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.
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
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
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
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
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
Silberstein, SD. Headaches and women. Treatment of the pregnant and lactating migraineur. Headache 1993; 33: 533–40PubMedCrossRefGoogle Scholar
Genazzini AR, Facchinetti F, Parrini D. β-Lipotrophin and β-endorphin plasma levels during pregnancy. Clin Endocrinol 1980; 14: 409–18CrossRefGoogle Scholar
Horrobin DF. Prevention of migraine by reducing prolactin levels. Lancet 1973; I(7806): 777CrossRefGoogle Scholar
MacGregor A. Treatment of migraine during pregnancy. News in Headache 1994; 4(3): 3–5Google Scholar
Heinonen OP, Slone S, Shapiro S. Birth defects and drugs in pregnancy. Littleton (MA): Publishing Sciences Group, 1977Google Scholar
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
Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. 3rd ed. Baltimore: Williams & Wilkins, 1990Google Scholar
Pfaffenrath V, Scherzer S. Analgesics and NSAIDs in the treatment of the acute migraine attack. Cephalalgia 1995; 15 Suppl. 15: 14–20PubMedGoogle Scholar
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
Mathew N. Zolmitriptan: from drug design to clinical practice. Cephalalgia 1997; Suppl. 18: 1–3Google Scholar
Schoenen J. Acute migraine therapy: the newer drugs. Current Opin Neurol 1997; 10: 237–43CrossRefGoogle Scholar
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
MacGregor EA, Wilkinson M, Bancroft K. Domperidone plus paracetamol in the treatment of migraine. Cephalalgia 1993; 13: 124–7PubMedCrossRefGoogle Scholar
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
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
Holroyd KA, Penzien DB, Cordingley GE. Propranolol in the management of recurrent migraine: a meta-analytic review. Headache 1991; 31: 333–40PubMedCrossRefGoogle Scholar
Freitag FG, Diamond S, Diamond M. A placebo controlled trial of flunarizine in migraine prophylaxis. Cephalalgia 1991; 11 Suppl. 11: 157–8Google Scholar
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
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
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
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