Migraines are common in pregnancy because migraines are common in women. Up to 25% of women of reproductive age report migraine headaches. The headaches are usually severe, often throbbing and frequently associated with other symptoms such as nausea or changes in vision. Migraines can be triggered by certain foods (such as red wine), exercise, stress, or hormones -- either in birth control pills or at certain points in the menstrual cycle.

In pregnancy, 60% to 70% of women with a history of migraines say they have no attacks or fewer headaches. Less than 10% say their headaches get worse. However, pregnancy can complicate the management of migraines; many women and their doctors are reluctant to use medication during pregnancy because information about safety, particularly for newer medications, may be limited. However, there are many medications that can be used during pregnancy.

Acetaminophen (Tylenol), narcotics (codeine, oxycodone) and anti-emetics (anti-nausea medications such as Compazine) can be safely used. Combination medications such as Fioricet (which includes acetaminophen, butalbital and caffeine) may be tried. However, overuse of Fioricet can lead to rebound and chronic headaches.

For some women, the easiest and most pleasurable place to start when faced with a migraine in pregnancy is with a good strong cup of coffee or other caffeinated beverage. One cup every now and again is fine. But daily use can lead to rebound headaches.

Non-steroidal anti-inflammatory medications, such as ibuprofen or naproxen, should be used only under the direct instruction of your obstetrician. These drugs are probably safe when used for short periods of time in the early part of pregnancy. However, you must avoid them in the later part of pregnancy. They may affect a baby's heart and kidney function.

There is limited data on the triptans, such as sumatriptan (Imitrex). Therefore, even though available information does not suggest concern, most doctors do not prescribe them.

Certain beta-blockers can prevent migraines in women with frequent attacks. In some studies, some beta-blockers have been associated with lower birth weight. However, these associations may be related to the conditions for which the beta-blockers are prescribed, such as heart disease and high blood pressure. There may not be any real cause and effect.

In some women, the benefits of beta-blockers are such that they and their doctors decide to continue them and use ultrasound to be sure the baby is growing appropriately.