Impact of Migraine and Comorbidities on Severe Maternal and Neonatal Outcomes
Overview
This large population-based cohort study from Ontario, Canada, found that pregnant individuals with both migraine and other chronic conditions had the highest risks of severe maternal morbidity/mortality (SMM-M) and severe neonatal morbidity/mortality (SNM-M). Migraine alone and other chronic conditions alone were also associated with increased risks, though to a lesser extent. The study highlights the additive but small synergistic effect of migraine combined with comorbidities on adverse perinatal outcomes.
Background
Migraine affects approximately one in five reproductive-aged women and is characterized by neurological symptoms such as unilateral headaches and aura. It is associated with maternal and neonatal complications including stroke, preeclampsia, preterm birth, and low birthweight. Comorbid chronic conditions frequently co-occur with migraine and may share pathophysiological mechanisms such as inflammation and vascular dysfunction. Understanding the combined impact of migraine and comorbidities on severe perinatal outcomes is critical to improving maternal and neonatal health.
Data Highlights
Exposure Group
Proportion of Cohort (%)
Adjusted Relative Risk (aRR) for SMM-M (95% CI)
Adjusted Relative Risk (aRR) for SNM-M (95% CI)
Migraine + Other Chronic Conditions
6.8
1.60 (1.54-1.66)
1.43 (1.39-1.46)
Migraine Alone
3.2
1.13 (1.07-1.20)
1.07 (1.04-1.11)
Other Chronic Conditions Alone
45.7
1.34 (1.32-1.37)
1.30 (1.28-1.32)
Neither Migraine nor Other Chronic Conditions (Referent)
44.3
1.00 (Reference)
1.00 (Reference)
Key Findings
6.8% of pregnant individuals had both migraine and at least one other chronic condition.
The incidence of severe maternal morbidity/mortality (SMM-M) was 1.6% and severe neonatal morbidity/mortality (SNM-M) was 7.1% in the cohort.
Those with both migraine and comorbidities had the highest adjusted relative risks for SMM-M (aRR 1.60) and SNM-M (aRR 1.43).
Migraine alone was associated with modestly increased risks of SMM-M (aRR 1.13) and SNM-M (aRR 1.07).
Other chronic conditions alone also increased risks of SMM-M (aRR 1.34) and SNM-M (aRR 1.30).
Additive interaction between migraine and comorbidity was small but statistically significant for both SMM-M (7.4%) and SNM-M (3.7%).
Clinical Implications
Pregnant individuals with migraine, especially those with additional chronic conditions, represent a high-risk group for severe maternal and neonatal complications. Preconception counseling and enhanced perinatal support should be considered to mitigate these risks. Clinicians should be aware of the compounded risks when managing pregnancies complicated by migraine and comorbidities.
Conclusion
This study demonstrates that migraine combined with other chronic conditions significantly increases the risk of severe maternal and neonatal morbidity and mortality. Targeted healthcare strategies are warranted to improve outcomes in this vulnerable population.
References
Albanese CM, et al. Dalla Lana School of Public Health, University of Toronto; 2025 -- Unpublished data on migraine and comorbidity in pregnancy
Omega Study, USA -- Risks of hypertensive disorders in pregnancy with migraine and comorbidities
