It is important to screen pregnant women with migraine for post-traumatic stress disorder (PTSD) due to its increased risk.

According to the National Health Interview Survey in 2011, 26.1% of women of 18–44 years of age reported migraines or severe headaches in the last three months. Migraine is one of the most prevalent diseases that adversely affect the health of women in reproductive age as compared to men and women in their early and old age. Migraine increases the risk of depression, suicidal ideation and perinatal complications including preeclampsia, preterm delivery, placental abruption, hypertensive disorders, as well as cardiovascular diseases and stroke. The principal risk factors for migraine in pregnant women are thought to be maternal mood and anxiety disorders. There are enough evidences supporting an association between post-traumatic stress disorder (PTSD) and migraine in the U.S. population, but studies evaluating the risk of PTSD in pregnant women are lacking.

Rationale behind the research:

Since there are little evidences explaining the association between migraine and PTSD in pregnant women, this study was conducted to probe out the same.

Objective:

To determine the association between migraine and PTSD in women during pregnancy.

Study outcome measures:

• The sociodemographic and reproductive characteristics like age, education, BMI, drug abuse
• The association of migraine and PTSD assessed by the PCL-C during pregnancy
• The association of migraine and PTSD stratified by depression status
  

Study outcomes:

Baseline: There were some differences between groups in baseline characteristics

• While controlling depression, women with any migraine had almost 2-fold increased odds of PTSD (OR: 1.97; 95% CI: 1.64–2.37) as compared to women without migraine
• Women with migraine alone (i.e., excluding probable migraine) had 2.85-fold increased odds of PTSD (95% CI: 2.18–3.74), and women with probable migraine alone had 1.61-fold increased odds of PTSD (95% CI: 1.30–1.99) as compared to those without migraine, even after controlling depression
• Women with both migraine and co-morbid depression exhibit increase in the odds of PTSD in all migraine patients as compared to those women without migraine
  

The results of this study indicate an increase in odds of PTSD in probable migraine and migraine pregnant women as compared to women with no migraine irrespective of presence and absence of antepartum depression. This study was the first study that included a large sample size and population with a high prevalence of migraine and PTSD to determine the link between PTSD and migraine in pregnant women. The results of this study were comparable with studies that show an association between PTSD and migraine in men and nonpregnant women. Previous studies have shown comorbidities between migraine and PTSD despite differences in geographic location, population characteristics, and sociodemographics. The association between PTSD and migraine were explained by several potential biological and neurochemical mechanisms such as biochemical markers serotonin, cortisol, and norepinephrine. It was postulated that decrease in serotonin levels cause the trigeminal nerve to release neuropeptides, which is responsible for migraine pain. Moreover, PTSD was also found to be linked with serotonin function. The decreased levels of cortisol and elevated levels of pro-inflammatory cytokines (e.g. tumor necrosis factor-alpha, interleukin-6 (IL-6) in patients with PTSD is believed to be linked with migraine.

Mental health is of utmost importance during pregnancy. A previous study in the same cohort had found 70% of participants with a history of childhood abuse, and 36.7% with a history of intimate partner violence, which was associated with an increased risk of migraine. During pregnancy, PTSD is prevalent and can increase postpartum if left unidentified. It was found that a large number of women during reproductive health suffering from migraine, but the underlying mechanisms remains partially understood.