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Why can migraine hit harder after birth?
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Welcome to Migraine Heroes, a podcast for anyone living with migraine and wondering
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why nothing has fully worked yet.
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I'm Diane Ducarme.
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Over the past 7 years, I've helped hundreds of people living with migraine.
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What I've learned?
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No two migraine stories are exactly the same, and none of them are simple.
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That is why, in this podcast, we explore migraine from many different angles.
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Food, hormones, stress, sleep, the nervous system, emotions, and much more, through the
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lens of both modern science and traditional Chinese medicine.
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A quick note before we start.
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What we talk about here is educational.
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For anything related to diagnosis or medication, please keep working with your doctor.
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Now take a breath, and let's dive in.
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In this episode, you will learn why migraines often return after childbirth, even if pregnancy
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gave you months of unexpected relief, and what hormones, sleep, and the nervous system
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have to do with it.
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Why a postpartum migraine is not always just your usual migraine, and which changes in
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a headache deserve medical attention, rather than simply trying to push through.
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And a different way of looking at postpartum recovery through traditional Chinese medicine.
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A question that asks not only how do we stop the headache, but also what resources does
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your recovering body need right now.
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Stay with me till the end, because at the end of this episode, you will have a very
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simple postpartum migraine recovery practice you can begin today, without turning your
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already overwhelming newborn schedule into another health project.
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Having a migraine when you are caring for a newborn is not the same as having a migraine
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on an ordinary Tuesday.
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You may be recovering from birth, from surgery, you may be bleeding, your muscles are sore,
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your hormones are shifting dramatically, you may be feeding a baby every few hours, you
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may not remember the last time you slept for more than two or three uninterrupted hours,
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you may not have had the time to shower, or even take care of yourself, or dress.
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Your home may be full of noise, visitors, smells, and decisions.
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And then comes the throbbing, the nausea, the sensitivity to light, the feeling that
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even the sound of your baby crying is physically painful, and perhaps one of the hardest part
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of it is the guilt.
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You've been waiting to meet this little person, and now your nervous system is asking you
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to retreat into a dark room, silently.
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So if postpartum migraine feels disproportionately hard, there is a reason.
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Your brain is experiencing migraine at precisely the moment when the rest of your body is going
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through one of the most intense physiological transitions of your life.
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So there's an interesting pattern in migraine that researchers have observed for decades.
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It's that for many people, particularly those who experience migraine without ORA, migraines
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become less frequent during pregnancy.
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So there was a prospective study published in Cephalalgia in 2003 that followed women
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with migraine through pregnancy and after delivery.
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And migraine improved progressively during pregnancy, and by the third trimester, a substantial
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majority of participants reported improvement.
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But after birth, the pattern began to reverse, and about one-third experienced migraine recurrence
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during the first few weeks of postpartum, and more than half had recurrence during the
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Another prospective study reported that more than half of the women with migraine experienced
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recurrence in the first month following delivery.
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So there's a very important message here.
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If your migraine has improved during pregnancy and then suddenly returned after your baby
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was born, that pattern is not unusual.
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And hormones appear to be an important part of that explanation.
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Now again here, I do not want to generalize because we have met women with more migraines
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in pregnancy, and you are not a number.
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You are not a statistic.
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So this is your full life, so I want to acknowledge that reality for some of you as well.
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Now, during pregnancy, estrogen concentrations rise, it rises dramatically, and it remains
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After the placenta is delivered, however, the hormonal environment changes remarkably
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Estrogen levels fall.
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And for a migraine-sensitive nervous system, rapid hormonal change may matter as much as
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the absolute hormone level itself.
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And so the relationship between estrogen and migraine has been analyzed, for example, in
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the journal Systematic Reviews in 2021.
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And one of the most consistently discussed explanations in the literature is that estrogen
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withdrawal hypothesis.
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So after sustained exposure to higher estrogen, a substantial decline may increase susceptibility
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to migraine in some people.
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And so this explains an important paradox.
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So pregnancy can sometimes create a relatively stable hormonal environment that quiets migraine,
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but birth creates an extraordinary rapid transition.
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Your body has not failed, it has changed states, and migraine brains can be extremely sensitive
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But you know, hormones, as you can probably guess, they're only part of the story.
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Now, as you can imagine, that hormonal shift is occurring alongside another enormous migraine
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stressor, sleep disruption.
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Sleep and migraine have a complicated, a two-way relationship.
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So poor sleep can increase vulnerability to migraine, while migraine itself can disrupt
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And so this close relationship is documented in a systematic review published in the Journal
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of Headache and Pain in 2020.
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And more recent research continues to support that bi-directional relationship between migraine
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In 2026, for example, there was a systematic review in the European Journal of Neurology
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that examined interventions targeting this connection.
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Now, bring that into postpartum life.
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A newborn does not care about your migraine threshold.
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Feeding may happen every few hours.
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You may fall asleep and then wake 20 minutes later.
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You may spend the night listening for breathing, changing diapers, pumping milk, or settling
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And the issue is not merely that you're tired.
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Your brain is losing one of its most important mechanisms for maintaining physiological stability.
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And migraine often dislikes that instability.
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Then we're going to add several other factors that often arrive together to form the postpartum
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migraine perfect storm.
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The baby intends to eat breakfast.
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Then the baby needs feeding.
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Then there's the diaper.
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Then somebody calls.
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Then you realize it's 2 in the afternoon and you have eaten half a piece of toast.
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Hydration changes.
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Food requirements can be substantial postpartum, particularly when breastfeeding, and it can
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be surprisingly difficult to keep drinking regularly while caring for another human being.
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Then there's stress and sensory overload.
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Dry at hospital lights, phones, family visits, new routines, anxiety, physical discomfort.
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Migraine is not simply a physiological response to stress, but changes in stress, changes
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in sleep, changes in nutrition and routine can all affect migraine susceptibility.
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And there's another piece that receives much less attention.
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Your recovery reserve is already being used.
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Your body is healing tissue.
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Your uterus is contracting.
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Your cardiovascular system is readjusting.
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Your fluid balance is changing.
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You may be recovering from blood loss.
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You may be producing breast milk.
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Your immune and endocrine systems are transitioning out of pregnancy.
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So when migraine arrives, you're not beginning from your normal baseline.
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You may already be operating with very little space, very little spare capacity.
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That is why postpartum migraine can make recovery feel so much harder.
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You're asking one body to heal, feed, regulate, sleep, parent and endure the pain all at the
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And then we have breastfeeding.
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And breastfeeding and migraine is a more young story.
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And it will be the object of a podcast of its own.
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So why does postpartum headache need a bit of a special consideration?
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So we need to talk about something actually extremely important.
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A headache after childbirth is not automatically your typical migraine.
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So even if you've had migraine for 20 years, the postpartum period includes several uncommon,
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but potentially serious conditions that can present with headaches.
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A 2023 clinical review in the American Journal of Emergency Medicine emphasizes the need
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to distinguish primary headache disorders such as migraine from secondary causes, including
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preeclampsia, cerebral venous thrombosis, and headaches associated with procedures involving
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the spinal tissues.
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And the American College of Obstetricians and Gynecologists also published a dedicated
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clinical practice guideline on headaches during pregnancy and postpartum, emphasizing careful
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evaluation of new or concerning headaches during this period.
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So here's a rule I want you to remember.
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Do not assume that every postpartum headache is your migraine.
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If a headache is new, is suddenly severe, is dramatically different from your normal
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migraine, is rapidly worsening, or is accompanied by concerning symptoms, do seek medical assessment.
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Particularly important symptoms include neurological changes such as weakness, confusion, difficulty
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speaking, fainting, seizures, or new major visual disturbance.
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And because hypertensive disorders can occur postpartum, a severe or unusual headache associated
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with high blood pressure or other concerning postpartum symptoms also deserves medical
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So if you recently had an epidural or another procedure involving the spinal area and developed
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a significant new headache, particularly one that changes substantially with body position,
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tell your healthcare team.
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So this is one of the moments when being cautious is appropriate.
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I'll just repeat that.
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This is one of those moments in life when being cautious is appropriate.
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Your newborn needs you and I want you to be safe and to feel safe.
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So while migraine makes recovery harder emotionally too, there's also an emotional layer.
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Migraine takes away predictability and predictability is already in short supply with a newborn.
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Perhaps you planned to go for your first walk outside and migraine says no.
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Perhaps you finally have 90 minutes while somebody else watches the baby and migraine
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Perhaps the baby falls asleep and instead of sleeping yourself, you're nauseated and
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starting to see and staring at the ceiling because the pain is so strong and it can begin
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to feel as though your body is betraying your recovery.
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There's a more useful interpretation.
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Your postpartum nervous system is moving through an enormous recalibration.
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Hormones are changing.
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Your sleep is fragmented.
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Sensory input is high.
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Energy demands have changed.
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Your normal routines have disappeared overnight.
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So instead of asking, why is my body doing this to me?
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It's maybe more kind to ask what sources of stability have disappeared and which ones
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can I gently rebuild?
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That question takes us beautifully into the Eastern perspective.
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And I also want to take a moment to remember we had a woman in particular who went through
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our Thrive Plan and she was living with such severe migraines that she would communicate
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with us entirely through voice messages because looking at a screen was just simply too much.
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And yet through all of it, she showed an extraordinary amount of strength and determination.
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I also remember her husband vividly who did so much to support her along the way.
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Their story stayed with me because it was such a powerful reminder that behind every
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migraine journey, there's a person fighting incredibly hard and often someone besides
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them fighting with them.
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So traditional Chinese medicine looks at postpartum period through a very different lens.
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And before we explore it, of course, one important distinction.
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These traditional concepts are not established by our medical explanations for migraine,
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but that does not make them uninteresting or irrelevant.
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Traditional Chinese medicine and Chinese culture more broadly developed an extraordinarily
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rich body of thinking around women's health, women's fertility, pregnancy, and recovery
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And when it comes to postpartum period, the contrast with much modern Western culture
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So I remember this really clearly from when I was living in China.
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One of my German colleagues had a Chinese wife who had just given birth and she was
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going through something called Zuoyuezi, literally the sitting month, but funny because it's
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the sitting month, but you're technically lying down and not seated and everyone does
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everything for you.
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So it's a traditional postpartum period and usually lasting around a month centered around
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rest and warmth and nourishment and being cared for while the body recovers from birth.
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And I remember my colleague sounding almost apologetic when he told me about it.
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And I thought he had to explain why his wife was taking this tradition so seriously.
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And I remember thinking, good for her, because underneath some of the rules that may sound
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unfamiliar to Western ears, there's something deeply wise in the basic principle.
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So the mother has just given birth, she needs to recover.
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In much of the West, the message after birth can sometimes feel almost absurdly different.
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Use the babyweight, get the baby sleeping, answer the messages, do the paperwork, send
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the birth announcement, welcome the in-laws, manage the family.
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Oh, and preferably don't complain too much while doing any of it.
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And the focus shifts immediately to the baby.
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Society is interested in the baby.
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In traditional Chinese medicine postpartum culture, there's often much stronger emphasis
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on protecting and restoring the mother.
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Family members may take over the cooking, or you go in a center that does that and you
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Household responsibilities and practical tasks are taken over so that you can rest, eat nourishing
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food and regain your strength.
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And there's a beautiful logic underneath all of that.
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If the mother is cared for, she is in a much better position to care for the baby.
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And the mother is all the baby cares about.
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The mother is not an accessory to the birth.
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She is recovering from it.
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And for someone vulnerable to migraine, the distinction matters enormously.
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Giving birth is not considered the end of pregnancy, it is the beginning of restoration.
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In traditional Chinese thought, childbirth represents a major expenditure of the body's
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Blood has been lost, fluids have shifted, energy has been spent, sleep becomes fragmented,
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and something extraordinary has been created.
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I remember giving birth to my daughter and I really thought, wow, this is probably the
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most impressive thing I've ever done, you know, in my life.
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It's extraordinary.
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Wow, go you, go me.
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And traditional practitioners often describe this period using concepts such as blood deficiency,
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qi deficiency, in some circumstances, blood stasis, etc.
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And these terms, of course, they should not be confused with biomedical diagnoses such
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as anemia or circulatory disease.
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They belong to an entirely different medical framework, but listen to the metaphor behind
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After birth, the question is not simply what symptom do we suppress?
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The question becomes what has been depleted?
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What has become stuck?
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And what needs to be replenished before the system can regain its balance?
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It's a powerful postpartum question.
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The weeks after birth are supposed to contain recovery, warmth, rest, food, support, protection
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from excess demand.
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Not because the mother is weak, but because the body has done something physiologically
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So within traditional Chinese medicine, different headache patterns would be interpreted differently.
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A person who feels profoundly exhausted, pale, dizzy, and depleted after birth might
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traditionally be described through a deficiency pattern.
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A different person whose pain feels fixed, sharp, or stubborn might be interpreted through
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a stagnation or a stasis pattern.
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Another person whose symptoms seem connected with irritability, tension, and emotional
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constraints might be described using the traditional concept of liver qi stagnation.
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Again, these are not biomedical disease mechanisms, they are pattern languages.
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And perhaps the greatest value here is that they force us to ask more nuanced questions
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than simply where does it hurt?
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Traditional Chinese medicine asks when does it hurt?
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What makes it better?
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What makes it worse?
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Do you feel cold or hot?
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Are you deeply tired?
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Is the pain moving or is it fixed?
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What is happening emotionally?
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What happened before the headache?
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In other words, what is the context of this pain?
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And modern medicine is increasingly appreciating context as well.
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Hormonal changes matter, sleep matters, meal regularity matters, stress physiology matters,
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sensory environment matters.
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So although the explanatory languages are very different, there is an interesting point
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The headache does not exist separately from the person experiencing it.
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Now there is an idea in many Eastern traditions that birth transforms more than the infant.
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A mother is also entering a new state.
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A mother is also being born.
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Now I'd like to hand a few of those questions over to you now.
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No need to answer out loud, just notice what comes up for you.
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When a migraine arrives these days, are you more drained and dizzy or more tense and on
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Is it usually after the night you've slept least or on the days you suddenly realize
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you're hardly eaten?
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And while it's happening, what's the loudest for you?
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The overwhelm and the guilt or the irritability?
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Now you and another mother could have exactly the same newborn schedule and need very different
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When you're drained and you're dizzy, your body is often asking to be rebuilt, rest,
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warmth, regular food.
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When you're tense and on edge, it's asking for release, which is a very different kind
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of support altogether.
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And that's exactly what we look at in the Migraine Heroes Method.
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Where you feel your migraine, what comes along with it, what's happening around it, and how
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you feel in the middle of it.
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And whenever you find a quiet moment, the app walks you through these questions and
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a few steps in, you'll see a first look at your pattern.
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Because understanding what your body is asking for right now is really part of recovery.
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In Ayurveda, the postpartum period is traditionally considered a time when Vata becomes particularly
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And Vata is associated symbolically with movement, change in irregularity in the nervous system.
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And again, it's not a biomedical mechanism, but considering the metaphor, what if postpartum
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life is not movement and irregularity, interrupted sleep, changing hormones, unexpected feeding
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schedules, emotional transitions, physical healing, noise, visitors, responsibility,
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A system that was organized around pregnancy suddenly has to reorganize itself around recovery
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and caring for another person.
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Migraine also tends to dislike abrupt changes in rhythm.
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So perhaps this is why one of the most useful ideas we can borrow from Eastern philosophy
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Where rhythm is still possible.
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You cannot control when your newborn wakes, but perhaps you can control whether there
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is water beside your bed.
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You cannot guarantee 8 hours of sleep, but perhaps you can protect one period of rest.
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You cannot make postpartum hormones stable tomorrow, but perhaps you can make meals slightly
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You cannot remove every sound, but perhaps somebody else can hold the baby for 15 minutes
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while you sit somewhere quiet.
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And traditional Chinese medicine often speaks about balance.
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Balance doesn't mean everything receives equal attention.
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Sometimes balance means recognizing that one side of this kid is currently carrying an
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extraordinary weight and responding accordingly.
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Now our culture can be strangely impatient with postpartum recovery.
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There's often praise for bouncing back.
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Back into your genes, back into your work, back into exercise, back into social life.
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But the body does not know what bouncing back means.
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It knows healing, adaptation, hormonal transition, sleep depth, energy, safety, pain and nourishment.
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And traditional postpartum philosophy encourages something many people with migraine desperately
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need, permission to reduce demand.
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Not forever, just for now.
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Your goal in the early postpartum period does not have to be becoming your previous self
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as quickly as possible.
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Your goal can be helping your nervous system find small islands of predictability inside
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a season that is inherently unpredictable.
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That might be one of the most migraine-friendly things you can do.
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Here's something extremely simple you can begin today.
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Create what I call a postpartum migraine station.
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In the place where you spend the most time feeding or resting with your baby, put a large
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bottle of water there, an easy snack containing both carbohydrates and protein, any migraine
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medication that your doctor has confirmed is appropriate for you during the postpartum
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or breastfeeding period, a phone charger, and something you can use to reduce sensory
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It can be an eye mask or a way to dim the lights.
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And then ask one person in your support system for one very concrete form of help.
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When you're here, please make sure that my water is filled and that I have eaten.
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Do not make recovery depend entirely on remembering things when you are exhausted.
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Change your environment so that caring for your nervous system becomes easier by default.
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And congratulations on being a new mom.
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That's all for today.
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I hope this episode added another piece to your migraine puzzle.
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If you'd like to apply what we've discussed to your own life, you can find us by searching
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Migraine Heroes in the App Store or Google Play.
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Look for the green icon with the love heart in the brain.
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Migraine is complex, but it's not random.
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And every step forward brings us closer to lasting relief.
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Your body has a story to tell.
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Let's keep listening.
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I will be back with you soon.
