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What Migraine Medicine Is Safe In Pregnancy

Coffee Helps Prevent My Migraines Can I Have Caffeine While Pregnant

Ask Dr Charlotte: What medications for migraine sufferers are safe to take during pregnancy?

Caffeine and migraine have an interesting relationship. According to the National Headache Foundation, caffeine can help with pain relief, since âit contains properties It can even make some pain relievers work better. Yet for some people, caffeine a migraine trigger. And becoming reliant on caffeine every day can lead to rebound headaches.

All that said, even if you know caffeine helps fight your migraines, what can you do? Isnât caffeine off limits during pregnancy?

If youâve been resisting the urge to reach for a cup of coffee, take comfort. Dr. Crystal points out that some caffeine is okay during pregnancy . âDrinking up to 12 oz. of coffee per day, or about 200mg of caffeine, is considered safe,â she says. Still, itâs always smart to double check with your doctor before pouring yourself a cup.

What Can I Do During Pregnancy To Decrease The Chance Ill Get A Migraine

Since so many migraine treatments are off the table while pregnant, it might feel like your arsenal is running low.

With fewer medications to turn to, lifestyle changes can make a huge difference in keeping your migraines under control while youâre pregnant.

Dr. Crystal recommends:

  • Avoiding your known migraine triggers
  • Dental evaluation for a night guard, if necessary
  • Eating frequent, small meals
  • Getting good sleep, and enough of it
  • Physical therapy for neck pain and muscle spasms
  • Prenatal massage
  • Reducing stress as much as possible, and exploring techniques for managing stress

Migraine Medication In Pregnancy

Many experts caution pregnant women from taking unneccessary medications when they are pregnant, forfear of causing defects in the developing fetus. However, many expectant mothers develop painful migraines that may force them to try taking migraine medication during pregnancy. Is this safe?

Some experts believe that the consulting physician should try to isolate the causes of the headaches before prescribing migraine medication during pregnancy. Common reasons why a pregnant women develop migraines include:

  • Exhaustion
  • Fasting
  • Oral contraceptive use.

Migraines are believed to be either the result of imbalances in brain chemicals or the inflammation of blood vessels in the brain. Many women may inherit the tendency to develop migraines from their own parents. Some believe that fluctuating estrogen levels can cause migraines to develop at certain times in a woman’s life. Even environmental factors, like a change in weather or extreme rise or drop in temperature, are also thought to be potential migraine-triggers.

In addition to the pain and discomfort caused by developing debilitating headaches during pregnancy, these headaches may be accompanied by symptoms that can actually harm the growing fetus. These include, nausea, vomiting and dehydration. In severe cases, it might be necessary for the physician to prescribe medication in order to relieve the distress of the mother and ease pressure on the fetus within.

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Treatment Of Headaches In Pregnancy And Breastfeeding Women

During pregnancy, inadvertent exposure to teratogenic agents can lead to irreversible fetal malformations . Unfortunately, most patients are not aware of possible teratogenic risks of used medications and their safety profiles during pregnancy .

During pregnancy and breastfeeding the preferred therapeutic strategy should always be a non-pharmacological one. Nevertheless, an undermanaged headache can lead to stress, sleep deprivation, depression and poor nutritional intake which in turn can have negative consequences for mother and baby. Therefore, if non-pharmacological interventions seem inadequate, a well-considered choice should be made concerning the use of medication, taking into account all the benefits and possible risks . A basic rule should be to aim for the lowest effective dose and the shortest duration of treatment.

Table 4 Summarizing table on treatment of headache in pregnant women

Lidocaine is compatible with breastfeeding in any formulation .


There is some concern about early lung maturation and a slightly increased risk for cleft palate, but in disabilitating CH and status migrainosus prednisone and prednisolone remain a reasonable alternative . Therefore, they should be avoided during first trimester and the dose should be kept as low as possible .


Treatment Options During Pregnancy

Taking Migraine Medicine During Pregnancy May Not Be Safe

Certain medications used for migraine treatment and prevention are contraindicated for pregnancy, due to safety concerns for the developing fetus. For patients who use oral contraceptives to regulate their hormone levels and manage migraine, having a conversation about migraine treatment options may happen when they want to go off of birth control and start trying to conceive. The good news is there are safe options for migraine prior to and during pregnancy.

Im always telling my patients, either preconception or patients that are pregnant, that we recommend in general to use the number of different medications for anything that were treating, Dr. Grossman says. And also, of course, the lowest dose possible that we can use in pregnancy and preconception is what we recommend. Her first-line treatment is non-medication options, and she then layers in other treatments as needed.

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Drugs To Prevent Migraine

If daily medication is considered necessary to prevent migraine during pregnancy, the lowest effective dose of propranolol is the drug of choice.9 Low dose amitriptyline is a safe alternative.9 There are no reports of adverse outcomes from pizotifen used during pregnancy or lactation, although it is less often used than the drugs above.

In contrast, sodium valproate, should not be taken during pregnancy for migraine as there is a high risk of fetal abnormalities. Indeed, women prescribed sodium valproate for migraine must use effective contraception.

Topiramate should not be used for migraine during pregnancy and breastfeeding as there are insufficient data regarding safety.

Why Does My Head Hurt

Women often experience tension headaches during the first trimester. It’s most likely because of fluctuations in hormones, says Sheena Aurora, M.D., director of the Swedish Headache Center, in Seattle. By the second trimester, she says, the pain subsides because the hormones are steadily high.

Of course, there are many other possible reasons for your throbbing head. Ask yourself, ‘Are my headaches being stimulated by something in my diet?’ says Lillian Schapiro, M.D., an OB-GYN in Atlanta. ‘What medications am I taking? What time of day are they happening? Is there anything I can change?’

In the third trimester, when you’re carrying a lot of additional weight, consider whether poor posture might be a factor in your headaches. The strain on your neck and shoulders could lead to muscle spasms, which can irritate nerves in the back of your head. Or you might develop muscle tightening and spasms from sleeping with your head in an unnatural position.

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Pregnancy Can Have A Significant Impact On Migraine Symptoms And How Women Should Treat Them Heres What Experts Have To Say

First, the good news: Between 50 and 80% of pregnant migraine patients actually experience a reduction in migraine attacks during their pregnancy, according to David Dodick, a professor of medicine at the Mayo Clinic School of Medicine in Arizona. Many doctors believe rising estrogen levels help reduce migraine frequency and intensity. Hormone replacement therapy that mimics pregnancys effect on the body is increasingly being used in migraine treatment plans, especially for those who experience migraines around the time of menstruation. Caution does need to be used however in women who have migraines with aura, as the increased risk of stroke may further be increased by the addition of an estrogen-containing oral contraceptive pill.

However, some women experience migraine for the first time during pregnancy and some experience an increase in migraine symptoms especially during the first trimester. The appearance or worsening of migraine in pregnant women should be taken very seriously: Studies show that migraine symptoms, when accompanied by high blood pressure, can increase the risk of developing preeclampsia or other vascular complications. Women whose migraine symptoms dont decrease during pregnancy should be particularly vigilant. Its important to work with your obstetrician and your headache doctor when you have migraine to establish a safe treatment plan.

Are Migraines Dangerous During Pregnancy

Pregnancy headaches

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.

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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.

Headache And Migraine Remedies That Are Safe During Pregnancy

    Most women deal with headaches at some point in their lives. Data from the Centers for Disease Control and Prevention suggest that one in five women had a severe acute headache or migraine in the previous three months. Additionally, migraines are more common in women than men approximately 18 percent of women have them compared to 6.5 percent of men.

    Because headaches and migraines are so common, its probably no surprise that many women deal with them during pregnancy. For the majority of pregnant women, occasional headaches or migraines are no cause for alarm, and most standard treatments are safe. However, suffering a severe headache at key times during or after pregnancy can indicate a serious medical emergency.

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    How Do Migraine Headaches Typically Change From First Trimester To Second Trimester To Third Trimester

    âDue to the abrupt hormonal changes and increased blood volume,â says Dr. Crystal, âthe first trimester is often a time of increased headaches for women with migraine.â

    Luckily, they can get better in the second trimester, âthough for some patients the turning point does not occur until around week 20.â

    For some women, migraines can come back near the end of pregnancy, possibly because the discomforts of late pregnancy can impact your sleep.

    What Causes Migraine Headaches During Pregnancy

    How To Manage Migraine During Pregnancy? by Erin Bell

    Migraine headaches seem to have a genetic component, which means they tend to run in families. That said, theres usually a triggering event that unleashes them. One of the most common triggers at least for women is fluctuating hormone levels, particularly the rise and fall of estrogen.

    Moms-to-be who get migraine attacks tend to experience them most often in the first trimester of pregnancy, when hormone levels, including estrogen, havent yet stabilized.

    An increase in blood volume, which is also common in the first trimester, can be an additional factor. As blood vessels in the brain expand to accommodate extra blood flow, they can press against sensitive nerve endings, causing pain.

    Other common migraine triggers, whether youre pregnant or not, include:

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    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

    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.

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    How Are Migraine Headaches Managed In Pregnancy

    Treatment of migraines in pregnancy may include things that soothe the pain. This includes cold packs, a darkened room, and sleep. Avoiding triggers such as certain foods and stress may also be helpful. Any medicines to treat pain, nausea, and vomiting must be carefully chosen. Here are some things to know about migraine treatment in pregnancy:

    • Many medicines pass through the placenta to your developing baby. You should not take these medicines in the first trimester.

    • Other medicines can be harmful in later pregnancy.

    • Generally, small amounts of acetaminophen and caffeine are safe in pregnancy.

    • Do not take nonsteroidal anti-inflammatory medicines such as ibuprofen.

    • Migraine headache medicine such as sumatriptan and opioid pain medicines such as morphine should be used only as directed by your healthcare provider. Opioid pain relievers can be addictive for both you and your baby.

    Talk with your pregnancy care provider about which migraine medicine can be used safely during pregnancy.

    Is It Safe To Breastfeed And Take My Migraine Treatments

    Acupressure : Acupressure for a Headache While Pregnant

    If youâre breastfeeding, youâll need to avoid the medications that are known to make it into your breastmilk .

    When it comes to your acute medications for treating migraines when they strike, âsumatriptan is generally considered safe,â Dr. Crystal notes, âbut eletriptan is preferred due to minimal excretion into breast milk.â

    In terms of preventive medications, propranolol and amitriptyline are generally considered safe, says Dr. Crystal, though thereâs not enough data about topiramate for doctors to assess how safe it is.

    To be safe, youâll want to discuss your migraine treatment with your doctor to be sure itâs safe for breastfeeding mothers. In the meantime, check out TOXNET, a database on which medications are safe to use while breastfeeding.

    During pregnancy, youâre juggling a million things, and dealing with migraines can add to the stress. And, since other types of headaches could crop up during pregnancy, like tension headaches, you may need extra guidance on how to handle headaches during pregnancy.

    To make it easier on you and to keep your baby safe, make a plan for treating your headaches early in your pregnancy, and always check with your doctor before taking a medication or starting a treatment.

    You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch: or call 1-800-FDA-1088.

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    Infertility & The Mthfr Gene

    What I didnt expect was to have issues with infertility and pregnancy loss. It took us almost a year to actually get pregnant and the excitement ended in complete heartbreak. I still had hope for us, that this was all just an unlucky event. But with more loss and consciously trying with a huge let down every month, we finally decided to see a reproductive endocrinologist.

    So far our journey has been great, and I wish I would have sought out the help of an RE sooner. I even got confirmation that I have the MTHFR gene, which is very common in people with chronic conditions like migraine. MTHFR can also be responsible for consecutive pregnancy loss, especially if left untreated. Part of the reason is that it interferes with your absorption of folic acid, so most prenatal vitamins that just contain folic acid youre not actually able to metabolize it properly.

    The Importance of L-Methylfolate with MTHFR

    Since folic acid is essential to prevent birth defects of a babys brain and spinal cord, its incredibly important to make sure youre absorbing it. Its recommended that those with this gene use L-methylfolate.

    This brings up a whole new topic of managing migraine while taking fertility medications. Let me tell you, it hasn’t been easy. Ill be sharing more about the migraine and infertility link in future posts, but I hope you enjoyed this intro into all the thoughts and emotions that go into the decision to try to conceive with migraine.

    Pregnancy And Lactation Migraine Management

    Along with the excitement of a possible pregnancy, migraineurs often experience a feeling of dread, wondering which headache medications need to be discontinued and how to manage expected migraines without their usual treatment regimen. This anxiety extends from the time when pregnancy is possible but not established, during the 9 months of actual pregnancy and beyond, when breastfeeding passes on mothers milk to the newborn infant.

    The good news is that most women notice their migraines either go away or greatly improve in the 2nd and 3rd trimesters of pregnancy. At least 4-8% of women do not have this lucky break, and for them managing migraines can be particularly challenging. After delivery, most women quickly return to their pre-pregnancy migraine pattern. While nursing, many medications remain off the safe list because of potential problems passed through the mothers milk, but treatment options do improve.

    Grouping medications into three broad categories, there are those known to cause fetal harm in humans or animals, those for which no harm has been found to date, and those that have been studied extensively through testing and/or patient and infant follow-up, with no increase in fetal or infant defects.

    The length of relief from nerve blocks varies, but overall they are considered a safe intervention if needed.

    Deborah Tepper, MD

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