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How to Handle Migraines While Pregnant

How to Handle Migraines While Pregnant Image
Emily Maurer

Medically reviewed by Emily Maurer, NP on September 1, 2020

Being pregnant brings enough physical changes as is — the last thing you need is to have to deal with a migraine on top of it all. As you navigate your pregnancy, there are a few key things to know about how your migraines may be affected and the types of migraine treatments that could work for you. 

How Pregnancy Affects Migraines

There is a strong link between migraine activity and the two female hormones, estrogen and progesterone, and levels of these hormones shift during pregnancy. Nearly half of women who suffer from migraines will see a drop in both frequency and severity during their first trimester, and between 50 and 80% will notice an overall reduction in the number of attacks they experience, particularly during the second and third trimesters.

Estrogen in particular is thought to have a dampening effect on migraines, particularly those that come without aura. Just because most women experience an improvement in symptoms doesn’t mean that all will. For those who do still get migraines while pregnant, there are several treatment options available.

Treating Migraines While Pregnant

There’s no “one-size-fits-all” treatment for migraines, so whatever you opt for should be chosen in close conjunction with your primary care provider. 

  1. Behavioral Approaches

Because of the various complications that popular migraine medicines can impose on pregnant women, behavioral treatments should always be the first option. Avoiding potential trigger foods, getting plenty of rest, staying hydrated, and focusing on relaxation are all great ways to avoid and weaken migraines.

  1. Vitamin Therapy

For women who experience particularly severe or frequent migraines, however, behavioral treatments may not be enough. Those looking for some additional firepower who don’t want to resort to prescription medications just yet should consider adding some vitamins to their diet: oral magnesium, riboflavin, and CoQ10 are all recommended supplements for pregnant women fighting migraines. 

  1. Oral Prescription Medications

For pregnant women who do seek prescription medication for their migraines, there are a few things to keep in mind. In 2015, the FDA removed its previous letter codes for assigning pregnancy risks to various medications, replacing them with narrative summaries that allow women to work with their doctors to find the treatments that work best for them. 

Even so, many of the most common oral pharmacological agents are not suitable for use by pregnant women. Beta blockers, Angiotensin blockers, anticonvulsants, and Botox are all popular treatments for migraines that are unlikely to be prescribed to pregnant women. Monoclonal antibodies, another common migraine medication, have a month-long half life, so doctors generally recommend that women stop taking them several months before they start trying to conceive. 

One notable exception is antidepressants, which is generally considered safe for pregnant women to continue taking if they have previously been prescribed. As always, talk to your doctor about which of your medications are safe for you to continue taking during your term. 

  1. Treatments to Stop Migraines Once They’ve Started

Abortive treatments are commonly used to stop migraines in their tracks, but not all are safe for use by pregnant women. Acetaminophen, more commonly known as Tylenol, is the most commonly used abortive for women and is safe in all three trimesters of pregnancy. It’s also one of the few widespread over-the-counter abortives, so you wont need a prescription to get your hands on some. 

There are a couple of prescription abortives that women who are pregnant or planning to become pregnant should be aware of. Metoclopramide, brand name Reglan, is the go-to anti-nausea medication during pregnancy for many. It can be combined with Benadryl when Tylenol alone is not sufficient. Reglan may have some benefits in treating the pain component of the migraine as well.

Triptans are also a mainstay of migraine treatment in pregnant women. Sumatriptan is the triptan best studied among pregnant women and is therefore the preferred choice. If eletripan is used, a fetal ultrasound in the first trimester is suggested in order to observe early development. 

Non-medication treatments which alter neural activity such Cefaly, gammaCore, and Nerivio have not been observed to cause any fetal malformations or birth defects and therefore are potential options for pregnant women looking to lower migraine frequencies. Your doctor may also suggest other drugs not listed here based on your patient profile. 

Dealing with your migraines on top of pregnancy is a challenge, so you need a treatment schedule that’s right for you. If you’re looking to find the right migraine treatment for you, the Nurx medical team is always here to prescribe a personalized treatment plan and provide ongoing care. Get in contact with Nurx today to take control of your migraines.

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