From the Guidelines
For pregnant women with headaches, paracetamol should be used as the first-line medication for acute treatment, due to its relatively safe profile compared to other options 1. When managing headaches in pregnant women, it's crucial to consider the potential harm to the fetus and balance this with the need to alleviate the mother's symptoms.
- Non-medication approaches can be beneficial and should be tried first, including adequate hydration, regular meals, proper sleep, stress reduction techniques, and cold or warm compresses on the forehead or neck.
- Paracetamol is recommended at a dose that is safe and effective, typically not exceeding 4000 mg daily 1.
- NSAIDs can be used only during the second trimester, but their use should be cautious and under medical supervision due to potential risks to the fetus 1.
- Triptans, such as sumatriptan, may be considered for severe migraines under strict specialist supervision, as the safety data available are limited 1.
- Preventive migraine medications are generally best avoided during pregnancy, but if clinically indicated, propranolol or amitriptyline can be used under specialist supervision due to their relatively safer profiles compared to other options like topiramate, candesartan, and sodium valproate, which are contraindicated 1.
- It's also important for pregnant women to be aware of severe symptoms that could indicate serious conditions, such as visual changes, sudden onset of severe pain, fever, or stiff neck, and to seek immediate medical attention if these occur.
From the FDA Drug Label
If pregnant or breast-feeding, ask a health professional before use. The recommended treatment for headaches in pregnant women is to consult a health professional before use of acetaminophen.
- Acetaminophen may be used for headaches, but only under the guidance of a health professional. It is crucial to follow the recommended dosage and not exceed 4,000 mg of acetaminophen in 24 hours to avoid severe liver damage 2. No other information is provided in the drug labels regarding alternative treatments for headaches in pregnant women.
From the Research
Recommended Treatments for Headaches in Pregnant Women
- Nondrug therapies such as relaxation, sleep, massage, ice packs, and biofeedback should be tried first to treat migraine in women who are pregnant 3
- For treatment of acute migraine attacks, 1000 mg of paracetamol (acetaminophen) preferably as a suppository is considered the first choice drug treatment 3
- The risks associated with use of aspirin (acetylsalicylic acid) and ibuprofen are considered to be small when the agents are taken episodically and if they are avoided during the last trimester of pregnancy 3
- Combination metoclopramide and diphenhydramine may be more effective than codeine for migraine or tension headache 4
- Triptans may not be associated with fetal/child adverse effects, but their use is contraindicated in women who are pregnant according to some studies 3, 4
- Calcium channel blockers and antihistamines may not be associated with fetal/child adverse effects and can be used for prevention of primary headache 4
- Non-pharmacologic treatment is the ideal solution, but analgesics such as acetaminophen and narcotics can be used on a limited basis 5
- Preventive therapy is a last resort and should be used with caution 5
Important Considerations
- Diagnostic testing serves to exclude organic causes of headache, to confirm the diagnosis, and to establish a baseline before treatment 5
- If neurodiagnostic testing is indicated, the study that provides the most information with the least fetal risk is the study of choice 5
- It is especially important to identify "red flag symptoms" suggesting that headache is a symptom of a serious disease 6
- Treatment should not be postponed as an undermanaged headache can lead to stress, sleep deprivation, depression, and poor nutritional intake that in turn can have negative consequences for both mother and baby 6