European Journal of Clinical Pharmacology

, Volume 72, Issue 12, pp 1525–1535 | Cite as

Use of antimigraine medications and information needs during pregnancy and breastfeeding: a cross-sectional study among 401 Norwegian women

  • Siri Amundsen
  • Torunn G. Øvrebø
  • Netta Marie S. Amble
  • Anne Christine Poole
  • Hedvig Nordeng
Pharmacoepidemiology and Prescription



Migraine is highly prevalent among women of fertile age. The main objectives of this study were to describe the prevalence and patterns of use of antimigraine medications during pregnancy and breastfeeding and to identify maternal and migraine-related factors associated with medication use during pregnancy.


The study is a cross-sectional internet-based survey among pregnant women and new mothers with migraine conducted in Norway from October 1, 2013 to February 1, 2014. Descriptive statistics were used to explore patterns of medication use, and logistic regression analysis was performed to examine the association between maternal socio-demographic and migraine-related factors and use of antimigraine medications during pregnancy.


Of the total 401 respondents, 34.9 % were pregnant and 65.1 % had delivered within the last 18 months. The majority reported use of antimigraine medications during pregnancy (73.3 %) and postpartum (64.8 %), yet less than a third considered their migraine to be optimally treated during pregnancy (31.7 %) and the breastfeeding period (27.2 %). The patterns of medication use markedly changed during pregnancy and postpartum. Women with moderate or severe migraine were more likely to use antimigraine medications during pregnancy compared to women with mild migraine.


Despite the fact that antimigraine medications were commonly used, the majority of the women felt that their migraine was suboptimally treated during pregnancy and postpartum. There was a decline in the use of medicines in pregnancy and postpartum, and the patterns of use markedly changed. Efforts to improve treatment of women with migraine during pregnancy and breastfeeding should be undertaken.


Migraine Pregnancy Breastfeeding Drug therapy Information needs 



The study was funded by a research grant from the Northern Norway Regional Health Authority (project ID 12165/SFP1248-15). Thanks to all the women who participated in the study, Tom Wilsgaard for advice and help with the statistical analyses, and Stefan Barfeld for the translation of the questionnaire into English. Thanks also to Abdelkader El Hasnaoui for the permission to use the MIGSEV scale and to Thibaud Freyd for the assistance with back-translation of the scale into French. We acknowledge the assistance of RELIS (, the Norwegian Migraine Association (, and the website administrators Siri von Krogh ( and Elisabeth Lofthus ( who all contributed to the recruitment process.

Contributions of authors

NMSA, SA, HN, and TGØ designed the questionnaire. NMSA and TGØ developed the electronic version of the questionnaire and were actively promoting the study and recruiting participants in social media. SA conducted the analyses and drafted the manuscript. HN aided in the analyses and interpretation of the data and contributed to revisions of the manuscript with important intellectual content. ACP aided in the development of the questionnaire and provided comments for the revision of the manuscript. All authors read and approved the final version of the manuscript.

Compliance with ethical standards

Conflict of interest

ACP has given lectures and presentations for Allergan, GlaxoSmithKline, MSD, Nycomed, and Pfizer from 1999 until 2014 and has occasionally participated in advisory boards for Allergan, Nycomed, and GlaxoSmithKline.

The other authors declare that they have no conflict of interest.

Supplementary material

228_2016_2127_MOESM1_ESM.docx (13 kb)
Online Resource 1(DOCX 12 kb)
228_2016_2127_MOESM2_ESM.docx (40 kb)
Online Resource 2(DOCX 40 kb)
228_2016_2127_MOESM3_ESM.docx (17 kb)
Online Resource 3(DOCX 17 kb)
228_2016_2127_MOESM4_ESM.docx (15 kb)
Online Resource 4(DOCX 15 kb)
228_2016_2127_MOESM5_ESM.docx (17 kb)
Online Resource 5(DOCX 17 kb)


  1. 1.
    Buse DC, Loder EW, Gorman JA, Stewart WF, Reed ML, Fanning KM, Serrano D, Lipton RB (2013) Sex differences in the prevalence, symptoms, and associated features of migraine, probable migraine and other severe headache: results of the American migraine prevalence and prevention (AMPP) study. Headache 53:1278–1299. doi:10.1111/head.12150 CrossRefPubMedGoogle Scholar
  2. 2.
    Stovner LJ, Zwart JA, Hagen K, Terwindt GM, Pascual J (2006) Epidemiology of headache in Europe. Eur J Neurol 13:333–345. doi:10.1111/j.1468-1331.2006.01184.x CrossRefPubMedGoogle Scholar
  3. 3.
    Allais G, Rolando S, De Lorenzo C, Manzoni GC, Messina P, Benedetto C, d’Onofrio F, Bonavita V, Bussone G (2013) Migraine and pregnancy: an internet survey. Neurol Sci 34(Suppl 1):S93–S99. doi:10.1007/s10072-013-1394-9 CrossRefPubMedGoogle Scholar
  4. 4.
    Maggioni F, Alessi C, Maggino T, Zanchin G (1997) Headache during pregnancy. Cephalalgia 17:765–769. doi:10.1046/j.1468-2982.1997.1707765.x CrossRefPubMedGoogle Scholar
  5. 5.
    Nezvalová-Henriksen K, Spigset O, Nordeng H (2009) Maternal characteristics and migraine pharmacotherapy during pregnancy: cross-sectional analysis of data from a large cohort study. Cephalalgia 29:1267–1276. doi:10.1111/j.1468-2982.2009.01869.x CrossRefPubMedGoogle Scholar
  6. 6.
    Kvisvik EV, Stovner LJ, Helde G, Bovim G, Linde M (2011) Headache and migraine during pregnancy and puerperium: the MIGRA-study. J Headache Pain 12:443–451. doi:10.1007/s10194-011-0329-1 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Axelsdottir TO, Sigurdsson EL, Gudmundsdottir AM, Kristjansdottir H, Sigurdsson JA (2014) Drug use during early pregnancy: cross-sectional analysis from the childbirth and health study in primary Care in Iceland. Scand J Prim Health Care 32:139–145. doi:10.3109/02813432.2014.965884 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Buitendijk S, Bracken MB (1991) Medication in early pregnancy: prevalence of use and relationship to maternal characteristics. Am J Obstet Gynecol 165:33–40. doi:10.1016/0002-9378(91)90218-G CrossRefPubMedGoogle Scholar
  9. 9.
    Bonassi S, Magnani M, Calvi A, Repetto E, Puglisi P, Pantarotto F, Lazzaroni F (1994) Factors related to drug consumption during pregnancy. Acta Obstet Gynecol Scand 73:535–540. doi:10.3109/00016349409006269 CrossRefPubMedGoogle Scholar
  10. 10.
    Larivaara P, Hartikainen AL, Rantakallio P (1996) Use of psychotropic drugs and pregnancy outcome. J Clin Epidemiol 49:1309–1313. doi:10.1016/S0895-4356(96)00203-X CrossRefPubMedGoogle Scholar
  11. 11.
    Baraka M, Steurbaut S, Coomans D, Dupont AG (2014) Determinants of medication use in a multi-ethnic population of pregnant women: a cross-sectional study. Eur J Contracept Reprod Health Care 19:108–120. doi:10.3109/13625187.2013.879568 CrossRefPubMedGoogle Scholar
  12. 12.
    Verstappen GM, Smolders EJ, Munster JM, Aarnoudse JG, Hak E (2013) Prevalence and predictors of over-the-counter medication use among pregnant women: a cross-sectional study in the Netherlands. BMC Public Health 13:185. doi:10.1186/1471-2458-13-185 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Odalovic M, Kovacevic SV, Nordeng H, Ilic K, Sabo A, Tasic L (2013) Predictors of the use of medications before and during pregnancy. Int J Clin Pharm 35:408–416. doi:10.1007/s11096-013-9750-7 CrossRefPubMedGoogle Scholar
  14. 14.
    Källén B, Nilsson E, Olausson PO (2011) Delivery outcome after maternal use of drugs for migraine: a register study in Sweden. Drug Saf 34:691–703. doi:10.2165/11590370-000000000-00000 CrossRefPubMedGoogle Scholar
  15. 15.
    Nordeng H, Eskild A, Nesheim BI, Aursnes I, Jacobsen G (2001) Drug use during early pregnancy. Eur J Clin Pharmacol 57:259–263. doi:10.1007/s002280100304 CrossRefPubMedGoogle Scholar
  16. 16.
    Hämeen-Anttila K, Jyrkkä J, Enlund H, Nordeng H, Lupattelli A, Kokki E (2013) Medicines information needs during pregnancy: a multinational comparison. BMJ Open 3:e002594. doi:10.1136/bmjopen-2013-002594 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Bakhireva LN, Young BN, Dalen J, Phelan ST, Rayburn WF (2011) Patient utilization of information sources about safety of medications during pregnancy. J Reprod Med 56:339–343PubMedGoogle Scholar
  18. 18.
    Nordeng H, Ystrøm E, Einarson A (2010) Perception of risk regarding the use of medications and other exposures during pregnancy. Eur J Clin Pharmacol 66:207–214. doi:10.1007/s00228-009-0744-2 CrossRefPubMedGoogle Scholar
  19. 19.
    van Trigt AM, Waardenburg CM, Haaijer-Ruskamp FM, de Jong-van den Berg LT (1994) Questions about drugs: how do pregnant women solve them? Pharm World Sci 16:254–259CrossRefPubMedGoogle Scholar
  20. 20.
    Hämeen-Anttila K, Nordeng H, Kokki E, Jyrkkä J, Lupattelli A, Vainio K, Enlund H (2014) Multiple information sources and consequences of conflicting information about medicine use during pregnancy: a multinational internet-based survey. J Med Internet Res 16:e60. doi:10.2196/jmir.2939 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Frost Widnes SK, Schjøtt J (2008) Advice on drug safety in pregnancy: are there differences between commonly used sources of information? Drug Saf 31:799–806. doi: 10.2165/00002018-200831090-00008 CrossRefPubMedGoogle Scholar
  22. 22.
    Sawicki E, Stewart K, Wong S, Leung L, Paul E, George J (2011) Medication use for chronic health conditions by pregnant women attending an Australian maternity hospital. Aust N Z J Obstet Gynaecol 51:333–338. doi:10.1111/j.1479-828X.2011.01312.x CrossRefPubMedGoogle Scholar
  23. 23.
    Lupattelli A, Spigset O, Nordeng H (2014) Adherence to medication for chronic disorders during pregnancy: results from a multinational study. Int J Clin Pharm 36:145–153. doi:10.1007/s11096-013-9864-y CrossRefPubMedGoogle Scholar
  24. 24.
    Li R, Fein SB, Chen J, Grummer-Strawn LM (2008) Why mothers stop breastfeeding: mothers’ self-reported reasons for stopping during the first year. Pediatrics 122:S69–S76. doi:10.1542/peds.2008-1315i CrossRefPubMedGoogle Scholar
  25. 25.
    Olang B, Heidarzadeh A, Strandvik B, Yngve A (2012) Reasons given by mothers for discontinuing breastfeeding in Iran. Int Breastfeed J 7:7. doi:10.1186/1746-4358-7-7 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Ito S, Moretti M, Liau M, Koren G (1995) Initiation and duration of breast-feeding in women receiving antiepileptics. Am J Obstet Gynecol 172:881–886. doi: 10.1016/0002-9378(95)90015-2 CrossRefPubMedGoogle Scholar
  27. 27.
    StatBank Norway (2015) Table 08921: Persons 16 years and older, by sex, age and level of education. Numbers and percent (C). Statistics Norway Accessed 02 January 2016
  28. 28.
    Medical Birth Registry of Norway (2015) Standard statistics. Accessed 02 January 2016
  29. 29.
    El Hasnaoui A, Vray M, Richard A, Nachit-Ouinekh F, Boureau F (2003) Assessing the severity of migraine: development of the MIGSEV scale. Headache 43:628–635. doi:10.1046/j.1526-4610.2003.03105.x CrossRefPubMedGoogle Scholar
  30. 30.
    Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika 16:297–334. doi:10.1007/bf02310555 CrossRefGoogle Scholar
  31. 31.
    Hosmer DW, Lemeshow S, Sturdivant RX (2013) Applied logistic regression. John Wiley & Sons, New YorkCrossRefGoogle Scholar
  32. 32.
    Worthington I, Pringsheim T, Gawel MJ, Gladstone J, Cooper P, Dilli E, Aube M, Leroux E, Becker WJ (2013) Canadian headache society guideline: acute drug therapy for migraine headache. Can J Neurol Sci 40(Suppl 3):S1–S80CrossRefPubMedGoogle Scholar
  33. 33.
    Evers S, Áfra J, Frese A, Goadsby PJ, Linde M, May A, Sándor PS (2009) EFNS guideline on the drug treatment of migraine—revised report of an EFNS task force. Eur J Neurol 16:968–981. doi:10.1111/j.1468-1331.2009.02748.x CrossRefPubMedGoogle Scholar
  34. 34.
    Pringsheim T, Davenport W, Mackie G, Worthington I, Aube M, Christie SN, Gladstone J, Becker WJ (2012) Canadian headache society guideline for migraine prophylaxis. Can J Neurol Sci 39(Suppl 2):S1–59PubMedGoogle Scholar
  35. 35.
    Merikangas KR (2013) Contributions of epidemiology to our understanding of migraine. Headache 53:230–246. doi:10.1111/head.12038 CrossRefPubMedGoogle Scholar
  36. 36.
    Ekman A, Dickman PW, Klint Å, Weiderpass E, Litton JE (2006) Feasibility of using web-based questionnaires in large population-based epidemiological studies. Eur J Epidemiol 21:103–111. doi:10.1007/s10654-005-6030-4 CrossRefPubMedGoogle Scholar
  37. 37.
    van Gelder MM, Bretveld RW, Roeleveld N (2010) Web-based questionnaires: the future in epidemiology? Am J Epidemiol 172:1292–1298. doi:10.1093/aje/kwq291 CrossRefPubMedGoogle Scholar
  38. 38.
    Norwegian Media Barometer (2014) Table 04519: Percentage internet users and minutes used for internet an average day, by sex and education. Statistics Norway. Accessed 04 March 2016
  39. 39.
    El Hasnaoui A, Vray M, Blin P, Nachit-Ouinekh F, Boureau F (2004) Assessment of migraine severity using the MIGSEV scale: relationship to migraine features and quality of life. Cephalalgia 24:262–270. doi:10.1111/j.1468-2982.2004.00660.x CrossRefPubMedGoogle Scholar
  40. 40.
    Baha M, Nachit-Ouinekh F, El Hasnaoui A (2008) Intrapatient variability of migraine attacks: stability analysis of the MIGSEV scale. Headache 48:79–85. doi:10.1111/j.1526-4610.2007.00806.x PubMedGoogle Scholar
  41. 41.
    Nachit-Ouinekh F, Dartigues JF, Henry P, Becg JP, Chastan G, Lemaire N, El Hasnaoui A (2005) Use of the headache impact test (HIT-6) in general practice: relationship with quality of life and severity. Eur J Neurol 12:189–193. doi:10.1111/j.1468-1331.2004.00934.x CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of Laboratory Medicine, Division of Diagnostic ServicesUniversity Hospital of North NorwayTromsøNorway
  2. 2.Medical Pharmacology and Toxicology Research Group, Department of Medical Biology, Faculty of Health SciencesThe Arctic University of Norway (UiT)TromsøNorway
  3. 3.Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, School of PharmacyUniversity of OsloOsloNorway
  4. 4.Sandvika Nevro ClinicSandvikaNorway

Personalised recommendations