migraine and pregnancy

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  • Hormonal changes
    • migraine is three times more common in women than in men. Attacks in most women start around puberty and continue until the menopause, with respites during pregnancy

  • Migraine and pregnancy
    • paracetamol in moderation is safe throughout pregnancy
    • aspirin and NSAIDs are safe except in the third trimester
    • for nausea, metoclopramide or domperidone are unlikely to cause harm throughout pregnancy and lactation
    • triptans and pregnancy
      • most of the available information relates to sumatriptan, and suggests that exposure during pregnancy leads to no higher risk of birth defects than is recorded in the general population (1)
      • women who have inadvertently taken triptans and then find themselves pregnant can be reassured that the outcome of the pregnancy is very unlikely to be adversely affected by the triptan. However, since present knowledge is still limited, triptans cannot be recommended as a routine

  • Migraine and breastfeeding
    • a number of drugs can be used by breastfeeding women to treat migraine. These include the painkillers ibuprofen, diclofenac, and paracetamol, which may be combined with domperidone
    • the manufacturers of almotriptan, eletriptan, frovatriptan and rizatriptan all recommend avoiding breast-feeding for 24 hours after treatment, and the manufacturer of sumatriptan recommends 12 hours, although studies on eletriptan and sumatriptan show that only negligible amounts enter breast milk. In contrast, the manufacturers' advice for naratriptan and zolmitriptan state only "Caution should be exercised when considering administration… to women who are breast-feeding". However, the American Academy of Pediatrics (AAP) Committee on Drugs advises that use of sumatriptan is compatible with breast-feeding
  • ergotamine and dihydroergotamine are contraindicated during pregnancy and lactation.

NICE suggest (2):

  • acute treatment
    • offer pregnant women paracetamol for the acute treatment of migraine. Consider the use of a triptan or an NSAID after discussing the woman's need for treatment and the risks associated with the use of each medication during pregnancy
    • in November 2015, this was an off-label use of triptans (except nasal sumatriptan) in under 18s
  • seek specialist advice if prophylactic treatment for migraine is needed during pregnancy

Reference:

 

Last edited 05/2021 and last reviewed 05/2021

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