Safe Migraine Drugs During Pregnancy
Thanks to the stable levels of migraine preventative estrogen that occur during pregnancy, women who frequently suffer from these debilitating headaches often get a break from them while they wait. For those in the minority who still suffer from migraines, the question of how to treat them is important. Although there are several medications that are effective for treating migraines, not all of them are considered safe for a developing baby.
Migraine pain, if experienced during pregnancy, is often severe enough to require medication. Sometimes other symptoms of migraine, such as nausea and vomiting, also need to be treated with medication.
Fortunately, there are a number of effective migraine medications that the Food and Drug Administration (FDA) considers safe to take during pregnancy. Before you get your usual prescription, make sure it is on this list (and make sure your obstetrician or midwife approves that you take a dose). If not, discuss these safer options with your health care provider.
Also known as pain relievers, these are medications that have the primary purpose of relieving the often excruciating headaches associated with a migraine episode.
The most common pain relievers used for headaches are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). Both types of medications are available over the counter (OTC) as brand name, brand name, and generic products, as well as on prescription.
Pain relievers are also often combined with other medications to create multi-symptom treatments, such as those for coughs and colds.
Considered the safest pain reliever for pregnant women and their babies, acetaminophen blocks nerve impulses to the area of ââthe brain where pain signals are produced. There are dozens of brand names for acetaminophen; the best known is Tylenol.
A small amount of research has found possible associations between prenatal acetaminophen and certain health problems in children. These include asthma, learning problems, attention deficit hyperactivity disorder (ADHD) and others.
However, according to a 2017 study, any potential link between acetaminophen taken during pregnancy and negative effects on babies is weak at best. For this reason, the author writes: âAcetaminophen should not be forbidden to children or pregnant women lest it develop unwanted effects. “
Rather than not taking acetaminophen for migraine pain relief, a mom-to-be is advised to always use the lowest dose possible for the shortest amount of time.
When not used correctly, acetaminophen has been shown to cause liver damage in some people (pregnant or not). This is more likely to happen when too much acetaminophen is taken, which often happens accidentally when acetaminophen is taken at the same time as a combination of drugs containing it.
You can prevent this from happening by carefully reading the labels of any medicine you are taking and always checking with your caregiver before taking anything that is not prescribed for you. Also be aware that no one should take more than 4000 milligrams (mg) of acetaminophen in a day.
NSAIDs are generally considered the second line of defense against migraine pain during pregnancy. These drugs, which work by lowering the production of hormonal compounds called prostaglandins that send pain messages to the brain, include:
- Aspirin (the most common brand is Bayer)
- Advil, Motrin (ibuprofen)
- Aleve (naproxen)
In general, NSAIDs are safe for most pregnant women until the third trimester, according to the Organization of Teratology Information Specialists (OTIS).
During the last three months of pregnancy, there is a risk that ibuprofen will cause a blood vessel called the of the ductus arteriosus to close prematurely, which can affect the blood pressure in the developing baby’s lungs. OTIS also states that ibuprofen used in late pregnancy can lead to low levels of amniotic fluid or blocked labor.
There is some evidence to suggest that using NSAIDs in early pregnancy (up to eight weeks) could cause bleeding and potential miscarriage, although it is important to note that a miscarriage can occur during pregnancy. during any pregnancy and the reason is often not precisely known.
If you are pregnant and know that ibuprofen is more effective for your headaches than other pain relievers, ask your caregiver how to safely continue using it during your first and second trimesters.
There are several NSAIDs used for migraine pain that are only available with a prescription, such as Cambia (diclofenac) and ketoprofen. Like other NSAIDs, these should not be taken after the second trimester of pregnancy.
Since a healthcare professional other than your obstetrician may prescribe one for you, be sure to tell this doctor that you are pregnant and check with your obstetrician before taking any prescription NSAIDs.
Finally, note that there are a few health concerns associated with NSAIDs that apply to everyone, including an increased risk of heart attack or stroke, especially for people who take these drugs for a long time. . NSAIDs have also been found to cause ulcers, bleeding, or holes in the stomach or intestines. This risk is especially high for people who take NSAIDs for an extended period of time or who drink a lot of alcohol (which pregnant women are advised not to do anyway).
Drugs in this class of prescription drugs are most effective for moderate to severe migraines and work best when taken at the first signs of an impending attack. Triptans work by stimulating the production of serotonin, a neurotransmitter (brain chemical), thereby reducing inflammation and constriction of blood vessels.
Triptans may also lower levels of a protein called calcitonin gene-linked peptide (CGRP) which is elevated during migraine attacks, and medications may be an effective way to relieve nausea and sensitivity to light and to sound. The seven triptans used to fight migraines are:
- Axert (almotriptan), available as a tablet
- Relpax (eletriptan), available as a tablet
- Frova (frovatriptan), available as a tablet
- Amerge (naratriptan), available as a tablet
- Maxlt, Maxlt-MLT (rizatriptan), available as a tablet or blister pack that melts on the tongue
- Imitrex (sumatriptan), available as a tablet, nasal spray, or subcutaneous injection (under the skin)
- Zomig (zolmitriptan), available as a tablet, nasal spray, or blister
- Treximet (sumatriptan plus NSAID naproxen), available as a tablet
There are concerns that since triptans work by narrowing the blood vessels in the brain, there may be a narrowing of the blood vessels that supply the placenta. However, research has shown that triptans are safe during pregnancy without a significant increase in birth defects, prematurity, or miscarriages.
In addition to headaches, migraines often cause nausea and vomiting, unpleasant symptoms that some women may already experience as a result of their pregnancy (meaning their migraines only make things worse).
Because of the risks associated with dehydration and difficulty keeping fluids, food, and medications low, medications called antiemetics are often given to people seeking emergency care for migraines.These are usually given intravenously or by injection into a muscle.
While metoclopramide is considered the safest antiemetic for pregnant women, exposure to metoclopramide during the first trimester has been associated with an increased risk of genital abnormalities.More research is needed to determine if other antiemetics can be used safely during pregnancy.
Non-Drug Strategies for Managing Migraine
For women looking to avoid medication, the following non-pharmacological options have been shown to help people cope better with migraine symptoms:
- Cognitive-behavioral therapy or psychotherapy focused on stress management
Medicines for migraine to avoid during pregnancy
Some medications often prescribed for migraines have been linked to an increased risk of serious side effects for expectant mothers and / or their babies.
- Dihydroergotamine, which is available as DHE 45 or Migranal (an alkaloid from rye ergot)
- Opioids such as oxycodone and morphine
- Depakene and Depakote (anticonvulsant valproic acid)
A word from Verywell
Most migraines during pregnancy are a nuisance, but not an emergency. However, you should see a doctor immediately if you develop a migraine that does not improve with treatment or is accompanied by other symptoms, such as fever or blurred vision. In addition to persistent headaches, these may indicate serious illness such as stroke, preeclampsia, pituitary tumor, or cerebral venous thrombosis.
Seek immediate medical attention if you suffer from a migraine along with other symptoms.