The following is the summary of “Pre-pregnancy migraine diagnosis, medication use, and spontaneous abortion: a prospective cohort study” published in the December 2022 issue of Headache and Pain by Crowe, et al.

Migraine affects 17–24% of women of childbearing age, and its incidence may be linked to a woman’s fertility by means of underlying central nervous system excitability, autoimmune disorders, and autonomic dysfunction. In this study, researchers analyzed the relationship between a history of migraines and the use of preventative medicine before conception with the probability of a woman having a spontaneous abortion (SAB). Investigators looked at information gathered from women who planned pregnancies before they conceived (2013–2021). Women in the United States or Canada (n=7,890) who self-identified as female and became pregnant during the study’s follow-up were considered eligible. 

Participants filled out a baseline survey and two further surveys bimonthly for 12 months or until they reported being pregnant, whichever came first. Participants then filled out questionnaires both early in their pregnancies (about 8-9 weeks) and late in their pregnancies (around 32 weeks). Individuals who self-identified as migraine sufferers or had used a drug to treat migraines were classified as migraineurs. Migraine medication use in the previous 4 weeks was obtained by preconception questionnaires, and SAB was elicited via postconception and pregnant questionnaires. By using Cox regression models with gestational weeks as the time scale, we could account for potential demographic, medical, and lifestyle confounders to estimate hazard ratios (HRs) and 95% CIs for associations between preconception migraine, migraine medication use, and SAB.

Pregnancies in the study had a 19% termination rate because of SAB. Migraine headaches before conception were not significantly linked to SAB risk (HR=1.03, 95% CI=0.91-1.06). Overall, the use of migraine medication was linked with a moderate increase in the incidence of SAB (HR=1.14, 95% CI=0.96-1.36). Daily users of migraine medication were found to be at the highest risk (HR = 1.38, 95% CI: 0.81-2.35), followed by those who took prophylactic migraine drugs (HR = 1.43, 95% CI: 0.72-2.84) or analgesics with caffeine (HR = 1.42, 95% CI: 0.99-2.04). The incidence of SAB was higher among those whose use of migraine medication was consistent with a more severe underlying migraine condition. The results of this study add to the previous literature on migraine’s potential impact on reproduction.