Managing Migraine During Pregnancy: Medications, Safety & Strategies

Pregnancy can be a challenging time for individuals living with migraine. While many experience a reduction in migraine attacks due to hormonal stability, others may continue to have symptoms. Understanding safe treatment options is essential for managing migraine while ensuring the health of both mother and baby.

If you have concerns or are unsure if a medication is safe during pregnancy, you can consult the FDA’s Pregnancy and Lactation Labeling Rule (PLLR) and resources like LactMed® Drugs and Lactation Database

Does Migraine Improve During Pregnancy?

Studies indicate that around 87% of individuals with migraine without aura experience an improvement or even remission of migraine during pregnancy. This is due to hormonal stability, particularly the steady increase in estrogen. However, those with migraine with aura may not see the same improvement.

Risks of Untreated Migraine During Pregnancy

Leaving migraine untreated during pregnancy can lead to dehydration, poor nutrition, and increased stress, all of which may negatively impact maternal and fetal health. Effective, safe treatment options exist to manage migraine symptoms while protecting the pregnancy.

Medications Considered Safe During Pregnancy

  • Acetaminophen (Tylenol): First-line treatment for mild to moderate migraine pain.
  • Triptans: Sumatriptan, naratriptan, and rizatriptan have been studied and are considered safe when benefits outweigh risks.
  • Antiemetics: Metoclopramide (Reglan), prochlorperazine (Compazine), and diphenhydramine (Benadryl) can help with nausea and migraine symptoms.
  • Nerve Blocks: Lidocaine and other local anesthetics can provide relief for some individuals.

Medications to Use with Caution

  • NSAIDs (Ibuprofen, Naproxen, Aspirin): Can be used cautiously in the second trimester but should be avoided in the first and third trimesters due to potential risks to fetal development.
  • OnabotulinumtoxinA: While not systemically absorbed, data is limited, and its use during pregnancy is generally based on individual circumstances.
  • CGRP Monoclonal Antibodies: These medications have a long half-life and should ideally be discontinued 5-6 months before conception due to limited safety data during pregnancy.

Preventive Treatments for Migraine During Pregnancy

  • Beta Blockers (Propranolol, Metoprolol): Frequently used for migraine prevention and considered safe.
  • Calcium Channel Blockers (Verapamil): Another safe option for managing migraine.
  • Supplements: Riboflavin (Vitamin B2) 200mg twice daily and Magnesium 200mg twice daily can be beneficial for migraine prevention

Strategies for Managing Migraine Without Medication

  • Lifestyle Adjustments: Maintaining regular sleep patterns, staying hydrated, and eating small, frequent meals can help prevent migraine attacks.
  • Relaxation Techniques: Meditation, deep breathing, and biofeedback can help manage stress-related migraine triggers.
  • Cold Therapy: Applying cold packs to the head and neck can provide relief.

When to Talk to a Healthcare Provider

  • You experience sudden, severe headache different from your usual migraine.
  • You develop visual disturbances or neurological symptoms.
  • You have persistent vomiting and dehydration.
  • You experience headache with high blood pressure, which could indicate preeclampsia.

Managing migraine during pregnancy requires a careful balance between effective symptom relief and safety for the developing baby. Fortunately, there are multiple treatment options available, including safe medications, supplements, and lifestyle modifications. Consulting a healthcare provider can help create a personalized migraine management plan throughout pregnancy.

This resource is based on HeadWise Episode 210, What You Need to Know About Migraine During Pregnancy with Susan Hutchinson, MD
Published, February 2025

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