Migraines in pregnancy: a prospective study of symptom patterns and obstetric outcomes

Objective: We aimed to evaluate the frequency and characteristics of headaches across pregnancy and to examine obstetric and neonatal outcomes among pregnant patients with recurrent migraines. Study Design: This was a single-site prospective observational study of pregnant patients evaluated for recurrent headaches during prenatal visits from December 2020 through September 2022. Standardized questions were used at each visit to assess headache type, frequency, and associated symptoms. Obstetric and neonatal outcomes were recorded. Statistical analyses included mixed effects logistic regression, independent t-tests, and chi square tests to compare baseline characteristics and outcomes between groups. Results: During the study period, 858 pregnant patients were evaluated for recurrent headaches. Of these, 546 (63.6%) patients were diagnosed with migraine headaches and 312 (36.4%) with tension-type headaches. Migraine frequency was highest in the second trimester. Nausea, vomiting, and photophobia were the most commonly reported associated symptoms. In the first trimester, 58.7% of patients reported nausea, 59.4% photophobia, and 31.0% vomiting. The frequency of these symptoms decreased with advancing gestation. The composite outcome of preterm delivery, preeclampsia with severe features, abruption, and stillbirth did not significantly differ between patients with migraines and matched controls without headache disorders (25.4 vs 21.1%, p = 0.12). There were no significant differences in individual components of the composite outcome or in neonatal outcomes, including birthweight < 3%ile, birthweight < 10%ile, and need for neonatal respiratory support. Conclusion: Migraines were the most common headache diagnosis among pregnant patients with recurrent headaches, and migraine frequency and associated symptoms changed across gestation. After adjustment for comorbid conditions, obstetric and neonatal outcomes were similar between patients with recurrent migraines and those without headache disorders.