Treatment of migraine in pregnancy

Date: January 2023, Version 3.0.1

Quick read

Migraine often improves in pregnancy. If not, it can be treated with some painkillers and anti-sickness medicines.

What is migraine?

Migraine causes severe headaches often accompanied by nausea and visual disturbance. Migraine is common in women of childbearing age.

How can I treat migraine in pregnancy?

Many women find that migraine becomes less severe in pregnancy, meaning that medicines may not be needed. If migraine continues, some women can manage without medicines, using techniques such as:

• Avoiding triggers for migraine (including stress and certain foods)
• Relaxation and deep breathing techniques
• Getting enough sleep
• Massage
• Use of ice packs

However, this does not work for everyone. If drug treatment in pregnancy is required, there are a number of options to ensure that migraine does not affect quality of life and interfere with daily activities. Medicines to treat migraine should only be used in pregnancy on the advice of a doctor, who will help to weigh up the benefits of treatment against any risks.

Painkillers

Paracetamol is the first-choice treatment for mild-to-moderate pain in pregnancy. It has an excellent overall safety profile. For more information please see the bump leaflet on Paracetamol.

Non-steroidal anti-inflammatory drugs (NSAIDs) might be recommended by a doctor in the first and second trimesters if paracetamol does not control migraine pain. It is very important that NSAIDs are not used after 30 weeks of pregnancy as, at this stage, they may affect the baby. For more information please see the bump leaflets on Ibuprofen, Diclofenac, and Naproxen. PLEASE BE AWARE: The advice about use of NSAIDs in pregnancy has recently changed. It is now recommended that prolonged use of NSAIDs should be avoided after 20 weeks of pregnancy. The advice to avoid any use of NSAIDs after 30 weeks of pregnancy has not changed. For more information, please see the information here. We will be updating this document as soon as possible to include the new advice.

Sumatriptan may be offered if paracetamol has not controlled the pain and an NSAID cannot be used. There is no evidence that use of sumatriptan in pregnancy is harmful to the baby. For more information please see the bump leaflet on Sumatriptan.

Codeine may be offered if other treatments have not worked. While the majority of exposed babies show no long-term effects, some studies have shown that certain birth defects are slightly more common after codeine use in early pregnancy. Codeine use in the weeks leading up to delivery can cause withdrawal symptoms in the baby after birth. For more information, please see the bump leaflet on Codeine.

Drug treatments for nausea and vomiting

Cyclizine, prochlorperazine, or metoclopramide may be offered for nausea and vomiting caused by migraine. These drugs are also used to treat pregnancy sickness and are not known to be harmful to a developing baby. For more information, please see the bump leaflets on Cyclizine, Prochlorperazine, and Metoclopramide.

Over-the-counter migraine treatments

The over-the-counter medicine Migraleve (which contains paracetamol, codeine, and the anti-sickness medicine buclizine) should only be used in pregnancy on advice from a doctor. This is because there is very little pregnancy safety information about buclizine.

Long-term treatments to prevent migraine

Migraine does not always improve in pregnancy and some women may need to keep taking preventative treatment to ensure that they can function well. Sometimes the medicine that was being taken before pregnancy to prevent migraine may need to be changed to an alternative that is safer for the baby.

Sodium valproate and a family of medicines called ACE inhibitors (including captopril, cilazapril, enalapril, fosinopril, imidapril, lisinopril, moexipril, perindopril, quinapril, ramipril, and trandolapril) should not be used in pregnancy as they can harm the baby. Women taking these medicines to prevent migraine should urgently arrange to see their doctor, who will offer a safer alternative. For more information, please see the bump leaflets on Sodium valproate and ACE inhibitors.

Topiramate is also avoided in pregnancy as it is linked to a slightly increased risk of cleft lip and palate in the baby and might also affect the baby’s growth in the womb. For more information, please see the bump leaflet on Topiramate.

Gabapentin, venlafaxine, and botulinum toxin are only used in pregnancy to prevent migraine if other medicines have not worked or cannot be used. They are not known to harm the developing baby but more information on their pregnancy safety is ideally required. For more information, please see the bump leaflets on Gabapentin, Venlafaxine, and Botulinum toxin.

Low-dose aspirin, propranolol, amitriptyline, and verapamil can be used in pregnancy to prevent migraine. These drugs are also used to treat a number of other conditions in pregnant women and are not known to harm a developing baby. For more information, please see the bump leaflets on Aspirin, Propranolol, Amitriptyline, and Calcium channel blockers.

Will my baby need extra monitoring?

As part of their routine antenatal care, most women will be offered a very detailed scan at around 20 weeks of pregnancy to look for birth defects and to check the baby’s growth.

There is no evidence that taking medicines to treat migraine during pregnancy causes any problems that would require extra monitoring of your baby.

Are there any risks to my baby if the father has taken migraine treatments?

We would not expect any increased risk to your baby if the father took migraine treatments before or around the time you became pregnant.

Who can I talk to if I have questions?

If you have any questions regarding the information in this leaflet, please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.

How can I help to improve drug safety information for pregnant women in the future?

Our online reporting system (MyBump Portal) allows women who are currently pregnant to create a secure record of their pregnancy, collected through a series of questionnaires. You will be asked to enter information about your health, whether or not you take any medicines, your pregnancy outcome and your child's development. You can update your details at any time during pregnancy or afterwards. This information will help us better understand how medicines affect the health of pregnant women and their babies. Please visit the MyBump Portal to register.

General information
Sadly, miscarriage and birth defects can occur in any pregnancy.

Miscarriage occurs in about 1 in every 5 pregnancies, and 1 in every 40 babies are born with a birth defect. This is called the ‘background risk’ and happens whether medication is taken or not.

Most medicines cross the placenta and reach the baby. For many medications this is not a problem. However, some medicines can affect a baby’s growth and development.

If you take regular medication and are planning to conceive, you should discuss whether your medicine is safe to continue with your doctor/health care team before becoming pregnant. If you have an unplanned pregnancy while taking a medicine, you should tell your doctor as soon as possible.

If a new medicine is suggested for you during pregnancy, please make sure that the person prescribing it knows that you are pregnant. If you have any concerns about a medicine, you can check with your doctor, midwife or pharmacist.

Our Bumps information leaflets provide information about the effects of medicines in pregnancy so that you can decide, together with your healthcare provider, what is best for you and your baby.