UMEM Educational Pearls

Category: Neurology

Title: Neurological Conditions Affected by Pregnancy

Keywords: pregnancy, postpartum, migraine, RCVS, CVT, Bell's Palsy, facial palsy (PubMed Search)

Posted: 6/10/2020 by WanTsu Wendy Chang, MD
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  • The hormonal changes and hypercoagulable state associated with pregnancy can contribute to neurological conditions.
  • Migraine
    • Migraines decrease in frequency through second trimester with increased estrogen, while increase in frequency postpartum with drop in estrogen, stress, and sleep deprivation.
    • Women with history of migraine have higher risk of preeclampsia (odds ratio 2.87).
  • Reversible Cerebral Vasoconstriction Syndrome (RCVS)
    • Pregnancy is a risk factor for RCVS with 2/3 of cases of pregnancy-related RCVS occurring in the postpartum period.
  • Cerebral Venous Thrombosis (CVT)
    • CVT is associated with the hypercoagulable state in late pregnancy and postpartum period, though often associated with additional source of hypercoagulability.
    • Other risk factors include older maternal age, cesarean delivery, smoking, and dehydration.
  • Bell’s Palsy
    • Bell’s Palsy is more prevalent in pregnancy, occurring in the third trimester and the first week postpartum.

Bottom Line: Pregnancy is associated with an increased risk for RCVS, CVT, and Bell’s Palsy. Pregnancy also affects the frequency of migraines due to hormonal fluctuations.


  • O’Neal MA. Obstetric and gynecologic disorders and the nervous system. Continuum (Minneap Minn). 2020;26(3 Neurology of Systemic Disease):611-631.

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