MaMi study: Perceptions of pregnancy and reproductive decision‐making in women with migraine

OBJECTIVE: To characterize the influence of migraine on reproductive decision-making in women of childbearing age and to identify potentially modifiable beliefs that could guide preconception counseling in headache clinical practice. BACKGROUND: Migraine is a highly prevalent neurological disorder that disproportionately affects women of childbearing age. Although pharmacological management during pregnancy has been widely addressed, less is known about how migraine shapes desire for motherhood, pregnancy planning, and family-related decisions. METHODS: This observational, cross-sectional, multicenter study was conducted in six Spanish public hospitals. Women aged 18-49 years with episodic or chronic migraine were recruited by convenience during routine consultations between March 1 and November 30, 2023. Participants completed a structured questionnaire addressing reproductive decisions along with validated scales, including the Headache Impact Test-6 (HIT-6), the Migraine Disability Assessment Scale (MIDAS), and the Hospital Anxiety and Depression Scale (HADS). Descriptive statistics were used for data analysis. RESULTS: A total of 162 women were included, with a median age of 36 years (interquartile range [IQR]: 31-41); 117 (72.2%) had episodic migraine and 45 (27.8%) had chronic migraine. Headache burden was high: the median HIT-6 score was 65 (IQR: 61-68), and 131/162 participants (80.9%; 95% confidence interval [CI], 74.1-86.2) were classified as having severe headache impact. Emotional symptoms were also frequent, with abnormal HADS-A scores in 84/162 participants (51.9%; 95% CI, 44.2-59.4) and abnormal HADS-D scores in 34/162 (21.0%; 95% CI, 15.4-27.9). Migraine influenced reproductive decisions in 49/162 women (30.2%; 95% CI, 23.7-37.7). The most common consequence was postponing pregnancy, reported by 38/161 participants (23.6%; 95% CI, 17.7-30.7), whereas 9/161 (5.6%; 95% CI, 3.0-10.3) had definitively decided against childbearing and 6/160 (3.8%; 95% CI, 1.7-7.9) had considered adoption. The main perceived barriers were reduced ability to care for children during migraine attacks (129/161; 80.1%; 95% CI, 73.3-85.6), fear of treatment-related teratogenic risks (97/161; 60.2%; 95% CI, 52.5-67.5), concern about migraine worsening during pregnancy (63/161; 39.1%; 95% CI, 31.9-46.8), and fear of transmitting migraine to offspring (117/161; 72.7%; 95% CI, 65.3-79.0). CONCLUSION: Migraine affected reproductive decision-making in nearly one-third of women of childbearing age, most often by contributing to pregnancy postponement rather than definitive avoidance of motherhood. Concerns about childcare capacity, treatment safety, migraine worsening during pregnancy, and genetic transmission were highly prevalent. Some of these perceptions may not fully align with current evidence regarding migraine course during pregnancy or the safety of available treatments, suggesting that they represent potentially modifiable targets for clinical intervention.