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What Migraine Medication Is Safe During Pregnancy

There Are Ways To Manage Migraine When Youre Pregnant

It’s important to consider migraine as a disease with a threshold for attacks and to know that many different things can change that threshold, says Starling. There are things that will increase the threshold and make it less likely to have an attack, such as consistent sleep, consistent exercise, consistent eating patterns, preventing dehydration, and stress management, she says.

There are also medications or procedures that are used as a prophylaxis that can increase that threshold as well, such as a beta-blocker,  injections, or a tricyclic antidepressant, says Starling. In some cases, patients will use birth control medications for hormonal stabilization, and that will help with their migraine attack frequency, she says.

When someone is planning for pregnancy, we try to figure out how to reduce these preventive medications without a huge bounce back of migraine attacks, and so we work together to raise the threshold in other ways, she says.

One way to do that is to maximize non-medication approaches, says Starling. That can include biofeedback training, mindfulness training, and relaxation techniques. We could also initiate a lidocaine nerve block, she adds.

Once we have a good plan in place and we increase that threshold, then we can start decreasing the birth control and the preventive medication that we are trying to discontinue because we don’t want to use it in the setting of pregnancy, says Starling.

Hormonal Changes In Pregnancy

How a pregnancy might affect your migraine and how you will manage is a common question for women who have migraine and are trying to get or are pregnant. Key issues include what medicines are safe to use and whether your attacks will change, including whether you will have aura for the first time.

Hormonal change is a common trigger for women with migraine.

During pregnancy, oestrogen levels increase sharply, while progesterone levels decrease and rise again towards the end of the pregnancy.

Overall migraine improves during pregnancy especially during the second and third trimesters. This improvement may be due to the increased oestrogen levels and increased levels of natural pain-killing hormones .

These hormones are several times higher during pregnancy, and though the relief from migraine attacks they provide might last the whole pregnancy, the levels settle back down after delivery, normally allowing migraine attacks to return.

However, not everyone will see an improvement in their migraine, especially in the early weeks of pregnancy. For some women, their migraine is unaffected. Some women experience worsening migraine during pregnancy although this is rare.

During breastfeeding, stable oestrogen levels continue to be protective against having headache again after pregnancy.

However you are affected, it can help to identify any migraine attack triggers that you have, such as lack of sleep, stress, missed meals and dehydration.

How Can I Join

It is an FDA requirement to have a pregnancy registry for every medication released. You can visit the FDA website to search for the medication that you are on, and join the registry. 

For migraine, there is currently one study on the FDA website, and it is related to the use of Ajovy during pregnancy. You can also use Migraine Buddy to track your medications, and retroactively report them to the registry if you are joining it later in your pregnancy.

What If My Migraine Attacks Get Worse During Pregnancy

If a woman develops migraine for the first time during pregnancy, or if theres an increase in migraine symptoms during pregnancy, those symptoms should be taken seriously, according to the American Migraine Foundation.

Research presented at the 2015 International Headache Congress suggested that women who had acute severe migraine during pregnancy are at increased risk for adverse pregnancy outcomes. In the study, more than half of the women experienced adverse outcomes, which included preterm delivery, , and low birth weight. The investigators found no association between the medication the women were taking for migraine and their pregnancy outcomes.

Its important for all pregnant women with migraine to discuss disease management with the healthcare provider who treats their migraine, especially those women who have worsening symptoms of migraine during pregnancy.

Learn And Avoid Triggers

How To Cope With Pregnancy and Migraine

Go through the Causes section above and see if you can spot a few possible triggers. Then brainstorm ideas to avoid that trigger. For example, if you know you have low blood pressure, keep snacks with you. If you could be dehydrated, make it a habit to drink more water, especially if you get sick. If the added stress could be a cause, find ways to relax. You might need to try a few lifestyle changes to find the trigger. Sometimes, you wont know the trigger and youll need a doctors advice.

Which Migraine Medications Are Safe To Use While Breastfeeding

Although it is safest to avoid all medications if breastfeeding, this is not always feasible. Therefore, to avoid unwanted side effects in the breastfeeding , medications should be used at the lowest effective dose and for the shortest duration. Generally, the same medications used during pregnancy can be continued after delivery and while breastfeeding. An exception is aspirin which may cause bleeding problems and Reye’s syndrome in the baby and should therefore be avoided. Mothers who must take medications should also consider not breastfeeding.

Divalproex should not be used in patients with liver or disease.

What Are Pregnancy Registries

Before any medications are approved for public use, it goes through stringent clinical trials to ensure it is safe for human use. However, most clinical trials do not include pregnant to reduce the risk to the pregnancy and the child.

Pregnancy registries are meant to examine the effects of medications on pregnant people and the baby. Registries are made up of people who take pain remedies among others, during their pregnancy and often follow the person during their pregnancy and post-pregnancy to see the outcomes. It also includes studying the baby as well. The information gathered is used to ensure that people are informed about safe medications during their pregnancy.

How To Treat Patients For Migraine During Pregnancy

Its important for providers who treat women during their reproductive years to be aware of treatment options that are safe during pregnancy. Many women with migraine who are pregnant or considering pregnancy stop taking their migraine medications and assume they dont have safe treatment options availablebut this is simply not true.

Women typically start to experience migraine attacks during adolescence, which aligns with when menstruation begins. The highest incidence of migraine is between ages 18 and 44, which are also the year many women experience pregnancy. The rate of migraine among women is three times higher than it is for men. Because of these figures, it is believed that fluctuations in estrogen levels play a role in migraine development.

Dr. Tracy Grossman, an obstetrician-gynecologist who has completed a fellowship in maternal-fetal medicine and earned a masters in neuroscience, shares the range of treatment options available for pregnant patients with migraine.

How Can I Treat A Migraine Attack While Pregnant

For migraine attacks that occur during pregnancy, there are several nonspecific migraine medication options, meaning they were not designed specifically to treat migraine, says Starling.

If a medication is needed, usually my first choice is to start the patient with and sometimes combine that with the drug , she says.

is typically used as an anti-vomiting medication, but it actually has benefits for stopping the migraine attack itself, and that, in combination with the , can be really helpful, she says.

Sometimes I’ll even add a little bit of in there, too, because that can help with providing some sleepiness or sedation. The idea is that the combination can help someone take a nap, and when she wakes up, the migraine attack will hopefully be done, says Starling.

The Right Way To Change Migraine Medication For Pregnancy Safety

The key to migraine management leading up to and during pregnancy is consistency; any changes that are made need to be made slowly, says Starling.

When we’re starting new medication, we usually start at a very low dose, and we increase slowly over time. If we’re deciding to discontinue a medication because someone is planning on getting pregnant, then we will typically reduce it slowly over time, she says.

It might sound scary to taper off a medication that has been working for you, says Starling. There are certain medications that are safe to use in the setting of pregnancy, and those that are not. I will always talk to my patients about family planning and reassure them that I will be there to support them through that journey, and that well come up with an alternative plan that will be safe, she says.

I Am Pregnant And Getting Blind Spots With My Migraine Should I See My Doctor

It is not uncommon for a woman to have her first attack of migraine aura during pregnancy. Symptoms are typically bright visual zig-zags growing in size from a small bright spot and moving across the field of vision over 20-30 minutes before disappearing. A sensation of pins and needles moving up an arm into the mouth may accompany this. If you experience these typical symptoms and your doctor confirms that this is migraine, there is no need to be concerned and no tests are necessary. However, if the symptoms are not typical of migraine aura, it is important to exclude other disorders, such as blood clotting disorders or high blood pressure, which may occasionally produce symptoms not dissimilar from migraine.

Can You Take Migraine Medication During Pregnancy

Most commonly, you pop a painkiller during one of your migraine attacks. In fact, medications such as aspirin or ibuprofen are non-steroidal anti-inflammatory drugs, known to cause a lot of complications for unborn babies, therefore they need to be avoided completely. Aspirin is known to cause miscarriages if taken during the period near conception. During the third trimester, it can cause heart complications to the baby.

On the other hand, medications like acetaminophen are considered to be safe to use during pregnancy. However, it is always better to take the advice of your doctor as self-medication can be extremely dangerous.

Onabotulinumtoxina Proves Safe As Migraine Treatment For Pregnant Women

The 25+ best Care during pregnancy ideas on Pinterest ...

Infants born to pregnant women with chronic migraine who received treatment with onabotulinumtoxinA did not show any physical, intellectual, or social disabilities.

Jacqueline E. Summers, MD

Research from a retrospective review presented virtually at the 2020 American Headache Society Annual Meeting demonstrated that treatment with onabotulinumtoxinA is safe and tolerable in pregnant women with chronic migraine.

Among a cohort of 9 subjects who received onabotulinumtoxinA injections for migraine during pregnancy, none of the 10 pregnancies reported any organ malformations at delivery. Additionally, 1 subject reported that her baby had low height, but no other physical, intellectual, or social disabilities were reported and all babies were appropriately met their developmental milestones.

Presented by Jacqueline E. Summers, MD, resident physician, Stanford Univeristy Medical center, the study noted that given the high prevalence of migraine in women of childbearing age, continued evaluation of the safety of available treatments for migraine in pregnancy is prudent.

READ MORE: Erenumab Shows Sustainable Efficacy in Refractory Episodic Migraine

Among the 4 patients who had abnormal outcomes, 1 was due to ventricular septal defect, otherwise considered a major fetal defect, 2 were minor fetal defects such as metalarsus and innocent asymptomatic cardiac murmur, and 1 was a birth complication stemming from Horner syndrome.2

For more AHS 2020 coverage, .

REFERENCES

Migraine Risk During Pregnancy

During pregnancy, migraines may increase or decrease due to changing hormones. Some women who were prone to getting headaches before getting pregnant may have worse migraines, more migraines, or, as happens to two-thirds of such women, fewer migraines after becoming pregnant. Women who have never had a migraine before becoming pregnant may begin to experience them for the first time.

One important thing to remember is migraines are not dangerous as long as they are not caused by a more serious medical condition. If your migraines are accompanied by a or , last for more than a few hours, or come and go, its important to get checked by a doctor.

I Am Pregnantbut What Is Going To Happen To My Migraine

Results from studies suggest that up to 80% of women who have migraine without aura experience improvement in migraine during pregnancy, particularly during the second and third trimesters.1-4 Since migraine without aura is often associated with falling levels of oestrogen, the reason for improvement in pregnancy is often considered to be the more stable levels of oestrogen. However, there are many physical, biochemical, and emotional changes in pregnancy that could also account for improvement, including increased production of natural painkillers known as endorphins, muscle relaxation, and changes in sugar balance. In contrast to migraine without aura, attacks of migraine with aura follow a different pattern during pregnancy as attacks are more likely to continue and aura may develop for the first time.5-7

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  • Amundsen S, Nordeng H, Nezvalova-Henriksen K, Stovner LJ, Spigset O. Pharmacological treatment of migraine during pregnancy and breastfeeding. NatRev Neurol. 2015 Apr;11:209-19.
  • Hamilton KT and Robbins MS. Migraine treatment in pregnant women presenting to acute care: a retrospective observational study. Headache.2019 Feb;59:173-179.
  • Amundsen S, Ovrebo TG, Amble NMS, Nordeng H. Risk perception, beliefs about medicines and medical adherence among pregnant and breastfeeding women with migraine: findings from a cross-sectional study in Norway. BMJ Open. 2019 Feb 27;9.
  • Wells RE, Turner DP, Lee M, Bishop L, Strauss L. Managing migraine during pregnancy and lactation. Curr Neurol Neurosci Rep. 2016 Apr;16:40.
  • Content and Format of Labeling for Human Prescription Drug and Biological Products; Requirements for Pregnancy and Lactation Labeling
  • Meidahl Petersen K, Jimenez-Solem E, Andersen JT, Petersen M, Brodbaek K, Kober L, Torp-Pedersen C, Poulsen HE. Beta-Blocker treatment during pregnancy and adverse pregnancy outcomes: a nationwide population-based cohort study. BMJ Open. 2012 Jul 19;2.
  • Robinson AY, Grogan PM. OnabotulinumtoxinA successfully used as migraine prophylaxis during pregnancy: a case report. Mil Med. 2014 Jun;179.
  • Yallampalli C, Chauhan M, Endsley J, Sathishkumar K. Calcitonin gene related family peptides: Importance in normal placental and fetal development. Adv Exp Med Biol. 2014;814:229-40.
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    What Could Be Causing Your Headache

    Its absolutely essential to figure out the cause of the headache before attempting to treat it, said Dr. James Bernasko, Director of the Regional Perinatal Center at Stony Brook Children’s Hospital. Pregnancy headaches can range from “the merely inconvenient to the actually life-threatening, so context is particularly important, Bernasko added.

    Possible causes include:

    How To Safely Treat Migraines During Pregnancy

    • Does my risk of migraine go up or down during ?
    • Can I take migraine medication while Im pregnant?
    • What alternative migraine treatments are available?

    If youve ever had migraines, you know they are wicked headaches that can stop you in your tracks. The exact cause of migraines varies and is not entirely understood. Migraines could be caused by any combination of genetics and environmental factors, including certain foods or food additives, alcohol, coffee, stress, bright lights and changes in wake-sleep patterns. However, a common cause of migraines in women is hormonal changes, which put them at greater risk during pregnancy.

    Are Migraines Dangerous During Pregnancy

    The only danger is when your headache may be a sign of something else. You should ALWAYS call your health care provider when:

    • Your headache is accompanied by a fever
    • Your headache persists for more than a few hours or returns frequently
    • You are experiencing blurred vision

    It is ALWAYS important to let your health care provider know when you are experiencing any headaches and the details about them.

    For What Conditions Are Migraine Medications Used

    Some of the migraine medications used to treat or prevent migraine headaches are also used for other conditions. Here are the pain reliever medications for migraine therapy.

    • Antidepressants,

    There are some migraines drugs, though, that are used because they directly target the pain pathways associated with migraine headaches rather than pain pathways in general.

    Who Can Help Me Manage Migraine During Pregnancy

    Taking Migraine Medicine During Pregnancy May Not Be Safe

    In addition to treating people with migraine, Starling lives with the disease of migraine. I’ve gone through multiple pregnancies and have two children, and I was able to figure it out and manage migraine in collaboration with my healthcare professional. I know it can be scary for patients, but it’s totally doable, she says.

    Try to channel those feelings into being proactive in how you will manage your migraine during pregnancy, says Starling. I always encourage patients to find a healthcare professional, whether it be your primary care doctor, your neurologist, or your headache specialist, who will collaborate with your ob-gyn to figure out how best to manage your migraine during pregnancy, she says.

    Pregnancy is hard enough for many different reasons, and I think that if we can manage migraine better, it makes it so much easier, she adds.

    Abortive Treatment In Pregnancy

    Pharmacologic Treatments

    Acetaminophen is commonly used as an abortive agent for migraine and is considered safe during all trimesters of pregnancy. Acetominophen use is reported by 65% of pregnant women.35 There was some concern of an association between acetaminophen use during pregnancy and neurodevelopment effects, in children with more than 28 days in utero exposure .36 The European Medicines Agency, however, found the data for this association insufficient.37

    Non-steroidal anti-inflammatory drugs , although commonly used for migraine treatment, have limited use in pregnancy. As prostaglandin synthetase inhibitors, NSAIDs can affect fetal development in a trimester-specific manner.38 Some studies have shown NSAID use in the first trimester leads to congenital malformations and miscarriages.38,39 A more recent study, however, evaluating the teratogenicity of NSAIDs in the first trimester did not find significant embryonic risk in women exposed to NSAIDs compared with women who were not exposed.40 In the third trimester, NSAID use should be avoided because of the known risk of premature ductus arteriosus closure and other adverse fetal outcomes.41

    Metoclopramide is a preferred antiemetic during pregnancy with established safety in the treatment of hyperemesis gravidarum.42 The combination of parenteral diphenhydramine and metoclopramide is an effective migraine abortive when acetaminophen is not sufficient.43

    Nerve Blocks

    Neuromodulation

    Which Medications Are Used For Preventing Migraines

    Preventative therapy should be considered for patients who suffer from migraines that cause significant disability, frequent migraines that require treatment more than twice a week, or migraines that do not respond or respond poorly to treatments. Currently there are no drugs that specifically target and prevent migraines. Certain blood pressure medications as well as some antidepressants, anti-seizure drugs, and herbals have been shown to have beneficial effects in preventing migraine headaches. It’s important to understand that medicines may not produce any significant benefits right away and maximal effects may not be seen for weeks to up to 6 months.

    Although a number of medications have been used for the prevention of migraines, the medications that have been shown to be effective in controlled clinical trials, and are therefore recommended by the American Headache Society and the American Academy of migraine prevention guidelines include:

    • Azole antifungals such as , , itraconazole

    Use of topiramate can result in decreased and increased body temperature. This may be especially concerning during hot weather. Wearing light clothes and drinking plenty of fluids while using topiramate during warmer months is very important. A should be consulted if body temperature rises.

    Preventive Treatment In Pregnancy

    Behavioral Approaches

    It is best to start nonpharmacologic behavioral changes known to decrease frequency and severity of migraines before pregnancy to make them learned behaviors. These approaches include relaxation therapy, biofeedback, and behavioral sleep modification, the latter of which may revert chronic migraines to episodic.11,12 Although these approaches are viable first-line treatment options for some pregnant women or individuals considering pregnancy, they may not be sufficient for others. For women with high frequency of migraine or significant disability due to migraine, the risk of pharmacologic agents needs to be weighed against the health consequences of untreated migraine, which can negatively affect both the mother and fetus. Untreated migraine can lead to poor oral intake, resulting in inadequate nutrition and dehydration in addition to sleep deprivation, increased stress, and depression.13

    Vitamins and Minerals

    Oral Pharmacologic Agents

    A recent cohort study evaluating outcomes of children born to mothers who used beta blockers during pregnancy showed no increased congenital malformation risk.18 A prior cohort study, however, did show an association between beta blockers and fetal growth restriction, preterm birth, and perinatal mortality. The use of beta blockers for migraine prevention in pregnancy may warrant close monitoring of fetal growth.19

    Monoclonal Antibodies

    OnabotulinumtoxinA

    Migraines During Pregnancy: Safe Medications And Tips To Manage Pain

    Shabana Kachhi

    Women face a lot of problems during their pregnancies owing to the changes happening in their bodies for the proper growth and development for the baby. All these pains settle down after the delivery. While the pregnancy symptoms aren’t enough, some of the mothers have to undergo pains which are not associated with pregnancy such as migraines.

    If you are suffering from migraines, you will find yourself at a dilemma during pregnancy because your go-to medication for the migraine headaches may not be safe anymore. So how do you manage migraine attacks during the crucial nine months of your pregnancy? Find out everything you need to know about pregnancy and migraines in our article below.

    Though there are many medications which help combat migraine headaches, what makes matters worse is that these medications are often not safe to be consumed during pregnancy.

    Most Read: Is Olive Oil A Good Option For Dry Hair?

    Now it may be interesting to know that some women suffering from migraine headaches may either be relieved of their symptoms or the situation could worsen. However, it is important to understand the cause of migraines during pregnancy so that avoiding them becomes easier.

    How Does Breastfeeding Affect Migraine

    The good news is that most women get a break from migraine while breastfeeding. If they’ve had relief from migraine during pregnancy, then they continue to have a break during the period of breastfeeding leading up to weaning. After several months of breastfeeding, migraine typically returns.

    Triptans, especially sumatriptan, are safe during breastfeeding. More caution is used with other acute therapies like nonsteroidal anti-inflammatories. and butalbital are to be avoided with migraine, in general, and particularly during breastfeeding.

    There are multiple preventive options that have good safety ratings to be used during lactation including magnesium, propranolol, and verapamil.

    As with pregnancy, breastfeeding may be a time to consider using injection approaches

    When During Pregnancy Should A Woman With A Headache Go To The Er

    If there’s an abrupt onset of severe headache, or what is called a thunderclap headache, that is concerning for a secondary cause and requires an emergency evaluation.

    Another reason would be if there are signs or symptoms of preeclampsia or eclampsia, high blood pressure which can cause headache. In the setting of pregnancy, if you experience new onset of neurological symptoms other than typical aura symptoms, please seek urgent medical evaluation to look for a secondary cause of headache

    Study Shows Fears About Pregnancy With Migraine Are Common

    According to a September 2020 study published in the Mayo Clinic Proceedings, nearly one in five women with avoids pregnancy because of her disease. The survey of 607 women with migraine found that the most common reasons women cited for avoiding pregnancy were fears that migraine symptoms would worsen during pregnancy, that having migraine would make their pregnancy difficult, and that migraine medication would affect their childs development.

    But according to Amaal Starling, MD, a neurologist and migraine specialist at the Mayo Clinic in Phoenix, Arizona, although its natural to be worried, having a successful pregnancy and delivery while living with the disease of migraine is totally doable.

    Having a healthcare provider, whether thats a neurologist, headache specialist, or primary care doctor, who can collaborate with your obstetrician- is an important first step, Dr. Starling says.

    The good news is we do have treatment options that can be effective during pregnancy; it’s just a matter of talking to your healthcare provider about it and making sure they feel comfortable using different treatment options, whether it be for the prevention of migraine or for migraine attacks themselves, Starling says.

    Understanding how migraine may impact your pregnancy and baby and what your options are for managing migraine during your pregnancy can help you decide what the right choice is for you. Heres what you should know about planning a pregnancy when you have migraine.

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