Elsevier

Mayo Clinic Proceedings

Volume 95, Issue 10, October 2020, Pages 2079-2089
Mayo Clinic Proceedings

Original article
Effect of Migraine on Pregnancy Planning: Insights From the American Registry for Migraine Research

https://doi.org/10.1016/j.mayocp.2020.06.053Get rights and content

Abstract

Objective

To evaluate the effect of migraine on women’s pregnancy plans.

Patients and Methods

Participants were enrolled in the American Registry for Migraine Research, an observational study that recruits patients from headache specialty clinics across the United States. Data for this analysis were collected via patient-completed questionnaires completed from February 1, 2016, through September 23, 2019. Participants were adult women with migraine who answered the American Registry for Migraine Research family planning questions.

Results

Of 607 women, 19.9% (n=121) avoided pregnancy because of migraine. 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), had fewer children (0.8±1.1 vs 1.5±1.5; P<.001), and were more likely to have chronic migraine (n=99 [81.8%] vs n=341 [70.2%]; P=.012) and menstrually associated migraine (n=5 [4.1%] vs n=5[1.0%]; P=.031). Women who avoided pregnancy believed that their migraine would be worse during pregnancy (n=87[72.5%]), disability caused by migraine would make pregnancy difficult (n=82[68.3%]), the migraine medications they take would negatively affect their child’s development (n=92[76.0%]), and migraine would cause the baby to have abnormalities at birth (n=17[14.0%]).

Conclusion

Migraine effects pregnancy plans of many women, especially of those who are younger and have menstrual migraine and chronic migraine. Women who avoid pregnancy because of migraine believe that migraine will worsen during pregnancy, make their pregnancy difficult, and have negative effects on their child. Study results highlight the importance of educating women with migraine about the relationships between migraine and pregnancy so that informed family planning decisions can be made.

Section snippets

Design and Setting

The ARMR database, established by the American Migraine Foundation, is a multicenter longitudinal patient registry that collects clinical and imaging data as well as biospecimens. The institutional review board approvals were obtained from each of the enrolling sites, and all participants completed an informed consent process that included signing informed consent documents. Patients were recruited and enrolled from ARMR sites, which are specialty headache clinics in the United States. Data

Results

Demographic and clinical characteristics are summarized in Table 1. In the entire patient cohort, the mean age was 45.3±13.2 years. Participants were predominantly white (n=560 [92.3%]) with a graduate degree (n=375 [61.8%]) who were working full-time (n=306 [50.4%]), were married/living with domestic partner (n=396 [65.2%]), and had at least 1 child (n=361 [59.5%]). The most common household income was in the range of $50,000 to $99,999 (n=188 [31.0%]).

The effect of migraine on pregnancy plans

Discussion

American Registry for Migraine Research data are real-world data from patients being seen in headache specialty clinics in the United States. All patients enrolled in ARMR have ICHD-3 headache diagnoses assigned by headache specialists working at headache specialty centers.

In our patient cohort, 19.9% of women with migraine avoid pregnancy because of their migraine. Our study reveals the enormous and substantial burden of migraine on pregnancy planning. According to previous studies, 1% to 3.2%

Conclusion

American Registry for Migraine Research data indicate a high burden of migraine on pregnancy planning, especially in women who are younger and have menstrual migraine, CM, and a history of depression. Those who plan to avoid pregnancy believe that migraine will worsen during pregnancy and make their pregnancy difficult. These beliefs are incongruent with the evidence that migraine typically improves during pregnancy. It is essential that women of childbearing potential with migraine receive

Acknowledgments

We gratefully acknowledge the American Registry for Migraine Research for the use of registry data to conduct this research. In addition, we thank the patients and clinicians who participated in this registry.

The principal investigator is Ryotaro Ishii, MD, PhD, who had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

References (25)

  • T.J. Schwedt et al.

    The American Registry for Migraine Research: research methods and baseline data for an initial patient cohort

    Headache

    (2020)
  • A.M. Adams et al.

    The impact of chronic migraine: the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study methods and baseline results

    Cephalalgia

    (2015)
  • Cited by (0)

    For editorial comment, see page 2054

    Potential Competing Interests: Dr Schwedt has served as a consultant for Alder, Allergan, Amgen, Avanir, Biohaven, Cipla, Click Therapeutics, Dr. Reddy’s, Eli Lilly, Equinox, Ipsen Bioscience, Nocira, Novartis, Salvia, Teva, Xoc Pharmaceuticals, and Weber & Weber. He has stock options in Aural Analytics, Nocira, and Second Opinion. He has received research funding from Amgen, American Migraine Foundation, Arizona State University, Henry Jackson Foundation, the National Institutes of Health, Patient-Centered Outcomes Research Institute, and the U.S. Department of Defense. He serves on the boards of directors of the American Headache Society and the International Headache Society. Dr Chong receives research funding from Amgen, Arizona State University, the National Institutes of Health, and the U.S. Department of Defense and personal compensation from Amgen. Dr Dodick receives personal fees from Amgen, AEON, the Association of Translational Medicine, University Health Network, Daniel Edelman Inc., Autonomic Technologies, Axsome, Allergan, Alder BioPharmaceuticals, Biohaven, Charleston Laboratories, Clexio, Dr Reddy’s Laboratories/Promius, Electrocore LLC, Eli Lilly, eNeura, Neurolief, Novartis, Ipsen, Impel, Satsuma, Supernus, Sun Pharma (India), Theranica, Teva, Vedanta, WL Gore, Nocira, PSL Group Services, XoC, Zosano, ZP Opco, Foresite Capital, Oppenheimer; Upjohn (Division of Pfizer), Pieris, Revance, Equinox, Salvia, and Amzak Health. He has received speaking fees from Eli Lilly, Novartis Canada, Amgen, and Lundbeck and CME fees or royalty payments from HealthLogix, Medicom Worldwide, MedLogix Communications, Mednet, Miller Medical, PeerView, WebMD Health/Medscape, Chameleon, Academy for Continued Healthcare Learning, Universal Meeting Management, Haymarket, Global Scientific Communications, Global Life Sciences, Global Access Meetings, Catamount, UpToDate (Elsevier), Oxford University Press, Cambridge University Press, and Wolters Kluwer Health. He has stock options in Precon Health, Aural Analytics, Healint, Theranica, Second Opinion/Mobile Health, Epien, Nocira, Matterhorn, Ontologics, and King-Devick Technologies. He serves as a consultant without fee for Aural Analytics, Healint, Second Opinion/Mobile Health, and Epien and on the boards of directors of Precon Health, Epien, Matterhorn, Ontologics, and King-Devick Technologies. He owns a patent (without fee) 17189376.1-1466:vTitle: Botulinum Toxin Dosage Regimen for Chronic Migraine Prophylaxis. He has received research funding from American Migraine Foundation, the U.S. Department of Defense, Patient Centered Outcomes Research Institute, and Henry M. Jackson Foundation and professional society fees or reimbursement for travel from the American Academy of Neurology, American Brain Foundation, American Headache Society, American Migraine Foundation, International Headache Society, and Canadian Headache Society. The other authors report no competing interests.

    Data Previously Presented: These data were presented in part at the 2020 virtual annual scientific meeting of the American Headache Society.

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