Survey Results Underscore Migraine’s Impact on Family Planning

Many women suffering from migraine say the condition affects family planning, while this finding is more prevalent among women who are younger and experience menstrual and chronic migraine. Survey results were published in Mayo Clinic Proceedings.

Although the underlying cause of migraine is unknown, numerous studies show women between the ages of 15 and 49 tend to experience the condition more than men.

Not only does migraine adversely affect a patient’s quality of life during an attack, but it also has substantial negative effects between attacks, authors wrote. “This interictal burden is associated with anxiety about the next migraine attack and concern over its possible adverse effect on future plans or activities.”

To better understand the effect of migraine on pregnancy planning, researchers analyzed data from the American Registry for Migraine Research (ARMR).

The ARMR database was established by the American Migraine Foundation and is comprised of clinical and imaging data and biospecimens. The multicenter longitudinal patient registry includes data from patients enrolled at ARMR sites (specialty headache clinics in the United States).

Of the 1289 patients who completed baseline questionnaires, 1112 were women and 607 completed the family planning questionnaire. All participants were at least 18 years old and had at least 1 migraine diagnosis. Data included in the current analysis were recorded between February 2016 and September 2019.

Mean (SD) patient age was 45.3 (13.2) years while participants were predominately white (n = 560 [92.3%]) with a graduate degree (n = 375 [61.8%]). Around 60% of participants had at least 1 child and around 50% were married/living with a domestic partner.

Researchers found:

• Of 607 women, 70 respondents (11.5%) answered that migraine resulted in “avoid pregnancy – significant” and 51 (8.4%) answered “avoid pregnancy – somewhat”
• Compared with women who did not avoid pregnancy, those who did were younger (37.5 [9.2] years vs 47.2 [13.3] years; P < .001) and had fewer children (0.8 [1.1] vs 1.5 [1.5]; P < .001)
• Compared with women who did not avoid pregnancy, those who did also were more likely to have chronic migraine (n = 99 [81.8%] vs n = 341 [70.2%]; P = .012) and experience menstrually associated migraine (n = 5 [4.1%] vs n = 5 [1.0%]; P = .031)
• Among women who avoided pregnancy, 87 (72.5%) believed their migraine would be worse during pregnancy while 82 (68.3%) believed disability caused by migraine would make pregnancy difficult
• 92 women (76%) who avoided pregnancy believed migraine medications they take would negatively affect their child’s development and 17 (14%) thought migraine would cause the baby to have abnormalities at birth

Analyses also showed the avoid pregnancy group included a higher proportion of patients who reported having a history of depression (n = 59 [48.8%] vs n = 183 [37.7%]; P = .026), a higher frequency of headache days per 3 months (53.9 [29.7] vs 42.5 [29.0]; P < .001), and higher Migraine Disability Assessment (MIDAS) scores (132.5 [80.7] vs 91.7 [69.8]; P < .001).

Because study participants were enrolled from specialty headache centers, most had chronic migraine, and the overwhelming majority were White, authors caution results may not be generalizable to the general population of migraineurs.

“Our study reveals the enormous and substantial burden of migraine on pregnancy planning,” researchers concluded. “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.”

Reference

Ishii R, Schwedt TJ, Kim S, Dumkrieger G, Chong CD, Dodick DW. Effect of migraine on pregnancy planning: insights from the American registry for migraine research. Mayo Clin Proc. Published online September 15, 2020. doi: 10.1016/j.mayocp.2020.06.053