TREATMENT OF MIGRAINE IN PREGNANCY

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(Date of issue: August 2016, Version: 2.1)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

A corresponding patient information leaflet on treatment of migraine in pregnancy is available at www.medicinesinpregnancy.org.

Summary

Migraine is common in women of reproductive age and may occur in pregnancy. It has been estimated that in up to 80% of women who suffer migraines, both the frequency and severity of attacks improve during the second and third trimesters of pregnancy, thus routine prophylaxis with therapies such as topiramate or propranolol is not recommended during pregnancy. However, in some cases migraine may fail to improve or worsen. In some women migraine presents for the first time during pregnancy.

Migraine itself does not appear to increase the risk of spontaneous abortion, congenital malformation or other pregnancy-related complications. However, if migraines are frequent or severe and left untreated, subsequent maternal effects such as dehydration, inadequate nutrition and stress may have an adverse effect on the fetus.

If appropriate, non-pharmacological measures, including identification and avoidance of trigger factors, should be tried before drug therapy is considered. Medication may be required for headaches that are severe and associated with nausea and vomiting. Adequate fluid replacement is needed for dehydration.

Paracetamol is considered the most appropriate first-line pharmacological therapy for acute attacks of migraine. Depending on the stage of pregnancy, NSAIDs may offer alternative therapeutic options, and sumatriptan may also be considered, although there is less evidence of safety in pregnancy for these agents than for paracetamol. Use of prophylactic therapies may be justifiable for some women and should be decided on an individual basis depending on severity and frequency of attacks, the patient’s prior responsiveness to treatment, stage of pregnancy, and risk of teratogenicity. Efficacy of prophylaxis and need for ongoing use should be reviewed throughout pregnancy.

Treatment of migraine at any stage in pregnancy with the medicines listed above would not usually be regarded as medical grounds for termination of pregnancy. Use of NSAIDS beyond the second trimester carries a risk of premature closure of the ductus arteriosus and is therefore best avoided. Should exposure to an NSAID after the second trimester occur, referral for fetal assessment is advised as additional monitoring may be indicated. Other risk factors which independently increase the risk of adverse pregnancy outcome may also be present in individual cases. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.
                  
This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.