Drugs To Prevent Migraine
If daily medication is considered necessary to prevent migraine during pregnancy, the lowest effective dose of propranolol is the drug of choice.9 Low dose amitriptyline is a safe alternative.9 There are no reports of adverse outcomes from pizotifen used during pregnancy or lactation, although it is less often used than the drugs above.
In contrast, sodium valproate, should not be taken during pregnancy for migraine as there is a high risk of fetal abnormalities. Indeed, women prescribed sodium valproate for migraine must use effective contraception.
Topiramate should not be used for migraine during pregnancy and breastfeeding as there are insufficient data regarding safety.
Are Any Home Remedies Not Recommended For Someone Who Is Pregnant
You might think itâs safe to assume that anything considered a âhome remedyâ or âalternative treatmentâ for migraine is safe during pregnancy, but thatâs not the case.
Dr. Crystal calls out a few preventive supplements that should be avoided during pregnancy, including:
âIf in doubt,â she urges, âalways ask your doctor or pharmacist for their advice about taking OTC products while pregnant.â
When Headaches Are Secondary To Other Problems
Headaches can result from other conditions, some of which are life-threatening:
Stroke: Sudden and severe headaches might be a sign of a stroke. Women who have strokes during pregnancy or after delivery typically describe the pain as the worst headache of their lives. They also might report other symptoms, such as speech problems, vision issues, or functional problems on one side of the face or body. At the emergency room, the doctor will evaluate you for stroke symptoms, such as visual changes, facial drooping, and arm or leg weakness. If you are having or had a stroke, we will get you emergency treatment at our Advanced Comprehensive Stroke Center.
Preeclampsia: A headache with preeclampsia can indicate a dangerous spike in blood pressure. The doctor will assess you and might admit you to the hospital for management of blood pressure and treatment to prevent seizures.
Spinal fluid leak: A headache after an epidural or spinal block can indicate a spinal fluid leak, especially if it worsens when you sit or stand up. The most effective treatment is an epidural blood patch, in which the doctor injects a sample of your blood into the leaking area, essentially plugging the hole. This therapy provides dramatic relief right away.
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When To See Your Doctor
Headaches in pregnant people are particularly concerning during the third trimester, when risk for preeclampsia rises.
If you experience vision changes or seeing spots, call your doctor immediately as this is a sign of preeclampsia.
To diagnose preeclampsia, doctors will check for elevated blood pressure and may conduct a follow-up urine analysis.
If preeclampsia is ruled out, and your headache persists and is not responding to treatment especially Tylenol itâs still important to talk with a doctor to identify the root cause.
Imaging including MRIs are safe during pregnancy and should be utilized by people with severe headaches, Columbo said. MRIs can help diagnose migraines, which could inform your treatment options.
After youâve figured out the cause, your doctor might recommend medication, like a combination of Benadryl and Reglan to treat headaches. If your doctor says the medication is safe, take it, Columbo says.
âDonât make yourself suffer needlessly,â he says.
What Medications Can Pregnant Women Safely Take For Migraine
If youâre not lucky enough to experience fewer migraine attacks during pregnancy, what can you do to treat them? It turns out that when you’re pregnant, many prescription and over-the-counter medications are considered unsafe or risky, or just havenât been researched enough for doctors to be confident making a recommendation.
According to Dr. Crystal, âacetaminophen and metoclopramide , which can help relieve nausea and pain, are the safest medications to take.â She adds that some obstetricians may prescribe ondansetron to treat severe nausea âand consider it to be safe.â
That being said, Dr. Crystal notes that it is always best to take the lowest effective dose, even of approved medications.
Non-steroidal anti-inflammatory drugs such as ibuprofen are not safe to take in the first or third trimesters. Similarly, you should not take naproxen while pregnant. It may be safe during the second trimester, but only if specifically approved by your doctor.
Dr. Crystal adds that while many obstetricians will advise against using triptans while pregnant, they could be safe when used occasionally. Doctors may prescribe opiates for severe headaches while youâre pregnant, but they âmust be used sparingly,â she says.
Check with your doctor before taking any migraine treatment, to be sure it’s safe for you and your pregnancy.
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What Can I Take For A Headache While Breastfeeding
You have more migraine treatment options to choose from when you’re breastfeeding, compared to when you’re pregnant. When breastfeeding, medication is deemed safe if your baby gets less than 10% of the dose through your breast milk.
A 2013 study in the journal Headache researched migraine medications that healthcare providers could safely recommend to their breastfeeding patients. Their findingsas well as newer researchindicate which medications are safer and which ones should be avoided.
Coffee Helps Prevent My Migraine Can I Have Caffeine While Pregnant
Caffeine and migraine have an interesting relationship. According to the National Headache Foundation, caffeine can help with pain relief, since âit contains properties that cause the blood vessels to narrow and restrict blood flow.â It can even make some pain relievers work better. Yet for some people, caffeine is a migraine trigger. And becoming reliant on caffeine every day can lead to rebound headaches.
All that said, even if you know caffeine helps relieve your migraine attacks, what can you do? Isnât caffeine off limits during pregnancy?
If youâve been resisting the urge to reach for a cup of coffee, take comfort. Dr. Crystal points out that some caffeine is ok during pregnancy . âDrinking up to 12 oz. of coffee per day, or about 200 mg of caffeine, is considered safe,â she says. Still, itâs always smart to double check with your doctor before pouring yourself a cup.
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When Should I Be Concerned
When a headache is severe, or just doesnt go away, or when you have dizziness, blurred vision, or changes in your field of vision, you should contact your healthcare provider. Headaches can sometimes be related to blood pressure problems in pregnancy. If they are persistent or severe and happen after 20 weeks of pregnancy, let your healthcare provider know. Although strokes during pregnancy are rare, migraines can increase a pregnant womans risk for them. If you have migraines, report them to your healthcare provider.
Headache And Migraine Remedies That Are Safe During Pregnancy
Most women deal with headaches at some point in their lives. Data from the Centers for Disease Control and Prevention suggest that one in five women had a severe acute headache or migraine in the previous three months. Additionally, migraines are more common in women than men approximately 18 percent of women have them compared to 6.5 percent of men.
Because headaches and migraines are so common, its probably no surprise that many women deal with them during pregnancy. For the majority of pregnant women, occasional headaches or migraines are no cause for alarm, and most standard treatments are safe. However, suffering a severe headache at key times during or after pregnancy can indicate a serious medical emergency.
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When Should I Talk To My Doctor
Although many medications are thought to be safe during pregnancy, its important to discuss any medications youre taking with your doctor. Thats especially true if you have a high-risk pregnancy. If you experience any unusual symptoms while taking an over-the-counter medication, contact your doctor immediately. You should also contact your doctor if you think you have the flu or experience dizziness, vaginal bleeding, severe vomiting, high fever, reduced fetal movement, difficulty breathing, or chest pain. The flu can increase the risk of birth defects or premature labor.
Causes Of Migraine Headaches
Exactly what causes migraine headaches isn’t known. But migraines appear to involve changes in nerve pathways, neurochemicals, and blood flow in the brain.
Researchers believe that overly excited brain cells stimulate a release of chemicals. These chemicals irritate blood vessels on the brain‘s surface. That, in turn, causes blood vessels to swell and stimulate the pain response.
Estrogen is thought to play a role in migraines. That’s why pregnancy, menstruation, and menopause often change a woman’s pattern of migraine headaches.
The neurotransmitter serotonin also appears to have a key role in migraines.
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Otc Medicines That Are Okay During Pregnancy
Every woman experiences pregnancy differently. You might have morning sickness for months, while your best friend feels great. One universal, however, is that pregnant women can still get sick and they experience more aches and pains than normal. Whether its the common cold, heartburn, or a headache, you might be tempted to reach for your go-to over-the-counter remedy. But before you do, its important to know what you should and shouldnt take during pregnancy. Reading labels will help you to understand whats in your medications before you take it.
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The Right Way To Change Migraine Medication For Pregnancy Safety
The key to migraine management leading up to and during pregnancy is consistency any changes that are made need to be made slowly, says Starling.
When we’re starting new medication, we usually start at a very low dose, and we increase slowly over time. If we’re deciding to discontinue a medication because someone is planning on getting pregnant, then we will typically reduce it slowly over time, she says.
It might sound scary to taper off a medication that has been working for you, says Starling. There are certain medications that are safe to use in the setting of pregnancy, and those that are not. I will always talk to my patients about family planning and reassure them that I will be there to support them through that journey, and that well come up with an alternative plan that will be safe, she says.
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I Am Pregnant And Getting Blind Spots With My Migraine Should I See My Doctor
It is not uncommon for a woman to have her first attack of migraine aura during pregnancy. Symptoms are typically bright visual zig-zags growing in size from a small bright spot and moving across the field of vision over 20-30 minutes before disappearing. A sensation of pins and needles moving up an arm into the mouth may accompany this. If you experience these typical symptoms and your doctor confirms that this is migraine, there is no need to be concerned and no tests are necessary. However, if the symptoms are not typical of migraine aura, it is important to exclude other disorders, such as blood clotting disorders or high blood pressure, which may occasionally produce symptoms not dissimilar from migraine.
Outlook For Headache During Pregnancy
Headache pain during pregnancy is common. You may have tension headaches during your first trimester of pregnancy. This may happen because of the many changes that youre going through in a short period.
Headache pain may happen in the second and third period of your pregnancy for other reasons. Some causes of headaches in your mid to late pregnancy may be serious.
High blood pressure is a serious cause of headache pain during pregnancy. You can have high blood pressure at any time in your pregnancy. You may not have any symptoms at all. Check your blood pressure at least once a day with a home monitor.
Tell your doctor if you have headaches at any time in your pregnancy. Let your doctor know right away if you have a personal or family history of migraine, high blood pressure, seizures or diabetes.
Take all medications and treatment exactly as prescribed by your doctor. Follow all diet and exercise advice carefully. See your doctor for all follow-up and regular check-ups. Most causes of headaches during pregnancy are treatable or preventable with the right care.
For more pregnancy guidance and weekly tips tailored to your due date, sign up for our Im Expecting newsletter.
Last medically reviewed on May 6, 2019
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Migraine Headaches During Pregnancy
Headaches are quite common in pregnancy. The most common are tension headaches and migraine headaches. Most headaches come and go, but others may be more bothersome or may be caused by other problems. It is important to talk with your healthcare provider about any headaches you have before, during, or after pregnancy.
Many pregnant women have migraine headaches. Over half of women find that their migraines happen less often in the last few months of pregnancy. But migraines may get worse after birth, during the postpartum period. Although migraine headaches may cause you severe pain, they do not harm your developing baby .
How To Plan For Pregnancy When You Have Migraine
Planning for pregnancy includes learning which migraine treatments are safe during pregnancy and which lifestyle measures can help.
Choosing if and when you want to have children is one of lifes biggest decisions. Your career path, relationship status, financial health, and long-term goals all factor into the equation.
For women living with migraine, the decision can be even more complex. Concerns about the pregnancy, the health of the baby, and the additional daily stressors of living with a debilitating disease can lead many women to question if having a baby is the right choice now or ever.
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Why You Should Discuss Medication Safety Before Pregnancy
A large percentage of pregnancies are unexpected or unplanned, and the majority of our patients at the headache clinic are women of childbearing potential, says Starling.
The latest data for the United States, published in 2016 in The New England Journal of Medicine, shows that 45 percent of pregnancies were unintended in 2011, a decrease from 51 percent in 2008.
I always discuss the importance of family planning when prescribing any medication that isnt safe to take during pregnancy to make sure the patient is aware that the medication could be harmful to take during pregnancy or when breastfeeding, says Starling.
Well talk about what different contraceptive options need to be in place so that we can prevent pregnancy in that situation, she says.
If a patient is planning on getting pregnant or if that is a possibility, there are many medication options that are still available to use, adds Starling.
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Complementary And Alternative Medicine
Non-drug treatments certainly can be helpful, and massage, acupuncture, relaxation and biofeedback have been found to be useful by some. Some women also find applications of heat or cold to the head can be useful.
Many women also prefer to take complementary and alternative medicines such as homoeopathic and herbal remedies rather than traditional medicines whilst they are pregnant, considering them to be milder.
However, some complementary treatments can have an unwanted effect on your pregnancy just as conventional medicines can. For instance, some women find aromatherapy massage very helpful, and may be unaware that some essential oils need to be avoided.
Reflexology treatment is not always advisable during pregnancy, and all complementary medicines should be taken under the supervision of a qualified practitioner. Feverfew should not be used during pregnancy.
The best advice is to take as few medicines as is realistically possible for you, and at the lowest effective dose, if needed. The use of any drugs or herbal remedy to treat your migraines during pregnancy and whilst breast feeding is a balance of risk and benefits, taken with medical advice. Any medication you do take should be recorded in your pregnancy notes.
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Acetaminophen Is The Only Otc Headache Medication Thats Safe For Pregnant Women To Take
Dr. O. Lawrence Stitt, MD, an OB/GYN at Mercy Medical, told INSIDER that acetaminophen is considered a safer medication compared to the majority of the headache remedies available.
While acetaminophen can definitely help in a pinch, itâs also important to note that there are other things you can do to prevent headaches during pregnancy.
Dr. Stitt said to make sure that your blood sugar is always within a normal range. âThis can be best managed by eating small frequent meals, which can allow you to keep your blood sugar in a normal range and hopefully, avoid headaches,â he added.
Are Migraine Attacks During Pregnancy Bad For The Baby
Migraine attacks can be so intense, you might worry theyâre affecting your baby too. âThe good news,â Dr. Crystal says, âis that large studies have not shown increased rates of birth defects or stillbirths in migraineurs.â
That being said, women who have attacks so severe that they end up in the emergency room have a higher risk of complications such as pre-eclampsia, preterm delivery, and low birth weight, according to the National Headache Foundation.
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What Lifestyle Changes Can I Make While Im Pregnant To Improve Migraine
Lifestyle measures and behavioral treatment options are important for everyone with migraine, but even more so if youre pregnant, because we want to avoid medications as much as possible, says Starling.
One thing I always discuss with people are the SEEDS for success in migraine management, which is a mnemonic that reminds people of things they can do to improve migraine, she says.
- S stands for good sleep hygiene. That means going to sleep around the same time and waking up around the same time every day, says Starling.
- E is exercising, and she recommends about 20 minutes of aerobic exercise at least three days a week.
- E stands for eating regular meals, so not fasting or skipping meals, says Starling. This is really important: Try to eat multiple small meals throughout the day.
- D is short for dehydration, or preventing dehydration, by drinking lots of water throughout the day, says Starling.
- S stands for stress response or stress management. Not stress reduction necessarily, but more managing the way that you respond to stress, she says.
There are also some behavioral treatment options that have proven to be beneficial in evidence-based, randomized, controlled trials. These include biofeedback training, cognitive behavioral therapy training, mindfulness, and relaxation techniques, says Starling.