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What To Do If You Have A Migraine While Pregnant

Migraine Medications That Are Safe During Pregnancy

Is it normal to get migraine headaches during pregnancy, and what should I do about them?

Thanks to stable levels of migraine-preventive estrogen that occur during pregnancy, women who frequently experience these debilitating headaches often get a reprieve from them when they’re expecting. For those in the minority who still get migraines, the question of how to treat them is an important one. While there are several effective medications for the treatment of migraines, not all are considered safe for a developing baby.

Migraine painif experienced during pregnancyis often severe enough to require medication. Sometimes other migraine symptoms, such as nausea and vomiting, also must be treated with drugs as well.

Fortunately, there are a number of effective migraine medications that the Food and Drug Administration considers safe to take during pregnancy. Before reaching for your regular prescription, make sure that it is included in this list . If it’s not, discuss these safer options with your healthcare provider.

How To Treat Migraines When Naturally Doesnt Work

Sometimes, a migraine might continue to plague you, even after you have tried the above remedies. If the pain persists, you can take Tylenol however, it is important to avoid Aspirin and Ibuprofen. These are not safe to take during pregnancy. If the migraines become a constant nuisance, you may want to talk to your doctor about alternative medications that are safe to take during pregnancy. You can learn more about which medications are safe during pregnancy here.

If you currently take pain medication for migraines, it is best to discuss with your doctor whether it is safe to continue using. It is best to avoid using any herbal remedies to alleviate migraines during pregnancy, as many have not been tested, and some have been shown to lead to complications.

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Treatment Options During Pregnancy

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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I Am Pregnant What Can I Take To Treat My Migraine

Drugs tend to exert their greatest effects on the developing baby during the first month of pregnancy, often before the woman knows she is pregnant. Hence take as few drugs as possible, in the lowest effective dose. Although many of the drugs taken by unsuspecting women rarely cause harm, there is a difference between reassuring the pregnant woman that what she has taken is unlikely to have affected the pregnancy and advising her what she should take for future attacks. Most evidence of safety is circumstantial few drugs have been tested during pregnancy and breastfeeding because of the obvious ethical limitations of such trials. Hence drugs are only recommended if the potential benefits to the woman and baby outweigh the potential risks.

Prescription Migraine Medication During Pregnancy

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Triptans are usually helpful for cluster headaches, but there isnt a lot of research about their use in pregnancy. Sumatriptan is the safest triptan the others are not recommended in pregnancy.

Opioids are not recommended for the treatment of pregnant women with migraine pain as they can lead to preterm birth, stillbirth, and certain birth defects. Short term use might be suggested but needs to be carefully monitored by a health care provider.

Ergot alkaloids are contraindicated in pregnancy they have been used in pregnancy, however, as a rescue treatment.

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When To See A Doctor

Check in with your doctor the first time you suspect you’re having a migraine. Ditto if an unexplained headache persists for more than a few hours, returns very often or is accompanied by a fever.

From the What to Expect editorial team and Heidi Murkoff, author of What to Expect When You’re Expecting. What to Expect follows strict reporting guidelines and uses only credible sources, such as peer-reviewed studies, academic research institutions and highly respected health organizations. Learn how we keep our content accurate and up-to-date by reading our medical review and editorial policy.

Nsaids And Opioids May Increase The Risk For Birth Defects Or Miscarriage

The use of NSAIDs should be avoided at certain times during a pregnancy. To avoid any confusion about when theyre safe and when theyre not, Starling suggests that pregnant women avoid them altogether.

NSAIDs include medications such as ibuprofen, aspirin, and naproxen.

A study published in October 2017 in the Annals of Epidemiology found that women who took NSAIDs and opioid pain medicines during early pregnancy were more likely to have babies with certain birth defects compared with women who took acetaminophen.

NSAID use early in pregnancy is also linked with increased risk of miscarriage, and the risk is higher for women with a lower BMI, according to a 2018 study published in the American Journal of Obstetrics and Gynecology.

A safety warning issued by the U.S. Food and Drug Administration in 2020 recommends that pregnant women avoid NSAIDs at 20 weeks or later because they can result in low amniotic fluid and may cause rare kidney problems in unborn babies.

The FDA advises that women discuss any medication or supplement they are currently taking with their doctor to make sure its safe to take while pregnant or while trying to get pregnant.

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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 Tylenol and sometimes combine that with the drug Reglan , she says.

Metoclopramide 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 acetaminophen, can be really helpful, she says.

Sometimes I’ll even add a little bit of Benadryl 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.

Do Migraines Get Worse When Pregnant

What Is a Migraine Headache?

Usually, migraines get worse during the first trimester. However, a reduction in the intensity and frequency of migraines is seen at a later stage of pregnancy .

Migraines during pregnancy can cause excruciating pain. Some women find it difficult to cope with it as certain medications are not good to take in pregnancy. However, there are few treatment options and medications available that can help a pregnant woman. It is essential to make a migraine management plan with the doctor by discussing individual migraine triggers.

References:

  • Migraine in pregnancy.
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    How Do I Treat Headaches During Pregnancy

    During pregnancy, you want to try and relieve your headache by natural means if possible, however your health care provider may recommend acetaminophen.

    You may want to try to relieve your headache with one or more of the following natural remedies:

    • If you have a sinus headache, apply a warm compress around your eyes and nose
    • If you have a tension headache, apply a cold compress or ice pack at the base of your neck
    • Maintain your blood sugar by eating smaller, more frequent meals this may also help prevent future headaches
    • Get a massage massaging your shoulders and neck is an effective way to relieve pain
    • Rest in a dark room and practice deep breathing
    • Take a warm shower or bath
    • Practice good posture
    • Get plenty of rest and relaxation

    Outlook For Headache During Pregnancy

    Headache pain during pregnancy is common. You may have tension headaches during your first trimester of pregnancy. This may happen because of the many changes that youre going through in a short period.

    Headache pain may happen in the second and third period of your pregnancy for other reasons. Some causes of headaches in your mid to late pregnancy may be serious.

    High blood pressure is a serious cause of headache pain during pregnancy. You can have high blood pressure at any time in your pregnancy. You may not have any symptoms at all. Check your blood pressure at least once a day with a home monitor.

    Tell your doctor if you have headaches at any time in your pregnancy. Let your doctor know right away if you have a personal or family history of migraine, high blood pressure, seizures or diabetes.

    Take all medications and treatment exactly as prescribed by your doctor. Follow all diet and exercise advice carefully. See your doctor for all follow-up and regular check-ups. Most causes of headaches during pregnancy are treatable or preventable with the right care.

    For more pregnancy guidance and weekly tips tailored to your due date, sign up for our Im Expecting newsletter.

    Last medically reviewed on May 6, 2019

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    Migraine Symptoms Often Improve With Pregnancy

    There is evidence that for many women, migraine can actually improve during pregnancy. A study published in the Journal of Headache Pain found several encouraging trends:

    • It was more common for pregnant women with existing migraine to stop having headaches than it was for pregnant women with no previous history of migraine to start having headaches.
    • There was a gradual decrease of headache and migraine attacks during pregnancy.
    • There was a significant decrease in the duration of headaches during pregnancy compared with prepregnancy headaches.

    As many as 50 to 80 percent of pregnant women with migraine have a reduction in migraine attacks during their pregnancy, according to the American Migraine Foundation.

    However, for some women, migraine can worsen during the first trimester, says Starling. A drop or big change in estrogen level can sometimes trigger a migraine attack, and there can be some drastic changes in estrogen early in pregnancy, she says. That usually levels off and improves in the second and third trimesters, she adds.

    What Can I Do To Prevent Migraines

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    One of the best ways to prevent migraines is to recognize what triggers an attack and trying to avoid them. For example, stress, eating certain foods or lack of sleep may bring on an attack.

    Avoiding your triggers can be difficult when youre pregnant. For example, if you have morning sickness you may not feel like eating or drinking much. This can cause low blood sugar or dehydration, so its important to try and find ways to cope.

    Getting enough sleep may also be difficult during pregnancy. Try our tips for a better nights sleep.

    You should also try to

    • rest and relax as much as possible. You could try things like mindfulness or yoga.

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    When Should I Call My Doctor

    Whether you experience headaches or not, its always important to discuss your pre-pregnancy history, obstetrical history and concerns with your doctor for an individualized assessment and management plan. However, if none of the above treatments resolve your mild headache or your headaches become more frequent and severe, talk to your doctor to determine the cause.

    This includes new headaches that present after 20 weeks, a sudden onset of severe headaches, headaches associated with a fever, mental health changes, elevated blood pressure and vision changes, Dr. Saunders said. Its important to keep an open line of communication with your physician and let them know about any changes in your health so they can rule out anything serious.”

    Is My Headache A Cause For Concern

    Sometimes. Headaches tend to be more common in the first and third trimesters, but they can occur in the second trimester as well. While there are common causes for headaches during pregnancy, its important to note that headaches during the second and third trimester can also be due to high blood pressure, called preeclampsia.

    Preeclampsia is a pregnancy-related condition that requires prompt evaluation and management with an obstetrician or maternal fetal medicine specialist, Dr. Saunders said. Elevated blood pressure prior to pregnancy puts a woman at increased risk for preeclampsia.

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    Complementary And Alternative Medicine

    Non-drug treatments certainly can be helpful, and massage, acupuncture, relaxation and biofeedback have been found to be useful by some. Some women also find applications of heat or cold to the head can be useful.

    Many women also prefer to take complementary and alternative medicines such as homoeopathic and herbal remedies rather than traditional medicines whilst they are pregnant, considering them to be milder.

    However, some complementary treatments can have an unwanted effect on your pregnancy just as conventional medicines can. For instance, some women find aromatherapy massage very helpful, and may be unaware that some essential oils need to be avoided.

    Reflexology treatment is not always advisable during pregnancy, and all complementary medicines should be taken under the supervision of a qualified practitioner. Feverfew should not be used during pregnancy.

    The best advice is to take as few medicines as is realistically possible for you, and at the lowest effective dose, if needed. The use of any drugs or herbal remedy to treat your migraines during pregnancy and whilst breast feeding is a balance of risk and benefits, taken with medical advice. Any medication you do take should be recorded in your pregnancy notes.

    How Does Pregnancy Affect Migraine Headaches

    Is it normal to get headaches during pregnancy, and what should I do about them?

    About 15 to 20 percent of pregnant women have migraines. Over half of women find that their migraines occur less often in the last few months of pregnancy. However, migraines may worsen after delivery, during the postpartum period. Although migraine headaches may cause severe pain for the mother, there are no dangers for the developing fetus.

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    What Causes Your Migraines And Headaches

    There are many different triggers for migraines, but estrogen is the primary culprit for pregnant women. It is even possible for a woman never to experience a migraine until she becomes pregnant. The elevated estrogen levels increase the probability of migraines.

    Some lucky women notice their migraines disappear once they become pregnant, but others notice an extreme increase in intensity . There is significant evidence linking migraines to hormones.

    Of course, there are other reasons you may suffer from one of these nasty headaches. Some triggers include:

    • Chocolate.
    • Sleep deprivation.
    • Caffeine.

    In addition to chocolate and caffeine, processed food is often thought to be a migraine trigger. Try to avoid processed food if at all possible, and eat a balanced diet throughout your pregnancy. Also, I always tell my patients to remember to eat. It may sound ridiculous, but pregnancy brain can make you forget a surprising number of things! Low blood sugar from not eating can also be a migraine trigger.

    Editor’s Note:

    Dehydration can also be a big trigger for pregnancy-related migraines, especially in the first trimester when you are likely to suffer from morning sickness . Be sure you are hydrating as best you can, and call your doctor if you cannot keep anything down.

    It should come as little surprise that many pregnant women will be sleep deprived or under some stress. Its not an easy feat to adjust your life and body around the growing baby inside you.

    How Frequent Are Migraines During Pregnancy

    The incidence and reoccurrence of migraine attacks in women vary widely. Some of them experience for the first time in pregnancy, while some women experience increasing migraine symptoms during the first trimester.

    According to the American Migraine Foundation, around 50 to 80% of pregnant women experience reduced attacks . This reduction in symptoms is attributed to the increasing levels of estrogen during pregnancy.

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    Never Be Afraid To Consult Your Doctor

    If you have a very severe headache or one that onsets very quickly, it is best to consult your doctor. Its better to be safe than sorry. One phone call can give you that peace of mind.

    Remember, headaches are a normal part of pregnancy so try not to become alarmed every time you develop one.

    Take Note

    Preventive Or Prophylactic Migraine Medication In Pregnancy

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    Beta-blockers are an option for preventing migraines in pregnancy. They are mostly used for high blood pressure and have some associated risks for the baby. These include preterm birth and small for dates.

    Anti-depressants, such as amitriptyline, can be used to treat headaches in most women during pregnancy. However, as with the beta-blockers, they come with increased risks for the baby, such as breathing problems at birth and having low blood sugar.

    Anti-emetics are drugs used to treat nausea and vomiting in pregnant patients. It was discovered they can also relieve pain from a migraine attack.

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    When To Call The Doctor

    Most of the time, a headache is just a headache, and it will go away once you eat something or get a little rest.

    A bad headache that does not go away in a few hours, gets worse, or keeps coming back could be a sign of a pregnancy complication, so you should call your doctor.

    You should also notify the doctor:

    • Before taking any medication or herbal supplement to treat your headache to be sure that its safe
    • If your natural treatments are not working
    • If you have a fever, pressure around your eyes, or a stuffy nose
    • If you get a headache and you have a history of high blood pressure
    • If you get a headache after you hit 20 weeks pregnant
    • If you have pain along with other symptoms such as nausea, blurry vision, abdominal pain, or swelling in the body
    • If you have head pain after falling and hitting your head

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