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Migraine Headaches and Pregnancy

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Acute Migraine Treatment continued...

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.

Preventive Migraine Treatment

If you have severe, recurring attacks, preventive treatment may stop future attacks or reduce their severity. Many of the drugs used for prevention were originally used for other conditions, such as depression.

Relatively safe medications for migraines in pregnancy include antidepressants (such as amitriptyline and fluoxetine). A class of drugs called beta-blockers, such as propranolol, atenolol, and labetalol, are also considered relatively safe.

When you're pregnant, always talk with your doctor before taking any drug, herbal product, or natural medicine. 

If you can't take medications or wish not to, a device might be worth considering. Cefaly is the first FDA-approved device for preventing migraines in people over age 18. The portable headband-like device gives electrical impulses on the skin at the forehead. This stimulates a nerve associated with migraine headaches. Cefaly is used once a day for 20 minutes, and when it's on you'll feel a tingling or massaging sensation.  

If you're seeing a headache specialist, double-check with your obstetrician or certified midwife about the safety of any medications during pregnancy. While migraine pain may be excruciating, taking a risk with your baby's health could cause lifelong health problems for your child.

WebMD Medical Reference

Reviewed by Richard Senelick, MD on September 30, 2014
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