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If you’re planning pregnancy, be sure to tell your healthcare provider. He or she will work with you to manage your migraines, including reviewing medicines that are safe for you and your baby. It makes sense to avoid taking medicine during pregnancy. However, if your migraines are very bad, there are medicines and non-drug treatments that have been used safely during pregnancy which should be discussed with your doctor. The Food and Drug Administration has a system for coding the suitability of medicines for women during pregnancy, and your healthcare provider can explain it to you.
Increased estrogen levels early in pregnancy can protect against migraine.1 As many as 7 out of 10 women gain relief of migraines during pregnancy. Even if headaches persist during the first trimester, they usually disappear after that.2 Menstrual migraine is the type most likely to improve during this time. One medical expert has noted that during pregnancy, migraine in women: 3
• improves or disappears in 69%
• remains unchanged in 8%
• varies in 5%
• worsens in 7%
• appears for the first time in 11%.
Research has shown that migraines do not harm the baby. There was no difference in pregnancy outcomes between mothers who had migraines and those who did not.4
However, if migraines are associated with nausea, vomiting and dehydration, pregnant women should ask their healthcare providers about potential risk to the fetus and treatment for these symptoms.5
Treating migraine during pregnancy
Non-pharmacological treatments – relaxation techniques, regular sleep, massage, ice packs and biofeedback – should be tried first. A medical study has shown these treatments can be very effective: symptoms improved in 79% of women, with an overall 72.9% reduction in headaches.5
If drug treatment is required, the following may be considered by your healthcare provider:
• Acetaminophen (alone or with codeine)
• Aspirin (not during last trimester)
• Ibuprofen (not during last trimester)
• Prochlorperazine, chlorpromazine, trimethobenzamide, promethazine (during pregnancy)
• Metoclopramide (for gastric symptoms)
• Triptans (but only with caution).
If pregnant, you should only use a medicine that has been prescribed or recommended by your healthcare provider. Do not self-medicate, even with over-the-counter medicines.
References:
1. Marcus DA. Pregnancy and chronic headache. Expert Opin Pharmacother. 2002;3(4):389-393.
2. Diamond S, Diamond ML, Contemporary diagnosis of headache and migraine. 2000. Handbooks in Health Care Co, a division of AMM Co., Inc.
3. Bousser et al. Migraine and pregnancy: a prospective study in 703 women after delivery. Abstr Neurology. 1990;40(Suppl 1):437.
4. 3.Wainscott G, Volans GN. The outcome of pregnancy in women suffering from migraine. Postgrad Med J. 1978;54:98-102.
5. Data on file, National Headache Foundation. (Women’s issues in migraine program, chaired by Merle Diamond, MD.)
6. Marcus DA et al. Nonpharmacological management of headaches during pregnancy. Psychosom Med. 1995;57 (6):527-523.
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