early pregnancy headaches and migraines

[expert@preeclampsia.org]

I read in a pregnancy book by Sheila Kitzinger that suffering from migraine is a risk factor to develop pre-eclampsia. Is that true?? I had (probably mild) PE in my first pregnancy, blood pressure around 140/90, 150/100 from week 36, no protein in the urine, no edema. Baby was born in a very fit state after induction and cesarean in week 38+5, weighing 2900g (normal in our family). Now, 15 years later at 39, I'm thinking of getting pregnant again. My internist diagnosed labile hypertension (around 135/90), said I don't need medication at this point and is optimistic. I'm of normal weight and have no other medical conditions. But I have migraines on and off, not too bad, but a few times per month. Is there a connection between migraines and PE?

[expert@preeclampsia.org]

Hi---I am six weeks pregnant and very nervous. I had my first child in June of 2006. He was born early at 35 weeks due to my pre-eclampsia that began as hypertension at 31 weeks. He only lived for one week as he contracted a hospital infection and died from the shock to his system. So the pre-eclampsia was basically unrelated to his death, but being born early was not helpful.

Now, understandably, I am nervous and yet excited to be pregnant again. The reason for me writing is that I got a headache yesterday and still have one today that has not been fixed by Tylenol. It feels like the headaches I had during my first pregnancy. Unfortunately, I do not recall exactly when the headaches began in my first pregnancy. I remember that I began seeing my chiropractor quite often starting around the middle of pregnancy, because I thought the headaches were due to my neck being out of joint. The headaches never really went away. I am not having any visual disturbances. The headache is always on my right temple, about the size of a quarter. It is not throbbing----it is quiet and constant. It isn’t really painful as many headaches are. It feels like a strong person is constantly pressing his thumb into my temple.

Could it be that this is just something that my body does due to hormone changes during pregnancy? I realize that at 6 weeks, it is unlikely to have anything to do with pre-eclampsia…right? What do other women report for headaches during pregnancy/pre-eclampsia? Similar location on the head?

[expert@preeclampsia.org]

You could get many different answers to these questions. I can only answer them in context of the way that we practice.

Yes, we do believe that migraines and preeclampsia are related. Both, at their core, are related to small blood vessels that are dysregulated. They do not maintain proper vascular tone appropriately.

ß-blockers such as atenolol are effective for treating migraines in pregnancy. We also use ß-blockers to treat BP in pregnancy. In our hands, the approach is safe. However, our approach is very controversial.

If a woman has had preeclampsia when much younger, is now 39 years, and has BP's of 135/90, we would treat her BP aggressively prior to conception. We have good data from women who have complicated diabetes that treatment of BP prior to pregnancy improves outcomes. Recommendations outside pregnancy (JNC-7 Report) recommend treating BP to < 130/80 in patients with cardiovascular complications or risk factors. Is a history of preeclampsia a sufficient risk factor? We are not sure. Do you have protein in your urine now? Proteinuria prior to pregnancy in a woman with cHTH is a significant risk factor for preeclampsia. Treatment of BP (particularly with a ß-blocker) may help migraines.