Migraines and Fertility After 40: What to Know When Trying to Conceive

What You Need to Know: Evidence Based Holistic Solutions

Trying to Conceive While Dealing with Chronic Migraines

Chronic migraine can be a debilitating condition characterized by severe headaches, nausea, and increased sensitivity to light and sound. Fertile Optimism knows firsthand that it can be especially difficult for women who are struggling to conceive to cope with the physical and emotional effects of chronic migraines. However, with a modified approach, it may be possible to minimize if not alleviate migraines while maximizing fertility in hopes of preparing for a healthy pregnancy.

This article looks at evidence-based strategies for trying to conceive with chronic migraine, including the impact of migraine on fertility, the effects of migraine medications on conception and pregnancy, and holistic methods for managing migraine symptoms during your trying to conceive journey.

1. Understanding Chronic Migraines and Fertility

Neurologic and vascular factors primarily contribute to chronic migraine, which occurs 15 or more days per month. Although chronic migraine does not usually affect fertility, certain migraine-related factors can indirectly affect reproductive health.

Hormonal Influences

Hormones, especially estrogen, have a significant influence on the frequency and severity of migraines in women. Many women suffer from more severe migraines due to hormonal fluctuations during their menstrual cycle, pregnancy or the use of hormonal contraceptives. Can you relate to this? For women with chronic migraines, these hormonal changes can make the conception process more difficult. For some women, migraines subside during pregnancy, especially in the second and third trimesters when hormone levels stabilize. However, other women suffer from persistent migraine symptoms throughout their pregnancy.

Conditions such as polycystic ovary syndrome (PCOS) or endometriosis, which are more common in women with chronic migraine, can also affect fertility. These conditions may require additional treatment or management during the trying to conceive process.

Stress, Sleep, and Lifestyle Factors

Chronic migraines often lead to stress, sleep disorders and mood swings, all of which can have an indirect effect on fertility. For example, stress disrupts hormone regulation, interrupting ovulation and potentially reducing the chances of conception. Lack of sleep or irregular sleep patterns, which may play a role in women with chronic migraines, can also have a negative impact on reproductive health.

2. Impact of Migraine Medications on Conception and Pregnancy

Women who suffer from chronic migraines often need to take medication to control their symptoms. However, some migraine treatments can affect fertility or pose risks to pregnancy. It is important to consider the safety of migraine medications and have a frank discussion with your healthcare provider when trying to conceive and during pregnancy, which is what we did when TTC in order to develop a plan to best manage migraine symptoms without adversely affecting fertility by the use of migraine meds.

Acute Migraine Treatments

• NSAIDs (non-steroidal anti-inflammatory drugs): Medications such as ibuprofen (Advil, Motrin) and naproxen (Aleve) are commonly used to treat acute migraine pain. While they are generally considered safe for short-term use, there are concerns about their use during pregnancy, especially after the first trimester. Studies have shown that prolonged use of NSAIDs during pregnancy is associated with an increased risk of miscarriage and fetal complications, especially after the 20th week of pregnancy. Therefore, it is recommended to avoid regular use of NSAIDs when trying to conceive or during pregnancy. [1]
• Triptans (Sumatriptan, Rizatriptan, etc.): Triptans are a class of drugs that are often prescribed for acute migraine attacks. While there is no definitive evidence that sumatriptan and other triptans cause birth defects, studies suggest that they are generally safe when used during pregnancy. However, the effects of triptans on fertility have not been adequately researched, so women planning a pregnancy should discuss their use with a healthcare provider. [2]

Preventive Migraine Treatments

• Beta-blockers (e.g., Propranolol): Beta-blockers such as propranolol are sometimes prescribed to prevent migraine. While studies suggest that these drugs can be used with caution during pregnancy with caution, they can affect blood pressure and circulation, both of which are important during pregnancy. They should only be used if the benefits outweigh the risks, and alternatives should be considered when trying to conceive and in pregnancy. [3]
• Antidepressants (e.g., Amitriptyline): Amitriptyline and other tricyclic antidepressants are often used to prevent chronic migraines. However, there are concerns about their safety in pregnancy, especially in the first trimester. Although the risk of birth defects is relatively low, women should consider other options or switch to safer medications if they are planning a pregnancy. [4]
• Anticonvulsants (e.g., Topiramate, Valproate): Anticonvulsants such as topiramate are often used for migraine prophylaxis, but pose significant risks during pregnancy, including congenital malformations and developmental disorders. Valproate is particularly contraindicated during pregnancy due to its high teratogenicity, i.e. its ability to cause congenital malformations. Women who are trying to conceive should discontinue this medication and look for alternative treatment options together with their doctor. [5]

Medication Management and Transition

Before trying to conceive, be sure to discuss your current medication schedule with a licensed healthcare provider. Your healthcare provider may recommend discontinuing certain medications long before conception or switching to safer alternatives to reduce risks during pregnancy.

3. Natural and Holistic Approaches to Migraine Management While TTC

Although medications are often necessary to treat chronic migraines, there are several non-pharmaceutical approaches that can help reduce the frequency and severity of migraines during the trying to conceive process. These strategies can provide relief without compromising fertility.

3.1 Diet and Nutrition

Certain foods can trigger migraines in some people. Common migraine triggers are:

• Caffeine
• Alcohol
• Aged cheeses
• Processed meats
• Food additives (e.g., MSG)
• Chocolate

Identifying and eliminating these triggers can help to reduce the frequency of migraines. In addition, a diet rich in nutrients, particularly magnesium, riboflavin (vitamin B2) and Coenzyme Q10, may help prevent migraines. Studies have shown that magnesium supplements in particular can reduce the frequency of migraines in some people. [6]

3.2 Stress Reduction Techniques

Chronic stress is a known migraine trigger and can also have a negative impact on fertility. Relaxation techniques such as deep breathing exercises, massage therapy, (a technique we have significantly benefited from) or progressive muscle relaxation can help to reduce stress and reduce the frequency of migraines. Research shows that cognitive behavioral therapy (CBT) is effective in combating both chronic pain and stress, making it a valuable option for women with chronic migraine who are trying to conceive.

3.3 Adequate Sleep and Hydration

A regular sleep pattern and adequate hydration are essential for the treatment of migraine as well as for fertility. Sleep disturbances or dehydration can trigger migraines. Therefore, it is important to get 7-9 hours of quality sleep every night and drink enough water during the day. We have also found some minor relief in drinking hydrating beverages like coconut water or watermelon juice. So, a regular sleep routine and good hydration can help prevent migraines and support overall reproductive health.[7] [8]

3.4 Acupuncture

Studies show that acupuncture can reduce the frequency and intensity of migraines in some people. A review of studies on acupuncture found moderate evidence that it may be effective in preventing chronic migraines. Acupuncture may also help to improve circulation and hormonal balance, both of which are important when trying to conceive.[9] [10]

4. Considerations for Pregnancy

For women who conceive while managing chronic migraines, there are additional considerations during pregnancy:

• Pregnancy and Migraine Relief: During pregnancy, especially in the second and third trimester, hormonal changes may lead to less or more severe migraine attacks. However, some women continue to suffer from migraines during pregnancy and it is important to find a safe and effective treatment plan. Non-pharmacological treatments such as acupuncture and dietary changes are often preferred during pregnancy.
• Postpartum Migraine: After giving birth, many women experience a return of migraine symptoms due to fluctuating hormone levels, especially while breastfeeding. Some medications that are safe during pregnancy may not be suitable for breastfeeding, so it is important to work with a healthcare provider to find appropriate strategies for managing migraine in the postpartum period.

5. Conclusion

Trying to conceive while struggling with chronic migraine can be a challenge, but with the right combination of medical treatment and lifestyle adjustments, it is possible to find some, if not complete relief. Careful review of medications, attention to lifestyle factors and natural strategies to manage migraine can support both fertility and overall health. Work closely with your treating physician to address both migraine treatment and reproductive health together.

Through a comprehensive and individualized approach, women with chronic migraine can improve their chances of getting pregnant and have a healthier and more comfortable pregnancy, and to help you along the way, download Fertile Optimism’s complimentary free Migraine Tracker for TTC.

Disclaimer: This article provides educational and informational content, not medical advice. Always consult a qualified healthcare provider before changing your diet, medications, or supplements to ensure the changes suit your individual health needs.

References

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[1] National Institutes of Health. “Chronic Migraine.” National Institute of Neurological Disorders and Stroke. Accessed November 2024. https://www.ninds.nih.gov/health-information/disorders/chronic-migraine. 

[2] American College of Obstetricians and Gynecologists. “Migraine and Pregnancy.” ACOG Committee Opinion No. 804. Obstetrics & Gynecology, 2019. https://www.acog.org. 

[3] Mayo Clinic. “Migraine Medications: What You Need to Know.” Mayo Clinic. Accessed November 2024. https://www.mayoclinic.org. 

[4] Mayo Clinic. “Migraine Medications: What You Need to Know.” Mayo Clinic. Accessed November 2024. https://www.mayoclinic.org. 

[5] American Headache Society. “Dietary Factors in Migraine.” Headache: The Journal of Head and Face Pain, 2016. https://headachejournal.onlinelibrary.wiley.com. 

[6] Cochrane Review. “Acupuncture for Preventing Chronic Migraine.” Cochrane Database of Systematic Reviews, 2020. https://www.cochranelibrary.com. 

[7] Khorsha F, Mirzababaei A, Togha M, Mirzaei K. Association of drinking water and migraine headache severity. J Clin Neurosci. 2020 Jul;77:81-84. doi: 10.1016/j.jocn.2020.05.034. Epub 2020 May 20. PMID: 32446809.

[8] Duan S, Ren Z, Xia H, Wang Z, Zheng T, Liu Z. Association between sleep quality, migraine and migraine burden. Front Neurol. 2022 Aug 26;13:955298. doi: 10.3389/fneur.2022.955298. PMID: 36090858; PMCID: PMC9459411.

[9] Li YX, Xiao XL, Zhong DL, Luo LJ, Yang H, Zhou J, He MX, Shi LH, Li J, Zheng H, Jin RJ. Effectiveness and Safety of Acupuncture for Migraine: An Overview of Systematic Reviews. Pain Res Manag. 2020 Mar 23;2020:3825617. doi: 10.1155/2020/3825617. PMID: 32269669; PMCID: PMC7125485.

[10] Acupuncture Effective for Migraine Relief, https://acupuncturetoday.com/article/31775-acupuncture-effective-for-migraine-relief