Mothering with Migraine by Jennifer Evan

Mothering with migraine is complicated. Migraine is ubiquitous, affecting over 1 billion people in the world, with a lifetime prevalence upwards of 20-30%. It affects females 2 to 3 times more often than males.¹ Given that roughly half of the world’s population is female, this is a staggering number of women disproportionately affected by this common and oftentimes severe neurological condition. Moreover, the most affected age range of women with migraine is 20-50. This happens to coincide with one’s prime activity years in education, employment, and career building, as well as family planning.  Indeed, migraine has been found to be a leading cause of disability in women under age 50 in the Global Burden of Disease the preeminent study that analyzes epidemiological data from hundreds of countries worldwide.¹

Family Planning and Migraine

It is a common sentiment that being a mother is one of the most challenging roles a woman can assume. Parenthood is a joyful journey for many. It inherently comes with dozens (or, more realistically, hundreds) of new worries, pressures, and tasks involved in raising one’s children into adulthood. As if this new stage of life wasn’t difficult enough to navigate, when experienced by someone living with migraine, it can become daunting at times.

In one study of over 600 women with migraine, one-fifth surveyed reported actively avoiding pregnancy due to migraine. The overwhelming majority reported fear of worsening migraine status during or after pregnancy and fear of complications during pregnancy due to migraine as well as concerns for the health of their child in inheriting migraine or from migraine medications taken during the pregnancy.² The weight of this finding is impressive. This headache disorder can and does affect a woman’s reproductive plans and desires. It is truly representative of just how disabling this neurological disorder is.

Mothering with Migraine

Life in general is relatively unpredictable. The day-to-day experience of having children is a new level of unpredictability that still amazes me. When you couple this with the inopportune timing of having a migraine attack, figuring out how to be a mother and taking care of a tiny human, or multiple ones, is beyond difficult.

Imagine holding your teething infant or nursing when you are nauseated and swimmingly dizzy, and becoming more dehydrated by the minute. Imagine having to pick up your child from school or activity when your headache pain is throbbing and your vision blurred with searing light sensitivity to the mid-day sun. Even just imagine safely taking care of your children at home when you are light-headed and near vomiting, and your 2-year-old wants you to play and needs help opening a snack while toys that have loud children’s music and sounds play in the background, and your infant is crawling around and also needs a diaper change.

For many of us, we don’t have to imagine those scenarios, as we have been there. Those who haven’t yet, unfortunately, may experience similar situations in time if you happen to be mothering with migraine. 

Mother’s Day

Being proximal in timing to Mother’s Day that I am writing this is quite serendipitous. Although not at all planned, it does time well with my own thoughts on mothering with migraine. (Though I think a day is too short a time frame for this thoughtful occasion, perhaps a modification to Mother’s Week? Or even better Mother’s Month of May for some pleasing alliteration? I digress).

This topic is near and dear to my heart for several reasons. In my work as a neurologist, I have a special interest in treating women in all stages of life, particularly during pregnancy and post-partum stages.  I myself have migraine although it is quite infrequent now thankfully. When I was in medical training during which time I had no shortage of physiologic stressors (think 28-hour shifts on-call, missing dinner, forgetting to drink any fluids, day-night cycle disruption), I briefly had chronic migraine.

Migraine Specialist and Mom

Not all migraine specialists have migraine themselves. I think knowing first-hand the experience of having a migraine lends another level of compassion -and perhaps even expertise- in approaching the treatment of migraine in our patients. I recently had two migraine attacks in a three-week period of time. This is highly unusual for me in recent years, especially given that I am currently eight months postpartum myself. There is good data supporting that lactational status often provides some protective threshold against migraine.

How Can I be a Mother and Live with Migraine?

One of these migraine attacks occurred very suddenly when normally I have slow-to-build-up migraine attacks. It typically is a lighter headache over hours, allowing me to treat headache pain before it gets worse and even to change plans as needed for the day with regard to my children.

As I had my head down, holding a leaking bag of ice on my head, lost in nausea, asking my husband to turn off all the lights (including the small plant light for my garden seedlings in the corner of the kitchen that I could still perceive with my eyes closed and was exacerbating the pain), and waiting for the medication to kick in, I remember thinking to myself, if my husband was out of town or at work, how would I have been able to safely put my children to bed, and how would I have been able to get up when my infant cries and needs to nurse in a few hours?

Whether dealing with the migraine postdrome, a side effect of a migraine abortive, or both, how can we function as mothering with migraine? How would we be the best mother we can be? How could we safely do what needs to be done to take care of children when suffering from pain and associated symptoms? And yet, how do we?

Building a Village while Mothering with Migraine

I become a mother less than three years ago. I have come to realize a new-found appreciation for the expression ‘It takes a village’. Much like with lifeboat allocation on the Titanic, it is my belief that it is to the benefit of all of us in society to prioritize the health and wellness of women and children. (I’ll never miss an opportunity for a Titanic reference!) I believe supporting each other in this journey of raising children is an often under-utilized resource. There is a fear of being judged. We know the stigma of having migraine can be just as painful emotionally as the headache pain can be somatically.

Even without having migraine or any other disorder, there is a strong culture these days of pressure and judgment that is placed on women, particularly mothers, regarding if or how they raise children, and affecting our ability to ask for help.  I recommend all moms have a community to support themselves should they need an extra hand. Whether it be the next-door neighbor, a family member, your significant other or partner, a church group, or even a local group on social media of other people with migraine find someone to help. Find someone who understands the nature of this condition and who may be willing to assist, with childcare, pick-ups, fetching medication, or otherwise, when you have a migraine attack. I believe if we create it, the support will ensue. 

Sources: 

1. Stovner, L.J., Hagen, K., Linde, M. et al. The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates. J Headache Pain 23, 34 (2022). https://doi.org/10.1186/s10194-022-01402-2
2. Ryotaro Ishii, Todd J. Schwedt, Soo-Kyoung Kim, Gina Dumkrieger, Catherine D. Chong, David W. Dodick. Effect of Migraine on Pregnancy Planning: Insights From the American Registry for Migraine Research. Mayo Clinic Proceedings, 2020; DOI: 10.1016/j.mayocp.2020.06.053