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Migraines in pregnant women can be warning
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Published: March 11, 2009
Updated:
Having a migraine can be more than a pain for pregnant women.
It also can represent an increased risk for a stroke or other vascular diseases, according to a study by researchers at three of North Carolina's academic hospitals.
The report, which appears in this month's issue of British Medical Journal, is a follow-up on a study first released in May 2007. Participating in the study are Wake Forest University Baptist Medical Center, Duke University Medical Center and UNC Chapel Hill.
The study was based on the hospital-discharge records for more than 18.3 million pregnant women from 2000 to 2003. A review of the records showed that there were 33,956 who had been diagnosed with migraines during a pregnancy-related admission.
Research of the data found that women treated for migraines during pregnancy are 15 times more likely to have a stroke. They also are two times more likely to have heart disease and more than three times more likely to have blood clots and other vascular problems during pregnancy.
"Obstetricians, general practitioners and neurologists alike should all realize that these results do not apply to every woman with a migraine during pregnancy," the researchers said.
"However, for pregnant women hospitalized with active migraines, modifiable cardiovascular risk factors and pregnancy complications, such as preeclampsia, should be recognized and treated."
Migraine headaches are a neurovascular disorder that occurs in about 26 percent of women of childbearing age.
Women age 40 and older are 2.4 times more likely to have a migraine than women younger than 20. White women are more likely to have a migraine than other races/ethnic groups.
Previous studies have shown that some women have their first migraine while pregnant, and other women will have an increase or decrease in the intensity of their migraines in pregnancy.
Dr. Cheryl Bushnell, a neurologist at Wake Forest Baptist and lead investigator of the study, said that women with persistent and severe migraines during pregnancy should be aware of their risk factors, such as high blood pressure, high cholesterol, diabetes, history of blood clots, heart disease and prior stroke.
"There also seems to be a relationship between migraines and preeclampsia, one of the most common and dangerous complications of pregnancy," Bushnell said. "We don't want to come across as alarmist, considering that stroke still is rare in pregnancies, affecting between 10 and 30 women per 100,000 pregnancies.
"Migraines, particularly those associated with an aura or visual changes around the time of the headache, have been previously linked to stroke and heart disease in women," Bushnell said. "This study further validates the association between the two."
Bushnell said that the reason that severe migraines are associated with stroke and vascular disease is not clear. "Because the data cannot determine which came first, migraine or the vascular condition, prospective studies of pregnant women are needed to explore this association further," she said.
Brad Imler, the president of the American Pregnancy Association, said that the study's validation of a relationship between migraines and vascular diagnoses during pregnancy "equips health-care providers with insights for extending their examinations and care beyond the presenting migraine health concerns."
The study was financed in part by the National Institutes of Health.
■ Richard Craver can be reached at 727-7376 or at rcraver@wsjournal.com.
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