A 35-year-old woman, G2, P1, 36-week gestation, was evaluated for recurrent headaches.

This patient presented with headache during pregnancy. Patients with episodic headaches, throbbing or pounding in quality, associated visual aura, intolerance of light and noise, and nausea are typically diagnosed with migraine. Migraine headaches affect approximately 25% of women during childbearing years. The relationship between migraine and estrogens is well known, including the tendency for migraine to occur around menses, to be aggravated by contraceptive medication, to develop following removal of the ovaries, and to exacerbate or begin during pregnancy. Some women experience a reduction of migraine during and after menopause, whereas others begin to experience migraine in this setting. Similarly, pregnancy can be associated with a dramatic improvement in migraine for some women, especially those who have perimenstrual headaches. Approximately 60% to 70% of women have improvement in the frequency of migraines, mainly around the second and third trimesters. Conversely, approximately 10% of migraines start during pregnancy, while 4% to 8% of women experience worsening migraines during pregnancy.