From the Guidelines
Pregnant women with migraines should be treated with paracetamol as the first-line medication for acute treatment, due to its relatively safe profile compared to other options. According to the most recent and highest quality study available 1, paracetamol is recommended as the first-line treatment for acute migraine in pregnancy, despite its relatively poor efficacy.
Key Considerations for Treatment
- Paracetamol should be used as the primary medication for acute treatment of migraine in pregnancy
- NSAIDs can be used only during the second trimester, if necessary, due to potential risks associated with their use in the first and third trimesters
- Triptans, such as sumatriptan, should be used only under strict specialist supervision due to limited safety data
- Metoclopramide can be used for nausea associated with migraine in pregnancy
Preventive Treatment
- Preventive migraine medications are best avoided during pregnancy due to potential fetal harm
- If preventive therapy is necessary, propranolol or amitriptyline can be used under specialist supervision, as they have the best available safety data
- Topiramate, candesartan, and sodium valproate are contraindicated due to adverse effects on the fetus or teratogenic properties
Post-Partum Considerations
- In the post-partum period, paracetamol is the preferred acute medication for migraine treatment
- If preventive medication is required, propranolol is the recommended first choice due to its safety profile 1
From the Research
Treatment Options for Migraines 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 2.
- For treatment of acute migraine attacks, 1000 mg of paracetamol (acetaminophen) is considered the first choice drug treatment, preferably as a suppository 2.
- 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 2.
- Triptans, dihydroergotamine, and ergotamine tartrate are contraindicated in women who are pregnant 2.
- Prochlorperazine for treatment of nausea is unlikely to be harmful during pregnancy, and metoclopramide is probably acceptable to use during the second and third trimester 2.
- Prophylactic treatment is rarely indicated, and the only agents that can be given during pregnancy are the beta-blockers metoprolol and propranolol 2.
- Acetaminophen is advised for use in acute therapy during pregnancy, but mothers who used acetaminophen during pregnancy are more likely to have children with hyperkinetic disorders and characteristics resembling attention-deficit/hyperactivity disorder 3.
- Non-pharmacological techniques should always be used as the first line of treatment, in addition to any required drug therapy 3.
- Sumatriptan and acetaminophen are both effective treatments for transient migraine attacks that occur during pregnancy or breastfeeding 3.
- Metoclopramide and acetaminophen are the most common medications prescribed for pregnant women with migraine, with metoclopramide administered along with diphenhydramine in most cases 4.
- Women's healthcare providers feel comfortable recommending acetaminophen and caffeine for acute treatments for pregnant patients with migraine, but report higher levels of discomfort with triptans 5.
- Acetaminophen is the safest acute migraine drug during pregnancy, and acetaminophen with codeine is also an option, while sumatriptan may be an option during pregnancy for selected patients and is compatible with breast-feeding 6.
Medication Safety During Pregnancy
- The safety of medications during pregnancy is a major concern, and women's healthcare providers should be aware of the potential risks and benefits of different medications 5.
- Acetaminophen is considered safe for use during pregnancy, but other medications such as triptans and opioids may pose risks to the fetus 2, 5.
- The use of medications during pregnancy should be carefully considered, and women's healthcare providers should counsel patients on the potential risks and benefits of different medications 5.
Non-Pharmacological Treatment Options
- Non-pharmacological techniques such as relaxation, sleep, massage, ice packs, and biofeedback should be used as the first line of treatment for migraine in pregnant women 2, 3.
- These techniques can be effective in reducing the frequency and severity of migraine attacks, and can be used in conjunction with medication therapy 3.