While migraines are quite common (15-17% of women), the general consensus is that migraines tend to get better during pregnancy, especially during the second and third trimester (60-70% improvement). However, there are some reports of women who have had a history of migraines that experience increases in attacks as well.
There is no increased risk of birth defects, miscarriage, or stillbirths due to migraines; there is however a higher risk of migraines in the offspring. The main concern is alleviating discomfort of the patient. Non-pharmacological treatment should be attempted first since these methods are safe and effective. Relaxation, adequate sleep, stress relief, massages, biofeedback, and ice packs all help to alleviate an attack. Prevention of migraines by avoiding stress, lack of sleep, strong odors, or any other triggers is advisable. (1)
Pharmacological treatments should be a last resort after all other attempts of relief have failed. Acetaminophen (Tylenol) is the drug of choice for treatment of migraines during pregnancy; use of acetaminophen is proven to be safe during pregnancy under normal doses. Lower doses are safer. Do not exceed 4 grams per day.
Reference:
1. Aube, M. (1999). "Migraine in pregnancy." Neurology 53(4 Suppl 1): S26-28.
