What Medications May Treat Migraines in Pregnancy?

Are Your Pregnant and Suffering from a Headache?. Katja Kircher/Maskot/Getty Images

Pregnancy is a time for nurturing your little one —so, the last thing you need is a migraine. But, if you are a migraineur, what medication may your doctor recommend during pregnancy? Let's take a closer look.

The Skinny on Migraines in Pregnancy

While migraines are the most common headache experienced in pregnancy, they typically occur less frequently and are less severe than those outside of pregnancy— this is seen more commonly in women with migraine without aura than women who suffer from migraines with auras. The reason behind this is complex but has to do with the increased estrogen levels seen during pregnancy, which is also why it's unusual for women to develop new migraines during pregnancy.

Before delving into potential migraine treatments, please note that if your headache during pregnancy meets any of the below criteria, is not getting better with simple measures, or follows a different pattern from your usual headaches, seek medical attention right away. These signs can indicate a more serious cause of your headache.

  • "Worst headache of my life"
  • Blurry vision
  • Neurological symptoms, like weakness or numbness
  • Headache with fever
  • Headache with high blood pressure and/or swelling of the legs and feet (preeclampsia/eclampsia)
  • Headache with neck stiffness
  • Headache with exertion

Medications for Migraines in Pregnancy

Here are potential medical therapies for migraines during pregnancy that your doctor may recommend, taken mostly from UptoDate—a widely used professional and evidence-based resource. Please note that the information below is not meant to be a substitute for your doctor's advice. As always, do not take any medications without the advice from your physician.

Tylenol (Acetaminophen) is commonly recommended to treat headaches in pregnancy. It's a category B medication and typically considered safe for the fetus. If acetaminophen does not work alone, your doctor may recommend combining it with an anti-nausea medication called Reglan (metoclopramide) is helpful. Other tylenol combinations include tylenol-codeine, or caffeine-aspirin-butalbiltal (Fiorcet).

Please note that with caffeine, the American College of Obstetrics and Gynecology recommends less than 200 milligrams (mg) of caffeine daily during pregnancy. 

Finally, codeine should be limited to no more then nine days per month and butalbital to no more than four to five days per month to avoid medication overuse headache. Moreover, prolonged use of butalbital or codeine near the end of pregnancy can result in neonatal withdrawal.

Nonsteroidal anti-inflammatories, or NSAIDs, like ibuprofen (Advil, Motrin) or naproxen (Aleve) and aspirin are considered second-line medical treatments for migraines in pregnancy. They are safest in the second trimester. There is limited evidence that NSAIDs may be associated with miscarriage and certain birth defects in the first trimester. Your doctor will likely advise you not to use NSAIDs in the third trimester (or to limit it to fewer than 48 hours) due to a concern over potentially serious organ problems with the baby.

Opioids—like oxycodone or morphine—are third line treatments for migraines in pregnancy. They should not be taken for prolonged periods of time due to the risk of addiction and developing a medication overuse headache and/or chronic daily headaches. There is also a risk of neonatal withdrawal when your baby is born. Finally, opioids can worsen other common pregnancy symptoms, like nausea and constipation. 

For women who do not respond to the above drug or in women with moderate to severe symptoms, a triptan like Imitrex (sumatriptan) may be considered. This would need to be discussed carefully with a person's doctor, along with the help of a neurologist or headache specialist. There is some concern that since triptans works by narrowing brain blood vessels, there may be narrowing of the blood vessels that supply the placenta.

A study in Headache found no increase in birth defects, prematurity in women, or spontaneous abortions in migraineurs who took triptans during pregnancy versus pregnant migraineurs who did not use triptans during pregnancy. However, there was an increase in spontaneous abortions(not birth defects or prematurity) when the triptan exposed migraineurs were comapred to a population of healthy controls. It's hard to say what this means, precisely, and overall warrants more research.

Ergotamine and dihydroergotamine are both listed as pregnancy category X and should absolutely not be used during pregnancy or really in any woman of childbearing years who is not using proper contraception.

Non Medication Options for Migraines During Pregnancy

Keep in mind, besides medications there are a number of non-drug options to ease your migraine during pregnancy. These include heat, ice, massage, sleep, and avoiding triggers like sleep deprivation or skipping meals. In addition, behavioral therapies like cognitive behavioral therapy or relaxation training may be useful.

A Word from Verywell

For the majority of women, migraines improve during pregnancy. But if they worsen for you, don't fret. Speak with your doctor. There are lots of simple, conservative measures, as well as a few medications (if needed and confirmed with your doctor), that can help you get through this time.

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