Migraine in Pregnancy
- Most women with migraine improve during pregnancy (particularly migraine without aura).
- A need for prophylaxis does not commonly arise.
- Due to hormonal changes, migraine may change to aura without headache
- Non-drug therapies / lifestyle management should be promoted.
Acute Treatment
- Ibuprofen can be used until gestational week 28. After 28 weeks of gestation, repeated use of ibuprofen should be avoided
- Paracetamol may be used in all trimesters of pregnancy although routine use should be avoided.
- Where treatment with paracetamol or ibuprofen fail, sumatriptan, in all stages of pregnancy can be considered. None of the triptans however are classed as non-teratogenic.
Prophylaxis
- No prophylactic medication is 100% safe in pregnancy
- A need for prophylaxis does not commonly arise and time may be all that is needed
- Consider prophylaxis only when risk of uncontrolled migraine to mother’s health outweighs potential adverse risk.
- SIGN do not recommend a specific medication in pregnancy but Propranolol generally considered 1st followed by Amitriptyline (keeping to lowest possible dose)
Breastfeeding
- For acute treatment consider Paracetamol, Ibuprofen or Sumatriptan
- For preventative treatment Propranolol 1st line.
- Amitriptyline may be considered but caution in premature infants
Further information