Your Pregnancy Matters

BOTOX for migraines, and more pregnancy-safe treatment options

Your Pregnancy Matters

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Migraines are thought to be caused not only by nerve disruptions but also by hormone fluctuations, particularly estrogen.

If you've ever had a migraine, you know how debilitating these severe headaches can be. From the nausea and dizziness to the light- and sound-sensitivity, migraines can seriously disrupt patients' lives – and even their approach to family planning.

A study published by the American Headache Society found that nearly 20% of women with migraines avoided becoming pregnant due to their condition. Approximately 72% of them believed pregnancy would make their migraines worse, and 68% thought their symptoms would make pregnancy more difficult.

Actually, research suggests that 50% to 80% of women have less frequent, less severe migraines during their second and third trimester. Migraines are thought to be caused not only by nerve disruptions but also by hormone fluctuations, particularly estrogen. Having high levels of estrogen during pregnancy may be therapeutic.

However, migraines may carry a slightly higher risk of pregnancy complications. A Danish study found that women with a diagnosis of migraines had a slightly higher risk of hypertensive disorders and preterm birth, but having migraines didn’t increase the frequency of birth defects.

Fortunately, treatment for migraines does not carry any increased risk compared to untreated migraines – so women should not hesitate to seek care for this condition.

Many migraine treatments are proven to be generally safe and effective during pregnancy, including BOTOX®. Yes, this cosmetic injection to reduce the appearance of wrinkles can relieve certain types of migraines.

Before or early in pregnancy, tell your Ob/Gyn that you experience migraines. We can work with your neurologist to help you effectively manage your condition.

My colleague, Denisse Holcomb, M.D., has dealt with migraines since she was 10. I've invited her to discuss how she manages her condition, as well as options we offer our pregnant patients.

Safe, effective migraine treatments for pregnant moms

By Denisse Holcomb, M.D.

Women are more likely than men to get migraines, and nearly one in four of us will have at least one in our lifetime.

If you're like me and have had migraines for years, you probably already avoid certain foods and situations that can trigger migraines, such as:

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Dr. Denisse Holcomb has dealt with migraines since she was 10, and works with pregnant patients to help manage symptoms of the debilitating headaches.
  • Artificial sweeteners
  • Chocolate or cheese
  • Dehydration
  • Monosodium glutamate (MSG)
  • Not getting enough sleep
  • Stress
  • Weather changes

Avoiding triggers can be difficult, especially since we all have stress in our lives. My main triggers are stress, artificial sweeteners, MSG, and cheese – that last one is toughest for me! But it's worth it to reduce the risk of a migraine that wipes me out all day.

If you don't know your triggers yet, keep a migraine journal. Write down what you ate, where you were, and what you were doing when your symptoms began. After a month or so, you might see a pattern emerge.

If you avoid triggers and still get frequent migraines, you might benefit from medication.

Talk with your doctor about medication

Medications taken when symptoms occur, such as acetaminophen (Tylenol) or ibuprofen, are generally safe with limited use in pregnancy.

Stronger drugs, such as Midrin or Prodrin, contain acetaminophen and a mild sedative. These drugs narrow the blood vessels, reducing blood flow and pain. Triptans, such as sumatriptan (Imitrex), also reduce blood flow and contains serotonin, which helps calm overactive nerves that cause migraines.

Patients who get severe migraines may also take preventive drugs to avoid them altogether. Pregnancy-safe options include magnesium oxide, metoprolol, amitriptyline, propranolol (I take this medication daily).

Ergotamines are not recommended during pregnancy or while breastfeeding. These stronger drugs can interfere with fetal growth and increase the risk of preterm birth.

Advanced treatment options

If you have chronic migraines – getting headaches more than 15 days a month for at least three months – your doctor might recommend an advanced treatment option such as BOTOX.

Best known for reducing the appearance of fine lines and wrinkles, BOTOX was approved by the U.S. Food and Drug Administration in 2010 for treatment of chronic migraines. A 2018 study showed no increased risk of birth defects in babies whose mothers received BOTOX for migraines during pregnancy.

Here are UT Southwestern, we use anatomical regional targeted (ART) injection – a technique that can eliminate up to 50% of migraines in some patients. ART may be an option for you during pregnancy if your doctors feel the benefits of migraine relief outweigh the low but potential risks, including muscle pain and weakness, facial paralysis, and increased blood pressure.

During ART, a neurologist will inject BOTOX around nerve fibers in known pain points around your head, including areas where you might not normally feel migraine pain. The goal is to thoroughly block chemicals that transmit nerve pain. Patients typically get ART injections every three months. Watch the procedure now.

After pregnancy, your doctor may recommend nerve stimulation therapy, which uses electric or magnetic pulses to control nerve pain. Nerve decompression surgery may also be an option. This procedure involves removing small amounts of tissue found to be compressing nerves, leading to migraines. Care for patients with complex cases or who need advanced treatment will be co-managed with a neurologist.

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Nerve decompression to relieve migraines

UT Southwestern specialists can perform targeted botox procedures to relieve migraines. The advanced procedure can address up to six trigger sites. 

Watch the video

Cautions about headaches during pregnancy

Most headaches and migraines are not cause for alarm. However, severe migraines sometimes require hospitalization so you can receive fluids, pain medication, or anti-nausea drugs.

During pregnancy, a bad headache can signal a medical emergency such as stroke or preeclampsia – I had the latter when I was pregnant.

Seek care right away if you experience any of these symptoms:

  • Lasting headache
  • More or worse migraines
  • Nausea or vomiting
  • Particularly severe headache pain
  • Shortness of breath
  • Swelling in your legs or feet
  • Upper abdominal pain
  • Vision changes

Migraines can range in severity from annoying to debilitating. But the condition shouldn't stop you from having a baby. Talk with your doctor – you can have a healthy pregnancy with the right treatment.

To visit with an Ob/Gyn, call 214-645-8300 or request an appointment online.