Nearly one in five women who suffer from chronic migraine avoid pregnancy because of that condition, researchers found. In their observational study based on data from the American Registry for Migraine Research (ARMR), Ryotaro Ishii, MD, PhD, Department of Neurology, Mayo Clinic, Phoenix, and colleagues found that women with chronic migraine avoided pregnancy because they believe their migraines will worsen during pregnancy, make their pregnancy difficult, and negatively affect their babies. Their findings were published in Mayo Clinic Proceedings.

Migraine is a leading cause of disability worldwide, and according to Dr. Ishii and colleagues, is particularly burdensome for women. Not only does migraine affect quality of life during an actual episode, the condition creates anxiety concerning when the next attack will hit, and how it will affect future plans and activities, such as pregnancy.

Evaluating the Effect of Migraine on Reproductive Planning

While there have been studies on the relationship between headache disorders and pregnancy, the authors of this study pointed out that there is a lack of research focusing on the effect migraine has on pregnancy planning. Therefore, Dr. Ishii and colleagues used the ARMR database to evaluate the effect on reproductive planning in women who suffer from migraines.

The participants in the study were women with chronic migraine who answered an ARMR questionnaire containing family planning questions in the period from February 2016 until September 2019. The study included 607 questionnaire respondents. These women had a mean age of 45.3 years and were mostly White (92.3%) with graduate degrees (61.8%). Half (50.4%) worked full-time, and about two-thirds (65.2%) were either married or living with a partner.

Impact on the Decision to Not Get Pregnant

Of the women in the study, 19.9% responded that migraine either somewhat (8.4%) or significantly (11.5%) resulted in a decision not to get pregnant. While these women were younger (mean age 37.5 years) than women who reported that migraine had no impact on pregnancy decision making, there was no significant difference between the two groups regarding race, income, employment status, or marital status.

Dr. Ishii and colleagues also found that, compared with women who did not avoid pregnancy, the avoid pregnancy group had fewer children (0.8 vs 1.5), were more likely to have chronic migraine (81.8% vs 70.2%), and more likely to have menstrually associated migraine (4.1% vs 1.0%).

When asked how they thought migraine would impact pregnancy, more than half answered:

  • Migraines would get worse during or just after pregnancy (72.5%).
  • Disability caused by migraine would make the pregnancy difficult (68.0%).
  • Disability from migraine makes raising children difficult (82.6%).
  • Migraine medications could negatively affect child development (76.0%).
  • They could pass on genes that could cause their babies to have an elevated risk of having migraine (72.7%).

Additionally, one in seven of these women (14%) were concerned that migraine could cause their babies to have abnormalities at birth.

The authors pointed out that the medical literature shows that migraine headaches usually improve during pregnancy, with about one-half to three-fourths of those with migraine having a marked improvement. Yet, in their study, a significant percentage of women believed migraine would worsen during pregnancy and make it more difficult.

Beliefs Incongruent With Evidence

“These beliefs are incongruent with the evidence that migraine typically improves during pregnancy,” write Dr. Ishii and colleagues. “It is essential that women of childbearing potential with migraine receive education about the potential effect of migraine on pregnancy to facilitate informed decisions about pregnancy planning.”

In an editorial accompanying the study, Rashmi B. Halker Singh, MD, Department of Neurology, Mayo Clinic, Phoenix, AZ, and Joseph I. Sirven, MD, Department of Neurology, Mayo Clinic, Jacksonville, Florida, wrote that considering that the women in the ARMR are those being followed in headache specialty clinics, the study’s results illustrate the correlation between disease severity and the approach to making significant life decisions.

Leaving the Door Open for Future Dialogue

“Clinicians need to be aware of this association, particularly as we attempt to embody a more patient-centric approach to health care,” write Drs. Halker Singh and Sirven. “Discussions regarding a patient’s potential interest in pregnancy need to occur starting at the initial appointment, and for women who might not be interested at that time, the door needs to be left open for future dialogue should they desire.” They also observed that since women are avoiding pregnancy based on “potentially incorrect assumptions” about the association between migraine and pregnancy outcomes, it “underscores the importance of including discussions of pregnancy as part of migraine education.”