Introduction: Migraines are a prevalent neurovascular disorder that affects more than a billion people worldwide. Even though both women and men are affected by this neurological disorder, migraines are primarily recognized as a women’s health disruption factor. Pregnancy leads to significant hormonal changes, including a rise in estrogen, progesterone, and endogeny opioid levels, and, therefore, it can affect the course of migraines. Women dealing with migraines often experience migraine symptom reduction during the course of pregnancy, but in the setting of increased maternal body mass index and obesity, this common pattern may be altered. Due to the complexity of the interplay between pregnancy, obesity, and migraines, all mediated by hormonal changes, the aim of our study is to try to unravel the impact of migraines and obesity on maternal health and pregnancy outcomes. Methods: This study included 350 subjects who have suffered at least one migraine attack three months preceding pregnancy, or at any point during the course of pregnancy. Initially, the study subjects were divided into two groups. The first group included women suffering from migraines before pregnancy, but not during the course of pregnancy, and the other group included all subjects who remained symptomatic during the course of pregnancy or had a first migraine attack during their pregnancy. Further comparisons were made based on the patients’ BMI values, and correlations were made between the obese and non-obese study subjects. Results: Higher parity (p = 0.005), obesity (p = 0.005), earlier age of migraine onset (p = 0.004), and gestational diabetes mellitus (p = 0.004) were statistically significant predictors for migraine symptom persistence during pregnancy. Obese pregnant women were more likely to experience migraine intensity and frequency persistence during pregnancy (p < 0.001 and p < 0.001, respectively). They sought magnesium treatment more often (p < 0.001), but this had a modest therapeutic effect compared to non-obese pregnant women (p < 0.001). A diagnosis of hypertensive disorder of pregnancy and gestational diabetes mellitus was also more frequently established in the group of obese pregnant women (p = 0.002 and p < 0.001, respectively). Conclusions: Pregnancy induces substantial physiological changes that can both alleviate and exacerbate migraine symptoms. Obesity is a modifiable risk factor that not only may increase the intensity and frequency of migraine symptoms, but may also compromise pregnancy course and outcome. The co-occurrence of migraines and obesity during pregnancy may amplify health risks for the mother and fetus, including heightened susceptibility to gestational diabetes mellitus. Future research should prioritize focusing on better understanding the causal relationships between pregnancy, migraines, and obesity and providing treatment strategies the home in on weight management and the control of migraine symptoms and associated comorbidities.

Background: Migraine has been associated with vascular dysfunction and adverse pregnancy outcomes. However, the relationship between changes in migraine manifestations during pregnancy and fetal growth remains incompletely understood. This prospective study aimed to investigate whether migraine symptom progression during pregnancy is associated with abnormal fetal growth patterns and placental-mediated pregnancy complications among women with pre-existing migraine. Methods: This prospective cohort study included 400 pregnant women with a pre-pregnancy diagnosis of migraine who received antenatal care at the Department of Obstetrics and Gynecology, University Hospital “Dr Dragiša Mišović”, Belgrade, Serbia, between 2024 and 2026. Maternal migraine characteristics, pregnancy complications, and fetal growth assessments were evaluated. Fetal growth was categorized according to estimated fetal weight percentiles adjusted for gestational age. Univariable and multivariable logistic regression analyses were performed to identify factors associated with abnormal fetal growth. Because of the relatively small number of events, Firth’s penalized logistic regression was additionally performed as a sensitivity analysis. Results: Persistent or worsening migraine symptoms during pregnancy were more frequently observed among pregnancies complicated by impaired fetal growth, pregnancy-induced hypertension, gestational diabetes mellitus, abnormal gestational weight gain, and preterm birth. In univariable analyses, migraine worsening was associated with increased odds of abnormal fetal growth. However, after adjustment for maternal and obstetric factors, migraine worsening was no longer independently associated with abnormal fetal growth. Pregnancy-induced hypertension and inadequate gestational weight gain remained the strongest independent predictors. Findings were confirmed in sensitivity analyses using Firth’s penalized logistic regression. Conclusions: Among women with pre-existing migraine, persistent or worsening migraine manifestations during pregnancy were associated with a higher burden of placental-mediated complications and abnormal fetal growth patterns in unadjusted analyses. However, migraine worsening was not independently associated with abnormal fetal growth after adjustment for maternal and obstetric factors, suggesting that migraine symptom progression may represent a clinical marker of shared vascular, inflammatory, endothelial, and metabolic processes rather than an independent causal factor. Further prospective multicenter studies incorporating non-migraine control groups and detailed migraine phenotyping are warranted.