Managing Migraine during Pregnancy and Lactation
According to doctors at Wake Forest
Baptist Medical Center, medications and treatments long considered safe to
treat pregnant women with migraines may not be.
“We hope this review of medical treatments will serve as
a guide for doctors and patients on how to interpret new findings, especially
regarding four treatment options that doctors have commonly used for their
pregnant patients with migraines,” said Rebecca Erwin Wells, M.D., assistant
professor of neurology at Wake Forest Baptist and lead author of the paper.
“Patients and doctors need to be aware that concerns
exist and they should carefully weigh the risks and benefits of these
The review is published in the online issue of the
journal Current Neurology and Neuroscience Reports.
The four treatment options of concern are:
- Magnesium. Previously
considered one of the safest supplements that could be used during pregnancy it
is now rated at level D by the Food and Drug Administration (FDA), meaning that
it may not be safe.
- Ondansetron. It is
not FDA approved for migraines but is frequently used off-label to treat the nausea
and vomiting of pregnancy and migraines. Use during pregnancy has recently
become a controversial issue due to concerns over fetal and maternal safety,
but the data is not conclusive.
- Acetaminophen. More
than 65 percent of pregnant women in the United States report using it, but recent
evidence suggests possible links between maternal acetaminophen use and
pediatric development of attention deficit hyperactivity disorder.
- Butalbital. A
barbiturate used to treat headache in combination with caffeine, acetaminophen,
aspirin and/or codeine, it is routinely prescribed for migraines in pregnancy. A
small study suggests a potential increased risk of congenital heart defects.
Most women with migraines actually experience fewer
headaches during pregnancy, especially during second and third trimesters,
Wells said. And there are safe treatment options for women who keep having migraines
during pregnancy and lactation. Headaches during pregnancy and lactation need to
be taken seriously, and not all are migraines and may be due to a serious
“The most important thing is to talk to your doctor about
your headaches during pregnancy and lactation. He or she can guide you on the
available treatments and their safety, including non-pharmacologic options,
such as healthy lifestyle habits, relaxation training, stress management,
biofeedback, and possibly even meditation and yoga,” she said.
“There are many available treatment options for migraine
during pregnancy and lactation, so patients can be assured that they will not suffer
during this important time in their lives.”
Co-authors include: Dana P. Turner, M.S.P.H., Michelle
Lee, B.S., Laura Bishop, M.D., and Lauren Doyle Strauss, D.O., of Wake Forest
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