Migraine Headache

INFORMATION FOR PREGNANT WOMEN WHO HAVE MIGRAINE HEADACHE WHILE PREGNANT OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is a migraine headache?

Migraine belongs to a category of headaches known as vascular headaches, because they are thought to result from a process involving blood vessels not behaving properly. It is also a type of primary headache, meaning a headache that is not a symptom of some other medical condition. Migraines come as attacks that come and go, and often develop following an aura, which can be of a visual nature (flashing/flickering lights, spots or lines, or temporary loss of eyesight), body sensations (such as feelings of pins and needles or numbness in a body part), or speech disturbances.

How common is migraine headache during pregnancy?

Migraine headache is extremely common both in and out of pregnancy. A worldwide survey in 2010 found migraine to be present in 14.7 percent of people, making it the second most common medical condition.  Migraines tend to occur more in women than men and often begin in young adulthood, or sooner and continue throughout life, so the condition is common in pregnancy. In fact, migraines affect 25 percent of women of childbearing age.

How is migraine headache diagnosed?

Migraine is diagnosed clinically, which in this case means based on the presence of at least two of the following characteristics: pain is located on one side of the head; it has a pulsating quality (throbbing); the level of pain is moderate to severe (doctors may ask you to rate the severity of pain on a scale of 1-10. If you think it is 5 or higher this would count as a migraine characteristic); it gets worse with routine physical activity, or causes you to avoid such activity. In many cases, but not all, migraine attacks develop following an aura, which can be visual (flashing/flickering lights, spots, or lines, or temporary loss of eyesight), body sensations (such as feelings of pins and needles or numbness in a body part), or speech disturbances. An aura symptom typically develops over up to five minutes and may last from five minutes to one hour. The migraine typically begins within 60 minutes of the beginning of the aura. The aura may continue during the migraine, or it may end. If a patient reports headaches with these characteristics coming as attacks over the past few days, particularly within the past 4-72 hours, this is all very suggestive of migraine headache. Migraines are more common in women than men, and if the patient is a woman who has suffered migraines in the past, this is generally enough to diagnose the attacks as being migraine headache and there will be no need for imaging of the head.

Does migraine headache cause problems during pregnancy?

As noted earlier, migraine headache is very common among women of childbearing age. However, in 60-70 percent of these women, migraine improves over the course of pregnancy, and in 20 percent the headaches disappear all together.  After delivery, however, the symptoms soon return.

Does migraine headache during pregnancy cause problems for the baby?

Numerous studies have demonstrated that migraine headache does not have any negative consequences in terms of birth defects, miscarriage, or other bad outcomes, but sometimes other conditions can be confused with migraine headaches.  This is why the patients history is extremely important.

What to consider about taking medications when you are pregnant or breastfeeding:

  • The risks to yourself and your baby if you do not treat the migraine
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat migraine headache during pregnancy or breastfeeding?

Numerous medications are used to treat migraines, and to prevent attacks. Of these, the following migraine medications are considered to be safe during pregnancy: buclizine, cyclizine, domperidone, doxylamine, acetominiphen, paracetamol, metoclopramide, prochlorperazine, chlorpromazine (intramuscular injection), magnesium sulphate (intravenously), prednisolone, and codeine. Furthermore, the drugs naratriptan, rizatriptan, and sumatriptan are considered probably safe. Aspirin and a group of medications called non-steroidal anti-inflammatory drugs (NSAIDs) are thought to be safe during the first two trimesters, but should be avoided during the third trimester.

Who should NOT stop taking medication for migraine headache during pregnancy or breastfeeding?

Anyone who continues to experience migraine attacks during pregnancy should be on some type of medication, but medications can be switched and adjusted to minimize the risk to the developing baby.

What should I know about choosing a medication for my migraine headache during pregnancy?

There are many medication options for treating migraine headaches, so often one drug can be replaced with another. It is important to stay in communication with your health care provider as the release of new studies over time can change the outlook on the role of specific medications during pregnancy.

What should I know about choosing a medication for my migraine headache when I am breastfeeding?

Nearly all medications that are given for migraine headache are considered safe during breastfeeding. The exception is aspirin, which should be avoided if you are nursing a newborn.

You may find Pregistrys expert reports about the individual medications used to treat migraine headaches here. Additional information can also be found in the sources listed at the end of this report.

What alternative therapies besides medications can I use to treat my migraine headache during pregnancy?

Two non-drug procedures have been shown to be effective against migraine headaches. One is called vagus nerve stimulation and the other is called transcutaneous supraorbital nerve stimulation.

What can I do for myself and my baby when I have migraine headache during pregnancy?

It is very important to follow the instructions of your physician.

Resources for migraine headache in pregnancy:

For more information about migraine headache during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446] or visit the following organizations:

 

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Last Updated: 04-09-2018
General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.


Medications for Migraine Headache