Clinical Scorecard: Impact of Migraine and Comorbid Conditions on Severe Maternal and Neonatal Morbidity and Mortality: Findings from a Population-Based Cohort Analysis

At a Glance

Key Highlights

• Pregnant individuals with both migraine and other chronic conditions have the highest risks of severe maternal morbidity/mortality (SMM-M) and severe neonatal morbidity/mortality (SNM-M).
• Migraine alone modestly increases risks of SMM-M and SNM-M compared to those without migraine or other chronic conditions.
• Additive interaction between migraine and comorbidity on perinatal outcomes is small but suggests combined effects warrant targeted preconception and perinatal support.

Guideline-Based Recommendations

Diagnosis

• Identify pre-pregnancy migraine through physician visits or hospital/emergency department records.
• Screen for coexisting chronic conditions in pregnant individuals with migraine.

Management

• Provide preconception and perinatal supports tailored to individuals with migraine and comorbidities to reduce perinatal complication risks.
• Consider vascular and inflammatory mechanisms when managing migraine in pregnancy.

Monitoring & Follow-up

• Monitor pregnant individuals with migraine and comorbidities closely for signs of severe maternal and neonatal morbidity.
• Track pregnancy outcomes including hypertensive disorders, preterm birth, and low birthweight.

Risks

• Increased risk of severe maternal morbidity/mortality and severe neonatal morbidity/mortality in those with migraine and comorbid conditions.
• Migraine-associated risks may be influenced by vascular changes, inflammation, and medication use during pregnancy.

Patient & Prescribing Data

Pregnant individuals with pre-pregnancy migraine, with or without other chronic conditions

Acute and preventive migraine medications may contribute to perinatal risks; careful evaluation of treatment benefits and risks during pregnancy is needed.

Clinical Best Practices

• Assess and document migraine history and comorbid chronic conditions before conception.
• Implement multidisciplinary care approaches addressing neurological, vascular, and inflammatory aspects of migraine in pregnancy.
• Educate patients on potential perinatal risks associated with migraine and comorbidities and the importance of prenatal care.
• Coordinate care to optimize maternal and neonatal outcomes, including monitoring for hypertensive disorders and preterm birth.

References

• Albanese CM, et al.; Dalla Lana School of Public Health, University of Toronto; unpublished data; 2025
• Omega Study on migraine and pregnancy outcomes
• Ontario Health Insurance Plan (OHIP) and ICES data sources