From the Guidelines
For headaches during early pregnancy, paracetamol (acetaminophen) is the recommended first-line treatment. This is based on the most recent and highest quality study available, which emphasizes the importance of considering the potential harm to the fetus when selecting a treatment for migraine during pregnancy 1. The study suggests that paracetamol should be used as the first-line medication for acute treatment of migraine in pregnancy, despite its relatively poor efficacy, due to its safer profile compared to other options.
Key Considerations for Treatment
- Paracetamol is preferred over NSAIDs, which can only be used during the second trimester, and triptans, which should be used under strict supervision due to limited safety data 1.
- Non-medication approaches, such as staying hydrated, getting adequate rest, practicing stress reduction techniques, and maintaining regular meals, should be tried first to manage headaches.
- If headaches are severe, persistent, or accompanied by concerning symptoms like visual changes, swelling, or high blood pressure, immediate medical attention is necessary as these could indicate pregnancy complications.
Safety of Medications During Pregnancy
- Paracetamol is considered safe during pregnancy because it does not affect fetal development or blood flow to the placenta, unlike NSAIDs which can potentially cause problems with fetal development and circulation 1.
- Preventive migraine medications are best avoided during pregnancy due to the potential for fetal harm, but if necessary, propranolol or amitriptyline can be used under specialist supervision 1.
- Certain medications like topiramate, candesartan, and sodium valproate are contraindicated during pregnancy due to their adverse effects on the fetus 1.
Guidance from Recent Studies
- A recent clinical guideline from the American College of Physicians discusses the pharmacologic treatments of acute episodic migraine headache but does not specifically address pregnancy 1.
- However, the guideline emphasizes individualized decision-making and considering patient preferences and factors like route of administration and cost when choosing a treatment, principles that can be applied to pregnant patients as well, with the caveat of prioritizing fetal safety.
From the FDA Drug Label
If pregnant or breast-feeding ask a health professional before use. The FDA drug label does not answer the question.
From the Research
Treatment Options for Headaches in Early Pregnancy
- The recommended first-line symptomatic treatment for headaches during pregnancy is acetaminophen 2, 3, 4.
- Triptans may be considered as a second-line treatment for acute migraine attacks 2, 4, 5.
- Non-pharmacological approaches, such as relaxation, sleep, massage, ice packs, and biofeedback, should be tried first to treat migraine in women who are pregnant 3, 4.
- Preventive treatment should only be considered in the most severe cases, and beta-blockers such as propranolol may be preferred 2, 3.
Safety of Medications During Pregnancy
- Acetaminophen is considered safe for use during pregnancy 2, 3, 4.
- Triptans may not be associated with fetal/child adverse effects, but their use should be limited to sporadic cases 4, 5.
- NSAIDs such as ibuprofen can be used under certain circumstances, but their intake in the first and third trimesters is associated with specific risks and contraindications 3, 4, 5.
- Calcium channel blockers and antihistamines may not be associated with fetal/child adverse effects, but more research is needed to confirm their safety 5.
Considerations for Treatment
- Treatment of migraine during lactation is less restrictive than during pregnancy 2.
- Counselling is essential for women contemplating pregnancy to promote a safe and healthy pregnancy and postpartum period for the mother and child 4.
- The primary aim of clinicians should be to provide optimal treatment according to stage of pregnancy, while minimising possible risks related to drug therapy 4.