Which Migraine Medications Are Safe During Pregnancy?

Some headache medications are not safe to use while you're pregnant. This can be concerning if you get migraines with headache pain and other symptoms like nausea, and are worried about how you'll treat them throughout your pregnancy. Fortunately, there are several effective migraine treatments that the Food and Drug Administration (FDA) considers safe to use during pregnancy.

This article will go over migraine headache medications that are considered safe during pregnancy. You'll also learn which migraine medications to avoid during pregnancy, as well as some alternatives to using medications to treat migraines.

However, you should always talk to your provider or midwife before taking any prescription or over-the-counter (OTC) medication while you're pregnant.

Using Pain Medications for Migraines During Pregnancy

Pain medicine (analgesics) are drugs that can relieve the excruciating head pain of a migraine episode.

The analgesics that are most commonly used for head pain are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).

Both types of drugs are available over the counter (OTC) as brand name, store-brand, and generic products. You can also get stronger versions from your provider with a prescription.

Analgesics are often combined with other medications to make multi-symptom treatments for conditions like colds.

Acetaminophen

Acetaminophen is usually considered the safest pain relief medication for most pregnant people. It blocks nerve impulses to the part of the brain where pain signals are made. There are dozens of brand names for acetaminophen, but the most well-known is Tylenol.

Some research has suggested that taking acetaminophen while you're pregnant could be linked to health concerns for children later on—for example, asthma, learning challenges, and attention-deficit/hyperactivity disorder (ADHD).

However, the possible links between acetaminophen use during pregnancy and negative effects on children have been weak. In a 2017 study, the researchers concluded that "acetaminophen should not be withheld from children or pregnant women for fears it might develop adverse effects."

Avoiding Overdose

If it's not used properly, acetaminophen can cause liver damage in some people—whether they are pregnant or not.

Liver damage is most likely to happen when someone takes too much acetaminophen. This can easily happen accidentally if someone takes the drug at the same time as a combination product that also has acetaminophen in it.

You can prevent an overdose by carefully reading labels on any drug you take and always checking with your provider before starting new medications, even if they're over-the-counter.

NSAIDs

NSAIDs are the second-line treatment for migraine pain during pregnancy. These drugs decrease the production of hormone-like compounds called prostaglandins that send pain messages to the brain.

Examples of NSAIDs include:

• Aspirin (the most common brand is Bayer)
• Advil and Motrin (ibuprofen)
• Aleve (naproxen)

According to the Organization of Teratology Information Specialists (OTIS), NSAIDs are safe for most pregnant people up until the third trimester.

During the last three months of pregnancy, there is a risk that ibuprofen could cause a blood vessel called the ductus arteriosus to close prematurely. If this happens, it can affect blood pressure in the developing fetus's lungs.

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

There is some evidence to suggest that the use of NSAIDs early in pregnancy (up to eight weeks) could cause bleeding and potential miscarriage. However, it is important to note that miscarriage can happen in any pregnancy, and often the reason is not known.

There are several NSAIDs used for migraine pain that you can only get with a provider's prescription, such as Cambia (diclofenac) and ketoprofen. Like other NSAIDs, these should not be taken after the second trimester of pregnancy.

It's possible that a medical professional other than your obstetrician or midwife may prescribe one of these medications for you, so make sure all your providers know you're pregnant. Always check with your pregnancy provider before taking a prescription NSAID.

You should also know about the possible health problems associated with NSAIDs that can happen to anyone, such as an increased risk of heart attack or stroke. These risks are especially important for people who take these medications for a long time.

NSAIDs have also been found to cause ulcers and bleeding in the stomach or intestines. This risk is especially high for people who take NSAIDs for a long time or who drink a lot of alcohol.

Triptans

Triptans are a class of prescription drugs that are the most effective for moderate to severe migraines. They work best when taken at the earliest sign of an impending migraine attack.

Triptans stimulate the production of a brain chemical called serotonin which reduces inflammation and constriction of blood vessels.

Triptans also may lower levels of a protein called calcitonin gene-related peptide (CGRP) that is high during migraine attacks. The drugs can also be an effective way to relieve nausea and sensitivity to light and sound.

The seven triptans used to treat 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 as a wafer that melts on the tongue
• Imitrex (sumatriptan), available as a tablet, nasal spray, or under-the-skin (subcutaneous) injection
• Zomig (zolmitriptan), available as a tablet, nasal spray, or wafer
• Treximet (sumatriptan combined with the NSAID naproxen), available as a tablet

There is some concern that because triptans work by narrowing brain blood vessels, there could be a narrowing of the blood vessels that supply the placenta.

However, research has found triptans to be safe during pregnancy. They have not been linked to a major increase in birth defects, prematurity, or miscarriage.

Antiemetics

Along with headaches, migraines often cause nausea and vomiting—symptoms that some pregnant people already have. In this case, migraines can make those symptoms worse.

Since there are serious health risks of not being able to keep down fluids, food, and medication, drugs called antiemetics are often given to people who seek emergency care for migraines.

These medications do not have to be taken by mouth; in fact, they are usually given in a vein (intravenously) or by injection into a muscle.

Metoclopramide is considered the safest antiemetic for pregnant people, but it's not totally without risk. First-trimester exposure to metoclopramide has been associated with an increased risk of genital organ defects.

More research is needed to determine whether other antiemetics are safe to use during pregnancy.

Migraine Medications to Avoid During Pregnancy

Certain drugs prescribed for migraine headaches have been associated with an increased risk of serious side effects for pregnant people and developing fetuses, including:

• 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)

Non-Medication Strategies for Managing Migraines During Pregnancy

Thanks to stable levels of estrogen, pregnant people who tend to get bad headaches might actually be relieved of them for a while. In that way, pregnancy can sometimes be a temporary treatment for headaches.

According to the American Migraine Foundation, as many as 50% to 80% of pregnant people actually experience fewer headaches.

If you're one of the people who still get migraines during pregnancy, finding a safe way to treat them is important.

If you want to avoid taking medications for a migraine while you're pregnant, there are some other strategies you can try:

• Cognitive behavioral therapy (CBT) or psychotherapy focused on managing stress
• Meditation
• Mindfulness
• Relaxation
  

Summary

Most migraine headaches during pregnancy are uncomfortable but not an emergency. Thanks to stable hormone levels, you may even find that you have fewer headaches while you're pregnant.

If not, talk to your provider about the safest medications to use to manage your headache pain and other symptoms at home.

It's not as common as a run-of-the-mill headache or even a migraine, but sometimes a headache during pregnancy can be a sign of a more serious health condition.

If you develop a severe headache that does not get better with treatment or comes with other symptoms like a fever or blurred vision, you need to get medical care right away.