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Migraine Headaches and Pregnancy

Self-Care of Migraines

Your first line of defense against migraine headaches is a healthy lifestyle and self-care. Here are some tips to help you manage your migraines during pregnancy:

  • Avoid your known triggers, such as specific foods, as much as possible.
  • Keep a predictable schedule of meals and snacks.
  • Drink plenty of water.
  • Get plenty of rest.
  • Consider taking a class in biofeedback or other relaxation technique.
  • When pain strikes, try ice packs, massage, and resting in a quiet, darkened room.

Medications for Migraines

If you're pregnant -- or planning to get pregnant soon -- your doctor will generally advise you to stay off medications unless they're absolutely needed. Together, you'll have to weigh the potential effects of a drug on your unborn baby. In some cases, a decision will need to be made based on scant or inconclusive research into a particular drug.

Many of the anti-migraine medications to treat or prevent migraine headache and its symptoms should be avoided during pregnancy. That's because they've been linked to birth defects in babies. Other medications are associated with pregnancy complications. For instance, some have been associated with bleeding, miscarriage, or intrauterine growth restriction (IUGR), a condition in which the uterus and fetus don't grow normally.

Acute Migraine Treatment

Acute treatment aims to stop a migraine attack after its first signs appear.

Pain relievers, also called analgesics, may help ease the intense pain of migraines. These general pain-relieving drugs, though, aren't specific to the migraine pain pathway:

  • Acetaminophen is generally considered low-risk during pregnancy.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, may carry a risk of bleeding and miscarriage if taken near the time of conception. There is also a possible risk of blood pressure complications in the baby if they are taken in the third trimester. Aspirin taken near delivery may lead to excess blood loss in mothers during birth.
  • Most NSAIDs, including ibuprofen -- sold over the counter under the brand names Advil and Motrin -- and naproxen -- sold as Aleve and other brands -- don't have enough controlled human research studies to assess all their risks in pregnancy.
  • Narcotic pain relievers should generally be avoided. There is a dual risk of addiction in both mothers and babies if they are used for prolonged periods of time.

Ergotamines work specifically for migraine pain. But doctors advise against taking these drugs during pregnancy. They carry a risk of birth defects, especially if taken in the first trimester. These drugs may also stimulate labor contractions and premature birth.

Triptans work specifically on the migraine pain pathway. Triptans aren't known to cause birth defects. But most research to date has focused on animals, not humans. In 2008 The Journal of the American Medical Association renewed its warning against combining triptans with two common classes of antidepressant:

  • selective serotonin reuptake inhibitors (SSRIs)
  • selective serotonin/norepinephrine reuptake inhibitors (SNRIs)

The combination carries the risk of a life-threatening condition called "serotonin syndrome."

Other medications may be prescribed for relief of specific symptoms of a migraine during pregnancy. For instance, antiemetics help soothe the vomiting and nausea that can accompany a migraine. But many of the drugs typically used for migraine haven't been adequately studied in pregnancy, so their safety or risk to the fetus has not been determined.

WebMD Medical Reference

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