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What To Take For Migraine When Pregnant

Abortive Treatment In Pregnancy

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

How Are Migraine Headaches Managed In Pregnancy

If a woman has a history of migraine headaches, and there are no other health problems, migraines during pregnancy are not usually a concern. However, if a first-time migraine-like headache occurs in pregnancy, it is important to rule out any other type of condition that may be dangerous, such as bleeding in the brain, meningitis , or tumors. Further testing may be needed to determine the cause of the headache.

Treatment of migraines in pregnancy may include soothing and nondrug measures, such as cold packs, a darkened room, and sleep. Avoiding triggers, such as certain foods and stress, may also be helpful. Medications must be carefully chosen because many drugs pass through the placenta to the developing fetus. Small doses of caffeine and acetaminophen are generally safe, but only as advised by your doctor. Avoid nonsteroidal anti-inflammatory drugs. Drugs that can be used include acetaminophen, promethazine, and opioid pain relievers, such as morphine. However, limit the use of opioid pain relievers because of the potential for addiction of the mother and baby. Consult your doctor for more specific information regarding treatment for migraines during pregnancy.

Next Steps

What Lifestyle Changes Can I Make While Im Pregnant To Improve Migraine

Lifestyle measures and behavioral treatment options are important for everyone with migraine, but even more so if youre pregnant, because we want to avoid medications as much as possible, says Starling.

One thing I always discuss with people are the SEEDS for success in migraine management, which is a mnemonic that reminds people of things they can do to improve migraine, she says.

  • S stands for good sleep hygiene. That means going to sleep around the same time and waking up around the same time every day, says Starling.
  • E is exercising, and she recommends about 20 minutes of aerobic exercise at least three days a week.
  • E stands for eating regular meals, so not fasting or skipping meals, says Starling. This is really important: Try to eat multiple small meals throughout the day.
  • D is short for dehydration, or preventing dehydration, by drinking lots of water throughout the day, says Starling.
  • S stands for stress response or stress management. Not stress reduction necessarily, but more managing the way that you respond to stress, she says.

There are also some behavioral treatment options that have proven to be beneficial in evidence-based, randomized, controlled trials. These include biofeedback training, cognitive behavioral therapy training, mindfulness, and relaxation techniques, says Starling.

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When Should I Worry About Migraines During Pregnancy

When should I be concerned? When a headache is severe, or just doesnt go away, or when you have dizziness, blurred vision, or changes in your field of vision, you should contact your healthcare provider. Headaches can sometimes be related to blood pressure problems in pregnancy.

What Are The Sinuses And Sinus Headaches

Migraine Medications That Are Safe During Pregnancy

Sinuses are air-filled cavities located in the forehead, cheekbones, and behind the bridge of the nose. The sinuses produce a thin mucus that drains out of the channels of the nose. When a sinus becomes inflamed, often as the result of an allergic reaction, the inflammation will prevent the outflow of mucus and cause a pain similar to that of a headache. See a doctor if you are experiencing sinus headaches to determine the cause.

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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.

Want to Know More?

What Can I Take To Treat My Migraine If I Am Breastfeeding

The same drugs used in pregnancy can be taken whilst breastfeeding, with the following exceptions aspirin is excreted in breast milk, so should be avoided during breastfeeding because of the theoretical risk of Reyes syndrome and impaired blood clotting in susceptible infants metoclopramide is not generally recommended during lactation since small amounts are excreted into breast milk. The licensing for sumatriptan indicates that a 12 hour delay between treating and breastfeeding is necessary. However, the breastfeeding can continue without interruption during treatment with sumatriptan.13 Almotriptan,eletriptan, frovatriptan, and rizatriptan are licensed for use in breastfeeding providing that you do not breastfeed within 24 hours of the last dose. We would recommend similar advice for naratriptan and zolmitriptan.

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What Should I Watch For While Using This Medicine

Tell your doctor or health care professional if the pain lasts more than 10 days, if it gets worse, or if there is a new or different kind of pain. Tell your doctor if you see redness or swelling. If you are treating a fever, check with your doctor if the fever that lasts for more than 3 days.

Do not take Tylenol or medicines that have acetaminophen with this medicine. Too much acetaminophen can be very dangerous. Always read medicine labels carefully.

Report any possible overdose to your doctor or health care professional right away, even if there are no symptoms. The effects of extra doses may not be seen for many days.

This medicine can irritate your stomach or cause bleeding problems. Do not smoke cigarettes or drink alcohol. Do not lie down for 30 minutes after taking this medicine to prevent irritation to your throat.

If you are scheduled for any medical or dental procedure, tell your healthcare provider that you are taking this medicine. You may need to stop taking this medicine before the procedure.

Do not take this medicine close to bedtime. It may prevent you from sleeping.

This medicine may be used to treat migraines. If you take migraine medicines for 10 or more days a month, your migraines may get worse. Keep a diary of headache days and medicine use. Contact your healthcare professional if your migraine attacks occur more frequently.

What Can I Take For A Migraine While Pregnant

Pregnancy headaches

And now for the meds. As we saw above, many conventional migraine medicines arent recommended while youre pregnant, including ergotamine.

Unfortunately, ibuprofen and other so-called non-steroidal anti-inflammatory drugs arent advisable for use during pregnancy either. So, whats safe?

  • Acetaminophen is really your best bet. This general painkiller is considered safe during pregnancy. Many pregnant women use it without any harmful side effects. But doctors advise that you should only use it when necessary.
  • Sumatriptan is a dedicated medication for migraines and cluster headaches. Studies havent found evidence that sumatriptan, or other triptans, can negatively affect you or your baby while pregnant. But do tell your doctor if youre planning to take sumatriptan.

Talk to your doctor about what they recommend taking for migraines during pregnancy. Theyll be able to find the solution thats best for you.

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Secondary Headaches During Pregnancy

It is especially important to identify red flags suggesting that headache is a symptom of a serious disease . In these cases, electroencephalography, ophthalmoscopy, ultrasound of the vessels of the head and neck, brain MRI and MR angiography may be needed . In some cases, it is possible to perform multi-slice computed tomography . The risk for the fetus in this case is minimal and the contraindication is the mother allergy to the contrast agent .

Clinically, the most significant causes of the secondary headache in pregnant women are: stroke, subarachnoid hemorrhage, cerebral venous thrombosis, arterial dissection, pituitary tumor, choriocarcinoma, eclampsia, preeclampsia, posterior reversible encephalopathy syndrome, idiopathic intracranial hypertension, and reversible cerebral vasoconstriction syndrome.

Stroke

To identify the etiology and make a diagnosis of ACA in pregnant women and puerperas, one or more of the following methods can be required: MRI and angiography, computed tomography , MSCT, ophthalmoscopy electrocardiography and echocardiography, daily monitoring of arterial pressure and electrocardiograms, ultrasound examination of extra- and intracranial vessels with duplex scanning, and cerebral angiography .

Subarachnoid hemorrhage

Cerebral venous thrombosis

Arterial dissection

Pituitary tumor

Choriocarcinoma

Headache associated with preeclampsia and eclampsia

Posterior reversible encephalopathy syndrome

Primary and secondary intracranial hypertension

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.

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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.

How Can I Treat A Migraine Attack While Pregnant

What to Do About Migraines During Pregnancy and ...

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.

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What May Interact With This Medicine

Do not take this medicine with any of the following medications:

  • MAOIs like Carbex, Eldepryl, Marplan, Nardil, and Parnate
  • methotrexate
  • medicines that stimulate or keep you awake
  • medicines that treat or prevent blood clots like enoxaparin, heparin, ticlopidine, warfarin
  • NSAIDs, medicines for pain and inflammation, like ibuprofen or naproxen
  • other aspirin and aspirin-like medicines
  • some cough and cold medicines like pseudoephedrine
  • varicella live vaccine

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

Pregnant And No Longer Able To Take Migraine Medication :

I get monthly migraines and I recently started taking Nurtec. Now I can no longer take my meds and I have been getting migraines much more frequently since I got pregnant. I cant even take as much acetaminophen as I could before . I feel like Ive been spending so much time lying down in the dark. Keeping up with my job has been extremely challenging as its nearly impossible to concentrate.

Also, its tough talking about it with my family as I dont think any of them really understand. I just started getting them in my late teens and theyve gotten worse and more common each year. Ive tried to explain that these things often get worse when you get older, but theres very little sympathy or understanding. I know most people just think its just a headache, but Im feeling so run down, depressed, and alienated.

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When Headaches Are Secondary To Other Problems

Headaches can result from other conditions, some of which are life-threatening:

Stroke: Sudden and severe headaches might be a sign of a stroke. Women who have strokes during pregnancy or after delivery typically describe the pain as the worst headache of their lives. They also might report other symptoms, such as speech problems, vision issues, or functional problems on one side of the face or body. At the emergency room, the doctor will evaluate you for stroke symptoms, such as visual changes, facial drooping, and arm or leg weakness. If you are having or had a stroke, we will get you emergency treatment at our Advanced Comprehensive Stroke Center.

Preeclampsia: A headache with preeclampsia can indicate a dangerous spike in blood pressure. The doctor will assess you and might admit you to the hospital for management of blood pressure and treatment to prevent seizures.

Spinal fluid leak: A headache after an epidural or spinal block can indicate a spinal fluid leak, especially if it worsens when you sit or stand up. The most effective treatment is an epidural blood patch, in which the doctor injects a sample of your blood into the leaking area, essentially plugging the hole. This therapy provides dramatic relief right away.

Migraine With Aura In Pregnancy

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

If you experience migraine with aura you are more likely to continue to have attacks during your pregnancy. If you experience migraine for the first time while you are pregnant it is likely to be with aura.1

If you do think you are having migraine for the first time while you are pregnant it is important to visit your GP so the causes for your headache can be checked and treated if necessary.

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Coffee Helps Prevent My Migraines Can I Have Caffeine While Pregnant

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.

Remedies For Migraines During Pregnancy

Migraines are intense headaches that can occur as a symptom of pregnancy. These are different from stress or tension headaches. It is also normal to experience your first migraine during pregnancy. Some studies have found a slight correlation between migraines and hormones. This makes questions about how to treat migraines naturally while expecting common.

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Do Migraines During Pregnancy Affect Your Baby

If youre nursing a painful head right now, heres some good news: the migraines that are causing you such a headache wont affect your baby. Theres no evidence at all to suggest that.

Butand this is importantits possible that some migraine medications can affect your little one.

Ergotamine, for example, has been associated with birth differences. Your doctor wont prescribe this to you for a migraine if youre expecting a baby.

So, how to get rid of a migraine when pregnant? Here are some things you can try:

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