When you have to manage a chronic illness like vestibular migraine, the idea of pregnancy, birth, and postpartum can be quite overwhelming. Because I was diagnosed with vestibular migraine about the same time we were thinking about starting a family, it was something that weighed heavily on my mind. How can one even think about having a child to care for when I can barely drive or walk?
For a while, I knew I had to put off starting a family. But once I found the right doctor and got on the right migraine treatment plan, I started to see a light at the end of the tunnel. At that point, the fear was more about messing up all the progress I had made with hormonal changes. I remember asking myself if I had to go back to square one with my vestibular migraine, would it be worth it?
At the end of the day, I knew I was much better off now with a good team and migraine treatments that worked for me. I also knew that if I decided against having children because of my disorder, it felt like I was letting that rule my life. It had already stolen a career from me, and I hated it stealing the idea of a family for me as well. I grappled a lot with the risk vs. reward until I finally decided the reward outweighed the risk.
Little did I know we would struggle with infertility and have to go through IVF, which just added another layer of uncertainty. We were incredibly fortunate our first embryo transfer was successful. But after conquering one hurdle, I had a few more to clear.
Migraine and Early Pregnancy
The first trimester while coping with vestibular migraine was my hardest. During our two week wait after the embryo transfer, I texted my friend Kayla every little symptom. One new symptom we both had pop up was headaches, which neither of us really experienced before. Typically our symptoms included dizziness or lightheadedness, brain fog, and sometimes vertigo or derealization. The absence of head pain was what made our diagnosis of vestibular migraine so hard to get. Yet the first few headaches made me excited, because they can be a first sign of pregnancy.
During this period your options for pain relief are really limited. Because I was so nervous about miscarriage based on our past losses, I didn’t use anything outside of tylenol. A few things I relied on heavily that got me through the rest of the pregnancy were:
- Magnesium - which is so good for blood pressure during pregnancy as well.
- The Allay Lamp
- Meditation and Mindfulness, as well as CBT and Progressive Muscle Relaxation
I struggled heavily with anxiety my first few weeks, and it had not been that severe since I first was diagnosed with vestibular migraine. When I was about 7 weeks pregnant, we had a really horrible event and I began to spot that afternoon. Based on all my losses, I called my doctors sobbing that this was probably another loss that was brought on by such an intense situation. My reproductive endocrinologist brought me in, and although it was early, we saw his heartbeat. My bleeding was actually caused by what’s called a subchorionic hematoma, which can be common with IVF pregnancies.
I immediately had to go on bed rest and this only increased my anxiety. Because I hadn’t needed a therapist in years and had no idea how to contact the one who helped me with my migraine journey, I reached out to my sweet therapist friend Kristi DeName, who ran through some wonderful techniques that helped calm me.
At night, I’d use my Allay Lamp, which although it didn’t help much with the dizziness, I found extremely soothing and also helpful for nausea. That brings me to the debilitating nausea.
Migraine and Nausea During Pregnancy
About week 7 was when the “morning” sickness hit me hard, and I could never figure out why it was called that as I typically felt ok in the morning, but super nauseated the rest of the day. Evenings were spent next to the toilet.
Kayla had been diagnosed with hyperemesis gravidarum during her pregnancy and although I only got to be that severe a few times, nausea does seem to be more common during pregnancy if you have a vestibular migraine disorder.
Some things that helped me along the way were:
- Anything sour - Sour candies especially! I’ve reintroduced citrus, but loved green apple flavors. Dried green apples and preggie pops were wonderful. I also loved Yum Earth’s natural suckers, which can be found at Whole Foods.
- Ginger beer - I got so tired of the ginger flavor everyone constantly recommended, but sipping on ginger beer did seem to help. My favorite brand was Regatta, which wasn’t too spicy.
- Oatmeal and smoothies were fairly easy on the stomach and filling.
- Relaxing with the Allay Lamp.
- Blisslets acupressure bands.
- Huggaroo Eye Mask and Neck Wrap
- Migraine Glasses
- B6 and Unisom and/or Diclegis.
Your OB might recommend Bonjesta, Diclegis, or Unisom and B6. Essentially they’re all the same thing, but insurance doesn’t like to cover Bonjesta or Diclegis (probably because men don’t get pregnant, but that’s a rant for another day.) and they wanted me to pay about $600. I would recommend searching GoodRx or making your own at home if your doctor allows it. It helped a little bit, but mostly I just had to power through. The nausea let up a bit around 18 weeks.
IV Therapy is exactly what it sounds like - using IV fluids with different vitamins or treatments as a therapy option. Most people think of it for hangover cures, but for me, it was a quick way to get in fluids when I couldn’t keep anything down.
There was just one time that my sickness got so severe, I had to spend 2 nights in the antenatal floor of the hospital on fluids. But for the few times that I knew I was getting very dehydrated and would get really odd symptoms, like my fingers being so stiff I couldn’t type with them, a quick at-home IV would immediately get me feeling better almost immediately.
If you’re not pregnant, you can add vitamins for energy, or even magnesium and toradol for a migraine attack. They’re not cheap, ranging from $75-200, but it does cost a lot less than a visit to the hospital, so you have to weight the cost/benefit of them.
Vestibular Migraine Symptoms During Pregnancy
Overall, aside from the first trimester, I really only dealt with a few dizzy days here and there. Nothing too debilitating, but had to watch my footing sometimes on uneven pavement or rest on the couch instead of pushing myself. I’d say instead of me feeling 100% most days, I hovered around 90-95%, which really isn’t bad. Because you read so many stories of people having their migraine symptoms increase, I was really scared of what would happen to me. I’m happy to report that essentially, my symptoms stayed pretty much the same as they were before I was pregnant.
I did have to manage my threshold more strictly and make sure to keep my triggers as low as possible. This meant trying to eat a migraine-friendly diet as best as I could and avoiding my known food triggers, keeping up with hydration and my sleep schedule, and using therapy techniques to decrease my stress. I also worked a lot on setting boundaries, and letting go of toxic situations or people. You’d be surprised at how much that can help, especially if you’re like me and have a tough time saying “no”.
Vestibular-Friendly Exercises for Pregnancy
As for exercise, after I was cleared from my SCH (subchorionic hematoma), I found myself doing best with walks or rowing. It is best to avoid any situations that could throw you off-balance easily so I avoided a lot of bending over, step ups, and lunges.
Squats, dumbbell incline rows, banded chest flys and incline push ups were helpful. I also did makeshift burpees where I put both arms on a box, stepped back one foot, then the other, then stood up. A lot of my time was spent doing restorative yoga.
Vestibular Migraine Medications and Pregnancy
When I wrote about my path of trying to conceive and IVF, I discussed that I was very open with my neurologist and my OB on what I was comfortable with taking. Because I had such a high-risk pregnancy, I decided to hold off on the Timolol eye drops, even though my doctors had approved them for use. If I would have experienced more dizziness, I would have probably added it into my treatment plan.
One thing that really helped me was a conversation I had with my OB about making myself a priority. If you can take care of yourself, you’re essentially giving your baby the best environment possible. For some people, that means taking medications. And although there’s a slight risk to taking migraine medication during pregnancy, the benefits can often outweigh the risks if it keeps you feeling good and in a stable place with your disorder.
Outside of Benadryl and Tylenol, a few commonly prescribed migraine medications during pregnancy are:
- Beta Blockers
- Nerve Blocks
- Neuromodulation Devices (like nVNS gammaCore)
- Certain triptans
- Diclegis or Bonjesta for nausea with Zofran as a last resort.
Some medications with higher risk that are prescribed:
- Certain antidepressants, like nortriptyline.
- Certain SNRI’s (most commonly Effexor/venlafaxine) and SSRIs.
I have friends who continued their antidepressants during their pregnancy and they had fewer complications than I did avoiding medications. It’s a personal decision between your and your physician, but do not feel guilty if that’s what you need to take care of yourself.
Migraine and Preeclampsia Risk
The truth is that people with migraine disorders often have an increased risk for developing preeclampsia. A study from 2019 analyzed associations between migraine and adverse pregnancy outcomes, finding that there was an increased risk for preeclampsia and other issues. While another study from 2005 showed women with a history of migraine attacks had a 1.8 fold increase of risk, with overweight women carrying a 12 fold increase.
I personally invested in an at home blood pressure cuff just to keep an eye on it. If you have a big concern, bring it up with your OB-GYN.
Vertigo in Pregnancy
The most challenging part of my experience with vestibular migraine and pregnancy was the actual birth, which induced a horrible vertigo episode. Because I had several risk factors that had to do with my age, 2 vessel cord, the large size of my baby, polyhydramnios, and IVF history, we scheduled an induction at 39 weeks.
The evening before they offered something to help me sleep, which I took in an effort to be well-rested and reduce my chance for an attack. Everything seemed to be going well. I was dilating on schedule and I got the epidural put in without a hitch before the pain really ramped up. Then, I hit a wall. I was no longer dilating the way I should and started having significant pain, despite the epidural. When my OB came in to check, she found I had developed a hematoma that was a significant size. This had to do with my unique anatomy and the fact that George was very large. He was trying to get out, but kept hitting the same area, which was causing a hematoma. It was no longer safe to proceed with a vaginal birth.
Things got super crazy after that and my anxiety went through the roof. At the time, the hospital required labor in a mask when other people were in the room. As they wheeled me to the operating room I had horrible motion sickness come on very quickly. Before I could even warn them, I had a severe vertigo attack and threw up in my mask, which spilled all over my face. I couldn’t stop crying from how traumatic the whole situation was.
I told my anesthesiologists that I was experiencing a vestibular migraine vertigo attack. They were on it, giving me everything I needed to stop the attack. Unfortunately it made me super sedate. I don’t even remember much from when George appeared, and I had to wait a very long time to hold him.
If it’s in the cards to have another child, I will need to have a scheduled c-section. Hopefully being prepared and knowing what to expect will cut out the situation that triggered my vertigo attack. But your first time, you never know!
My best advice is just to warn all your providers that you live with migraine and what exactly that entails. Be upfront about moving you around if you are triggered by motion. If you’re nervous about the epidural, ask for the head of anesthesia to perform your placement. Don’t be afraid to advocate for yourself. Sometimes this is easier the second time around.
Postpartum with Vestibular Migraine
Early postpartum, like the first 6 months, was the most difficult period for me when it came to managing vestibular migraine. The best thing I did was to come up with a plan with Dr. Beh before I gave birth. Our plan of attack was to stick with what was working for me, and we have 3 other options in case that plan failed.
Lack of sleep is one of my triggers, and between that, hormones, struggling to breastfeed, and an insane amount of stress coming home to an ice storm with mass power outages in Texas, I was a wreck. This is what I wish I would’ve done differently.
Sleep - I wish I would’ve saved up to have a night nurse, at least a few nights a week. The more I talk to other women with vestibular migraine who have done this, the more I’ve heard that it was one of the best things they ever did. While you think you have help with your spouse or family, it’s very likely you will be the one always up with the baby. Paying someone financially may force you to take the rest more seriously. I had a few vestibular migraine mom's on instagram tell me they requested donations for this instead of gifts.
Breastfeeding - If I have another, I’m leaning towards skipping breastfeeding entirely. This mostly has to do with sleep, but I also think my personal breastfeeding struggles were a huge contribution to my postpartum anxiety and depression. Some people have this come naturally and it’s a beautiful situation for them…that was not me. If you’ve hired a night nurse, skipping it can help you get a significant chunk of sleep. I truly believe it’s the most essential part of brain health.
Medications and Supplements - If you do find yourself in a situation where you have debilitating postpartum anxiety and can’t even sleep when you have help, speak with your doctors about tryptophan, magnesium, lorazepam, and zoloft as options. By doctors, I mean a neurologist and a pediatrician.
Ask the Pediatrician - Your neurologist will know what is best for your head, but they are not experts about dosages that are safe for breastfeeding. This is where the pediatrician can be amazing! Both my OB and neurologist had told me I had to wait a few hours to breastfeed at my prescribed dosage, but our children’s hospital was able to approve immediate use at my dosage. This helped me immensely.
One tip other moms shared with me - this too shall pass. The first few weeks are truly the hardest. And then it gets a little bit easier as time goes by. Although I do feel like my head is much more sensitive to vestibular migraine attacks now, I also have 100% days again - so there is hope.
By sharing my experience, I hope that I can help some of you who are on the fence as well. I think too often we hear the negative stories, rather than the positive. Managing vestibular migraine during pregnancy isn’t easy, but it can be done with a good team and a solid plan.