Migraine Medications That Are Safe During Pregnancy

Thanks to an increase in migraine-preventive estrogen that occurs during pregnancy, women who frequently suffer from these debilitating headaches often get a reprieve from them when they're expecting. For those in the minority who still get migraines, the question of how to treat them is an important one. While there are several effective medications for the treatment of migraines, not all are considered safe for a developing baby.

Unfortunately, migraine pain—if experienced during pregnancy—is usually severe enough to require medication. Sometimes other migraine symptoms, such as nausea and vomiting, also must be treated with drugs as well.

Fortunately, there are a number of effective migraine medications that the U.S. Food and Drug Administration (FDA) considers safe to take during pregnancy. Before reaching for your regular prescription, make sure that it is included in this list (and be sure your obstetrician or midwife approves of you taking a dose). If it's not, discuss these safer options with your healthcare provider.

Also known as analgesics, these are drugs that have the primary purpose of relieving the often excruciating headache associated with a migraine episode.

There are two classes of analgesics—acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). Both types of drugs are available as over-the-counter (OTC) brand name, store-brand, and generic products, as well by prescription.

Analgesic drugs are also often combined with other medications to create multi-symptom treatments, such as those for coughs and colds.

Considered the safest of pain relief medications for pregnant women and their babies, acetaminophen blocks nerve impulses to the area of the brain where pain signals are produced. There are dozens of brand names for acetaminophen; the most well-known one is Tylenol.

A small body of research has found possible associations between prenatal acetaminophen and certain health issues for children. These include asthma, learning problems, attention-deficit/hyperactivity disorder (ADHD), and others.

However, according to a 2017 study, any potential links between acetaminophen taken during pregnancy and negative effects on babies are weak at best. For that reason, the author writes, "Acetaminophen should not be withheld from children or pregnant women for fears it might develop adverse effects."

When not used properly, acetaminophen has been found to cause liver damage in some people (pregnant or otherwise). This is most likely to happen when too much acetaminophen is taken, which often accidentally occurs when acetaminophen is taken at the same time as a combination drug containing it.

You can prevent this from happening by carefully reading labels on any drug you take and always checking with your caregiver before you take anything that hasn't been prescribed for you. Know, too, that no one should take more than 4,000 micrograms (mg) of acetaminophen in one day.

NSAIDs typically are regarded as the second line of defense against migraine pain during pregnancy. These drugs, which work by decreasing the production of hormone-like 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 up until the third trimester, according to the Organization of Teratology Information Specialists (OTIS). (Teratology is the study of birth defects.) During the last three months of pregnancy, there is a risk that ibuprofen might cause a blood vessel called the ductus arteriosus to close prematurely, which can affect blood pressure in the developing baby's lungs.

OTIS also states that ibuprofen used in late pregnancy might lead to low levels of amniotic fluid or slow or stop labor.

There are several NSAIDs used for migraine pain that are available only by prescription, such as Cambia (diclofenac) and ketoprofen. Like other NSAIDs, these should not be taken after the second trimester of pregnancy.

Since it's possible that a medical professional other than your obstetrician might prescribe one of these, be sure to let that doctor know you're pregnant—and check with your OB before taking a prescription NSAID.

Finally, note that there are a few health problems 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 period of time. NSAIDs have also been found to cause ulcers, bleeding, or holes in the stomach or intestines. This risk is especially high for folks who take NSAIDs for an extended period of time or who drink a lot of alcohol (something pregnant women are advised against doing anyway).

Medications in this class of prescription drug are most effective for moderate to severe migraines and work best when taken at the earliest sign of an impending attack. Triptans work by stimulating the production of the neurotransmitter (brain chemical) serotonin, thereby reducing inflammation and constricting blood vessels.

Triptans also may lower levels of a protein called calcitonin gene-related peptide (CGRP) that is elevated during migraine attacks, and the drugs can be an effective way to relieve nausea and sensitivity to light and sound. The seven triptans use for fending off migraines are:

• Axert (almotriptan)
• Relpax (eletriptan)
• Frova (frovatriptan)
• Amerge (naratriptan)
• Maxlt, Maxlt-MLT (rizatriptan), which comes as a tablet or as a wafer that melts on the tongue
• Imitrex (sumatriptan), which is available as a tablet, nasal spray, or subcutaneous (under-the-skin) injection
• Zomig (zolmitriptan), available as a tablet, nasal spray, or wafer
• Treximet (sumatriptan combined with the NSAID naproxen)

There is some concern that since triptans work by narrowing brain blood vessels, there may be narrowing of the blood vessels that supply the placenta. However, research has found triptans to be safe during pregnancy, with no significant increase in birth defects, prematurity, or miscarriage.

Along with headaches, migraines often cause nausea and vomiting, unpleasant symptoms that some women may already experience as the result of their pregnancy (meaning their migraines only make things worse).

Given the risks associated with dehydration and difficulty keeping fluids, food, and medication down, drugs called antiemetics often are given to people who seek emergency care for migraines.

These usually are given intravenously or by injection into a muscle. Many antiemetics haven't been studied enough to prove that they're safe during pregnancy. One that has been shown safe is called metoclopramide.

Certain drugs often prescribed for migraine headaches have been associated with an increased risk of serious side effects for moms-to-be and/or their babies.

These include:

• Dihydroergotamine, which is available as D.H.E. 45 or Migranal (an ergot alkaloid)
• Opioids such as oxycodone and morphine
• Depakene and Depakote (anticonvulsant valproic acid)

Most migraine headaches during pregnancy are a nuisance, but not an emergency. However, you should seek medical attention right away if you develop a migraine that doesn't get better with treatment or is accompanied by other symptoms, such as fever or blurred vision. Along with persistent head pain, these can indicate a serious condition such as a stroke, preeclampsia, pituitary tumor, or cerebral venous thrombosis.

Seek medical care right away if you experience a migraine along with other symptoms.