Women with a history of migraines are at a higher risk for certain pregnancy complications, according to a new study recently published online by the journal Neurology, and aspirin may play a role in mitigating this risk.

In the study conducted by a research team from Harvard Medical School and the University of Arizona, women who had experienced prepregnancy migraines were more likely to experience preterm delivery, gestational hypertension, and preeclampsia, suggesting the condition may be a clinical marker of elevated obstetric risk.

A cohort of nurses

To address these gaps, the investigators evaluated associations of prepregnancy, physician-diagnosed migraine and migraine phenotype with gestational hypertension, preeclampsia, preterm delivery, low birthweight, and gestational diabetes mellitus (GDM) among >30K incident pregnancies in the Nurses’ Health Study II (NHSII), a prospective cohort study of US nurses.  The study examined 30,555 pregnancies among 19,694 participants over a 20-year period who had no history of cardiovascular disease, diabetes, or cancer.

While migraines are common among reproductive-aged women the researchers noted, the question of whether migraine history and migraine type might serve as markers of obstetric risk has not yet been answered.

Migraine and pregnancy

According to data provided by Children’s Hospital of Philadelphia, ~15% to 20% of pregnant women experience migraines.  Over half of women find that their migraines occur less frequently during the last few months of pregnancy.  However, migraines may worsen during the postpartum period.

In this study’s results, after adjusting for age, adiposity, and other health and behavioral factors, prepregnancy migraine (11%) was associated with higher risks of preterm delivery (RR=1.17; 95% CI=1.05, 1.30), gestational hypertension (RR=1.28; 95% CI=1.11, 1.48), and preeclampsia (RR=1.40; 95% CI=1.19, 1.65) compared with no migraine.  However, migraine history was not associated with low birth weight (RR=0.99; 95% CI=0.85, 1.16) or GDM (RR=1.05; 95% CI=0.91).

The researchers noted that risk of preeclampsia was somewhat higher among participants with migraine with aura than migraine without aura, while other outcomes were similar by migraine phenotype.  Among individuals with migraine, 30% experience aura, which are transient neurological symptoms (e.g., visual, sensory, or language disturbances) that precede headache onset (Charles A, Hansen JM 2015).

The aspirin effect

Participants with migraine who reported regular aspirin use prior to pregnancy (more than 2x weekly) had a 45% lower risk for preterm delivery.  The US Preventive Services Task Force currently recommends low-dose aspirin during pregnancy for individuals at high risk of preeclampsia and those who have more than 1 moderate risk factor for preeclampsia.  Previous clinical trials have shown that low-dose aspirin during pregnancy is also effective at reducing rates of preterm birth.  However, the researchers note that migraine is not currently included among indications for aspirin use in pregnancy.

“Our findings of reduced risk of preterm delivery among women with migraine who reported regular aspirin use prior to pregnancy suggests that aspirin may also be beneficial for women with migraine,” the investigators hypothesized.  “Given the observational nature of our study, and the lack of detailed information on aspirin dosage available in the cohort, clinical trials will be needed to definitively answer this question.”

Clinical counsel for women’s health providers

First author Alexandra Purdue-Smithe, PhD, associate epidemiologist at Brigham and Women’s Hospital and instructor in medicine at Harvard Medical School, stated in a press release accompanying the study’s release, “More research is needed to determine exactly why migraine may be associated with higher risks of complications.  In the meantime, women with migraine may benefit from closer monitoring during pregnancy so that complications like preeclampsia can be identified and managed as soon as possible.”

The complete article, “Prepregnancy migraine, migraine phenotype, and risk of adverse pregnancy outcomes,” can be found here.

Clinicians’ Bonus:  More To Know

Resources for you and your patients

For You

For more on the latest guidance in the many clinical challenges of prenatal and postnatal headache, be sure to access NPWH’s just posted continuing education (CE) activity, “Management of headache in pregnancy and during lactation.”  Available now through February 28, 2025, this activity has been evaluated and approved by the Continuing Education Approval Program of the National Association of Nurse Practitioners in Women’s Health and has been approved for 1 contact hour CE credit, including 0.50 hours of pharmacology credit.  In it, co-authors Dalisa Barquero, DNP, MPH, WHNP-BC, and Amber S. Shapton, DNP, FNP-BC, WHNP-BC, describe pharmacologic options and special considerations for their use in prevention and management of primary headaches during pregnancy and lactation.

The American Headache Society has published a podcast series which provides educational resources to empower healthcare professionals to help improve headache and migraine care for patients.  Two episodes of the series deal specifically with Pregnancy and Migraine.  In them, Drs. Susan Hutchinson, Catherine Stika, and Nina Riggins provide guidance on headache red flags for pregnant patients, how to manage migraine after delivery, pregnancy-safe treatment options, and more.

For Your Patients

In January 2022, the American Migraine Foundation (AMF) convened a panel of experts to discuss how migraine can affect women throughout different stages of their lives and to answer patient questions.  The full, free webinar, “Migraine and Women’s Health: Your Questions Answered” is available on demand here.

Another no-cost, downloadable patient education resource to share includes a comprehensive, 5-page PDF, “Migraine in Pregnancy,” which gives patient-facing preventive strategies and pregnancy appropriate medication regimens.  In addition to these invaluable resources, the AMF provides over 2 dozen other no-cost patient education guides covering migraine topics from “A Guide to Nutraceuticals for Migraine,” to “How to Support Someone with Migraine,” to a “Meal Planning Toolkit.”  Find the AMF’s complete migraine essentials bookshelf here.

The contents of this feature are not provided or reviewed by NPWH.