone hit me in the back of the head with a hammer. I experienced a very sudden headache that was by far the worst of my life. Advil didn't help much and the pain was so bad i couldn't drive home.

My husband drive me to the ER where they pretty much blew me off. Maybe it was overreaction on my part but I was really scared! Lying down made the pain worse-within an hour it had subsided to a moderate throbbing pain that was only relieved when I stood or walked. The headaches recurred daily for about a month but they weren't ever as sudden as they were in the salon. The pain was easier to take too-more like a moderate throbbing pain that was relieved with advil. Always in the back right side of my head. What was this?? I'm wanting to have another baby but im scared I ruptured an aneurysm or something!!


Answer:

Hi,
You do not mention if you had headaches previously, before this incident so I will assume maybe you didn't or maybe they were mild.

Either way, a new onset of a serious headache or worsening headache after childbirth (especially within 4 days) is a neurological flag. What we worry about is not so much aneurysm, but a blood clot in the veins surrounding the brain. Blood clots can occur in pregnancy as it is considered a hypercoagulable state (your blood is naturally a bit thicker). Blood clots can occur anywhere in the body, not just the legs. Taking birth control pills, or smoking, increases your risk.

Since it happened three years ago, it is possible that it was a post-partum migraine, but at this point it is a little hard to say. Migraines like this happen as the estrogen levels fluctuate after delivery.

If you are really concerned and are continuing to have headaches, especially ones associate with your menses, then I would advise you make an appointment with a neurologist to discuss this. You do not say where you live, so I cannot recommend anyone, but your primary care may be able to help.

As far as an aneurysm is concerned, if you had had one and it ruptured it would have presented like a stroke, so I doubt that happened. Risk factors for aneurysem include smoking and a family history of them.

If you are planning another pregnancy, talk to your primary care or OB/GYN about these concerns.


Good luck!
Mary K. Betz MS RPA-C

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