What Medications May Treat Migraines in Pregnancy?

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Are Your Pregnant and Suffering from a Headache?. Katja Kircher/Maskot/Getty Images

Pregnancy is a time for nurturing your little one —so, the last thing you need is a migraine. But, if you are a migraineur, what medication may your doctor recommend during pregnancy? Let's take a closer look.

The Skinny on Migraines in Pregnancy

Migraines are the most common headache in pregnancy. Typically, migraines during pregnancy occur less frequently and are less severe than those outside of pregnancy—although this is seen more commonly in women with migraine without aura than women who suffer from migraines with auras.

It's unusual for women to develop new migraines during pregnancy.

Before delving into potential migraine treatments, please note that if your headache during pregnancy meets any of the below criteria, is not getting better with simple measures, or follows a different pattern from your usual headaches, seek medical attention right away. These signs can indicate a more serious cause of your headache.

  • "Worst headache of my life"
  • Blurry vision
  • Neurological symptoms, like weakness or numbness
  • Headache with fever
  • Headache with high blood pressure and/or swelling of the legs and feet (preeclampsia/eclampsia)
  • Headache with neck stiffness
  • Headache with exertion

Information on Medications for (or not for) Migraines in Pregnancy

Here are potential medical therapies for migraines during pregnancy that your doctor may recommend, taken mostly from UptoDate—a widely used professional and evidence-based resource.

Please note that the information below is not meant to be a substitute for your doctor's advice. As always, do not take any medications without the advice from your physician.

Tylenol (Acetaminophen) is commonly recommended to treat headaches in pregnancy. It's a category B medication and typically considered safe for the fetus.

If acetaminophen does not work alone, sometimes combining it with an anti-nausea medication called Reglan (metoclopramide) is helpful. Other tylenol combinations include tylenol-codeine, or caffeine-aspirin-butalbiltal (Fiorcet).

Please note that with caffeine, the American College of Obstetrics and Gynecology recommends less than 200mg of caffeine daily during pregnancy. 

Finally, codeine should be limited to no more then 9 days per month and butalbital to no more than 4 to 5 days per month to avoid medication overuse headache.

Nonsteroidal anti-inflammatories, or NSAIDs, like ibuprofen (Advil, Motrin) or naproxen (Aleve), are second-line medical treatments for migraines in pregnancy. They are safest in the second trimester. There is limited evidence that NSAIDs may be associated with miscarriage and certain birth defects in the first trimester. NSAIDs should not be used in the third trimester.

Opiods—like oxycodone or morphine—are third line treatments for migraines in pregnancy. They should not be taken for prolonged periods of time due to the risk of addiction and developing a medication overuse headache and/or chronic daily headaches.

There is also a risk of neonatal withdrawal when your baby is born. Finally, opiods can worsen other common pregnancy symptoms, like nausea and constipation. 

The triptan, sumatriptan, is still considered pregnancy category C—meaning animal studies have shown an adverse effect on the fetus but there are no adequate studies in humans, so the risk is not ruled out. Depending on the situation, sumatriptan may be acceptable in certain pregnant women. This would need to be discussed carefully with a person's doctor and with the help of a neurologist or headache specialist.

Ergotamine and dihydroergotamine are both listed as pregnancy category X and should absolutely not be used during pregnancy or really in any woman of childbearing years who is not using proper contraception.

A Word from Verywell

For the majority of women, migraines improve during pregnancy. But if they worsen for you, don't fret. Speak with your doctor. There are lots of simple, conservative measures, as well as a few medications (if needed), that can help you get through this time.

Sources

Digre, KB. Headaches during pregnancy. Clin Obstet Gynecol. 2013 Jun;56(2):317-29.

Gilmore B, Magdalena M. Treatment of acute migraine headacheAm Fam Physician. 2011 Feb 1;83(3):271-280.

Lee M-J, Guinn D, & Hickenbottom S. Headache in pregnant and postpartum women. In: UpToDate, Basow DS (Ed), UpToDate, Waltham, MA, 2015.

MacGregor EA. Headache in pregnancy. Neurol Clin. 2012 Aug;30(3):835-66

Nappi RE, Albani F, Sances G, Terreno E, Brambilia E, & Polatti F. Headaches during pregnancy. Curr Pain Headache Rep. 2011 Aug;15(4):289-94.

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