Drug Safety

, Volume 19, Issue 5, pp 383–388 | Cite as

Migraine in Pregnancy

What are the Safest Treatment Options?
Review Article Drug Safety Concepts


The occurrence of migraine in women is influenced by hormonal changes throughout the lifecycle. A beneficial effect of pregnancy on migraine, mainly during the last 2 trimesters, has been observed in 55 to 90% of women who are pregnant, irrespective of the type of migraine. A higher percentage of women with menstrual migraine find that their condition improves when they are pregnant. However, in rare cases migraine may appear for the first time during pregnancy.

The positive effects of pregnancy on migraine and the possible worsening post partum are probably related to the uniformly high and stable estrogen levels during pregnancy and the rapid fall-off thereafter.

Nondrug therapies (relaxation, sleep, massage, ice packs, biofeedback) should be tried first to treat migraine in women who are pregnant.

For treatment of acute migraine attacks 1000mg of paracetamol (acetaminophen) preferably as a suppository is considered the first choice drug treatment. The risks associated with use of aspirin (acetylsalicylic acid) and ibuprofen are considered to be small when the agents are taken episodically and if they are avoided during the last trimester of pregnancy.

The ‘triptans’ (sumatriptan, zolmitriptan, naratriptan), dihydroergotamine and ergotamine tartrate are contraindicated in women who are pregnant. Prochlorperazine for treatment of nausea is unlikely to be harmful during pregnancy. Metoclopramide is probably acceptable to use during the second and third trimester.

Prophylactic treatment is rarely indicated and the only agents that can be given during pregnancy are the β-blockers metoprolol and propranolol.


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  1. 1.
    Rasmussen BK. Epidemiology of headache. Cephalalgia 1995; 15: 44–5CrossRefGoogle Scholar
  2. 2.
    Stewart WF, Shetcher A, Rasmussen BK. Migraine prevalence: a review of population-based studies. Neurology 1995; 44: Suppl. 17–23Google Scholar
  3. 3.
    Whitty CWM, Hockaday JM, Whitty MM. The effect of oral contraceptives on migraine. Lancet 1966; 1(7442): 856–96PubMedCrossRefGoogle Scholar
  4. 4.
    Phillips BM. Oral contraceptive drugs and migraine. BMJ 1968; 2(597): 99PubMedCrossRefGoogle Scholar
  5. 5.
    Nilsson A, Jacobsen L, Ingemanson CA. Side effects of an oral contraceptive with particular attention to menstrual symptoms and sexual adaptation. Acta Obstet Gynecol Scand 1967; 45: 537–56CrossRefGoogle Scholar
  6. 6.
    MacGregor EA, Chia H, Vohrah RL, et al. Migraine and menstruation: a pilot study. Cephalalgia 1990; 10: 305–10PubMedCrossRefGoogle Scholar
  7. 7.
    Lance J, Anthony M. Some clinical aspects of migraine. Arch Neural 1966; 15: 356–61CrossRefGoogle Scholar
  8. 8.
    Callaghan N. The migraine syndrome in pregnancy. Neurology 1968; 18: 197–201PubMedCrossRefGoogle Scholar
  9. 9.
    Somerville BW. A study of migraine in pregnancy. Neurology 1972; 22: 824–8PubMedCrossRefGoogle Scholar
  10. 10.
    Ratinahirana H, Darbois Y, Bousser MG. Migraine and pregnancy: a prospective study in 703 woman after delivery [abstract]. Neurology 1990; 40 Suppl. 1: 437Google Scholar
  11. 11.
    Chen TC, Leviton A. Headache recurrence in pregnant women with migraine. Headache 1994; 34: 107–10PubMedCrossRefGoogle Scholar
  12. 12.
    Granella F, Sances G, Zanferrari C, et al. Migraine without aura and reproductive life events: a clinicoepidemiological study in 1300 women. Headache 1993; 33: 385–9PubMedCrossRefGoogle Scholar
  13. 13.
    Rasmussen BK. Migraine and tension-type headache in a general population: precipitating factors, female hormones, sleep pattern and relation to lifestyle. Pain 1993: 53: 65–72PubMedCrossRefGoogle Scholar
  14. 14.
    Boussser MG, Massiou H. Migraine in the reproductive cycle. In: Olesen J, Tfelt-Hansen P, Welch KMA, editors. The headaches. New York: Raven Press, 1993: 413–9Google Scholar
  15. 15.
    Welch KMA. Migraine and pregnancy. In: Devinsky O, Feldmann E, Hainline B, editors. Neurological complications of pregnancy. New York: Raven Press, 1994: 77–81Google Scholar
  16. 16.
    Silberstein, SD. Headaches and women. Treatment of the pregnant and lactating migraineur. Headache 1993; 33: 533–40PubMedCrossRefGoogle Scholar
  17. 17.
    Uknis A, Silberstein SD. Review article: migraine and pregnancy. Headache 1991; 31: 372–4PubMedCrossRefGoogle Scholar
  18. 18.
    Silberstein SD, Merriam GR. Estrogens, progestins and headache. Neurology 1991; 41: 786–93PubMedCrossRefGoogle Scholar
  19. 19.
    Sjaastad O. Headache and the ameliorating effect of pregnancy: an editorial. Cephalalgia 1984; 4: 211–2PubMedCrossRefGoogle Scholar
  20. 20.
    Maggioni F, Alessi C, Maggino T, et al. Headache during pregnancy. Cephalalgia 1997; 17: 765–9PubMedCrossRefGoogle Scholar
  21. 21.
    IHS classification and diagnostic criteria for headache, cranial neuralgias and facial pain. Cephalalgia 1988; Suppl. 8: 1–96Google Scholar
  22. 22.
    Wainscott G, Sullivan M, Volans GN, et al. The outcome of pregnancy in women suffering from migraine. Postgrad Med J 1978; 54: 98–102PubMedCrossRefGoogle Scholar
  23. 23.
    Silberstein SD, Merriam GR. Sex hormones and headache. J Pain Symptom Manage 1993; 8: 98–114PubMedCrossRefGoogle Scholar
  24. 24.
    Stein G, Morton J, Marsh A, et al. Headaches after childbirth. Acta Neurol Scand 1984; 69: 74–9PubMedCrossRefGoogle Scholar
  25. 25.
    Welch KMA. Migraine and ovarian steroid hormones. Cephalalgia 1997; 17 Suppl. 20: 12–6PubMedGoogle Scholar
  26. 26.
    Edelson RN. Menstrual migraine and other hormonal aspects of migraine. Headache 1985; 25: 376–9PubMedCrossRefGoogle Scholar
  27. 27.
    Somerville BW. The role of estradiol withdrawal in the etiology of menstrual migraine. Neurology 1972; 22: 355–65PubMedCrossRefGoogle Scholar
  28. 28.
    Sicuteri F. Opioids, pregnancy and the disappearance of headache. Headache 1980; 20: 220–1PubMedCrossRefGoogle Scholar
  29. 29.
    Genazzini AR, Facchinetti F, Parrini D. β-Lipotrophin and β-endorphin plasma levels during pregnancy. Clin Endocrinol 1980; 14: 409–18CrossRefGoogle Scholar
  30. 30.
    Horrobin DF. Prevention of migraine by reducing prolactin levels. Lancet 1973; I(7806): 777CrossRefGoogle Scholar
  31. 31.
    MacGregor A. Treatment of migraine during pregnancy. News in Headache 1994; 4(3): 3–5Google Scholar
  32. 32.
    Heinonen OP, Slone S, Shapiro S. Birth defects and drugs in pregnancy. Littleton (MA): Publishing Sciences Group, 1977Google Scholar
  33. 33.
    Niebyl JR, Lietman PS. The use of mild analgetics in pregnancy. In: Niebyl JR, editor. Drug use in pregnancy. 2nd ed. Philadelphia: Lea & Febiger, 1988: 21–8Google Scholar
  34. 34.
    Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. 3rd ed. Baltimore: Williams & Wilkins, 1990Google Scholar
  35. 35.
    Pfaffenrath V, Scherzer S. Analgesics and NSAIDs in the treatment of the acute migraine attack. Cephalalgia 1995; 15 Suppl. 15: 14–20PubMedGoogle Scholar
  36. 36.
    Wilkinson M, Pfaffenrath V, Schoenen J, et al. Migraine and cluster headache — their management with sumatriptan: a critical review of the current clinical experience. Cephalalgia 1995; 15: 337–57PubMedGoogle Scholar
  37. 37.
    Mathew N. Zolmitriptan: from drug design to clinical practice. Cephalalgia 1997; Suppl. 18: 1–3Google Scholar
  38. 38.
    Schoenen J. Acute migraine therapy: the newer drugs. Current Opin Neurol 1997; 10: 237–43CrossRefGoogle Scholar
  39. 39.
    Ellis GL, Delaney J, DeHart DA, et al. The efficacy of metoclopramide in the treatment of migraine headache. Ann Emergency Med 1993; 22: 191–5CrossRefGoogle Scholar
  40. 40.
    MacGregor EA, Wilkinson M, Bancroft K. Domperidone plus paracetamol in the treatment of migraine. Cephalalgia 1993; 13: 124–7PubMedCrossRefGoogle Scholar
  41. 41.
    Tfelt-Hansen P, Johnson ES. Antiemetic and prokinetic drugs. In: Olesen J, Tfelt-Hansen P, Welch KMA, editors. The headaches. New York: Raven Press, 1993: 343–7Google Scholar
  42. 42.
    Niebyl JR, Maxwell KD. Treatment of the nausea and vomiting of pregnancy. In: Niebyl JR, editor. Drug use in pregnancy. 2nd ed. Philadelphia: Lea & Febinger, 1988: 11–9Google Scholar
  43. 43.
    Holroyd KA, Penzien DB, Cordingley GE. Propranolol in the management of recurrent migraine: a meta-analytic review. Headache 1991; 31: 333–40PubMedCrossRefGoogle Scholar
  44. 44.
    Freitag FG, Diamond S, Diamond M. A placebo controlled trial of flunarizine in migraine prophylaxis. Cephalalgia 1991; 11 Suppl. 11: 157–8Google Scholar
  45. 45.
    Mathew NT, Saper JR, Silberstein SD, et al. Migraine prophylaxis with divalproex. Arch Neurol 1995; 52: 281–6PubMedCrossRefGoogle Scholar
  46. 46.
    Welch KMA. Drug therapy of migraine. N Engl J Med 1993; 329: 1476–82PubMedCrossRefGoogle Scholar
  47. 47.
    Mylecharane EJ, Tfelt-Hansen P. Miscellaneous drugs. In: Olesen J, Tfelt-Hansen P, Welch KMA, editors. The headaches. New York: Raven Press, 1993; 397–402Google Scholar
  48. 48.
    Mauskop A, Altura BM. Magnesium for migraine. CNS Drugs 1998; 9(3): 185–90CrossRefGoogle Scholar
  49. 49.
    Peikert A, Wilimzig C, Köhne-Volland R. Prophylaxis of migraine with oral magnesium: results from a prospective, multicenter, placebo-controlled and double-blind randomized study. Cephalalgia 1996; 16: 257–63PubMedCrossRefGoogle Scholar
  50. 50.
    Pfaffenrath V, Wesseley P, Meyer C, et al. Magnesium in the prophylaxis of migraine — a double-blind, placebo-controlled study. Cephalalgia 1996; 16: 436–40PubMedCrossRefGoogle Scholar
  51. 51.
    Niebyl JR. Teratology and drugs in pregnancy and lactation. In: Winters R, editor. Danforth’s obstetrics and gynecology. 6th ed. New York: Lippincott, 1990Google Scholar
  52. 52.
    Repke JT. Pharmacologic management of hypertension in pregnancy. In: Niebyl JR, editor. Drug use in pregnancy. 2nd ed. Philadelphia (PA): Lea & Febinger, 1988: 55–65Google Scholar

Copyright information

© Adis International Limited 1998

Authors and Affiliations

  1. 1.MunichGermany

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