Living With Migraines
Finding migraine treatment that works isn’t just a relief, it’s life-changing. It can mean getting days of your life back. So, what happens if you’re a migraine sufferer and you become pregnant?
Finding out you’re pregnant is a huge life adjustment, even if you don’t suffer from migraines. You may start to feel tired and nauseated and find yourself dealing with a new host of anxieties—even if you’re also bursting with joy!
On top of that, you’ll likely need to adjust to major lifestyle changes, like cutting out substances such as alcohol (and sometimes coffee, depending on what your doctor says), changing your diet to avoid risks of foodborne illness, and stopping certain medications.
That’s where it gets tricky for migraine sufferers. Your OBGYN may not be able to advise you on how to treat your migraines while pregnant. We asked migraine expert and Cove medical advisor, Dr. Sara Crystal some of the most common questions people with migraine headaches have when they become pregnant.
Instead of waiting until the first time you have a migraine attack while pregnant, Dr. Crystal recommends talking to your doctor to work out a treatment plan in case you get an attack.
When you find out you’re pregnant, you’ll probably need to work with both your obstetrician and the health care provider you see for headache treatment. Make sure to mention all of the medications you take for headaches, including supplements, and other migraine symptoms.
With so many changes in your body, it’s important to “be extra vigilant about avoiding triggers,” adds Dr. Crystal, and to avoid skipping meals, getting dehydrated, or developing poor sleep habits.
Of course, with pregnancy symptoms like morning sickness and trouble sleeping, that could be easier said than done. But do your best to maintain healthy habits.
For women who get them, they tend to hit just before or at the start of your period. The quick drop in estrogen and progesterone that occurs before your period starts could be what triggers menstrual migraines, according to the US Office on Women’s Health.
If you suffer from menstrual migraines, you might worry that you’ll also be prone to get migraines triggered by hormonal changes that happen in your body during pregnancy, but there’s good news. Dr. Crystal points out that many women who get menstrual migraines actually see an improvement in their migraines while pregnant.
If you’re not lucky enough to experience fewer migraines during pregnancy, what can you do to treat them? It turns out that, while pregnant, many prescription and over-the-counter medications are considered unsafe or risky, or just haven’t been researched enough for doctors to be confident making a recommendation.
According to Dr. Crystal, “acetaminophen (Tylenol®) and metoclopramide (Reglan®), which can help relieve nausea and pain, are the safest medications to take.” She adds that some obstetricians may prescribe ondansetron to treat severe nausea “and consider it to be safe.”
That being said, Dr. Crystal notes that it is always best to take the lowest effective dose, even of approved medications.
Non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil®, Motrin®) are not safe in the first or third trimesters. Similarly, you should not take naproxen (Aleve®) while pregnant. It may be safe during the second trimester, but only if specifically approved by your doctor.
Dr. Crystal adds that while many obstetricians will advise against using triptans while pregnant, they could be safe when used occasionally. Doctors may prescribe opiates for severe headaches while you’re pregnant, but they “must be used sparingly,” she says.
Check with your doctor before taking any migraine treatment, to be sure they’re safe for you and your pregnancy.
The two safest medications, acetaminophen and metoclopramide, can be mixed. You can also combine acetaminophen and ondansetron, Dr. Crystal notes.
Migraines can be so severe, you might worry they’re affecting your baby too. “The good news,” Dr. Crystal says,” is that large studies have not shown increased rates of birth defects or stillbirths in migraineurs.”
That being said, women who have migraines so severe that they end up in the emergency room have a higher risk of complications such as pre-eclampsia, preterm delivery, and low birth weight, according to the National Headache Foundation.
Dr. Crystal identifies a few home remedies that can help you get relief without turning to medication, including:
Taking magnesium could also help prevent migraines while pregnant, Dr. Crystal adds.
You might think it’s safe to assume that anything considered a “home remedy” or “alternative treatment” for migraines is safe during pregnancy, but that’s not the case.
Dr. Crystal calls out a few preventive supplements that should be avoided during pregnancy, including:
“If in doubt,” she urges, “always ask your doctor or pharmacist for their advice about taking OTC products while pregnant.”
Caffeine and migraine have an interesting relationship. According to the National Headache Foundation, caffeine can help with pain relief, since “it contains properties It can even make some pain relievers work better. Yet for some people, caffeine a migraine trigger. And becoming reliant on caffeine every day can lead to rebound headaches.
All that said, even if you know caffeine helps fight your migraines, what can you do? Isn’t caffeine off limits during pregnancy?
If you’ve been resisting the urge to reach for a cup of coffee, take comfort. Dr. Crystal points out that some caffeine is okay during pregnancy (rejoice!). “Drinking up to 12 oz. of coffee per day, or about 200mg of caffeine, is considered safe,” she says. Still, it’s always smart to double check with your doctor before pouring yourself a cup.
Since so many migraine treatments are off the table while pregnant, it might feel like your arsenal is running low.
With fewer medications to turn to, lifestyle changes can make a huge difference in keeping your migraines under control while you’re pregnant.
Dr. Crystal recommends:
“Due to the abrupt hormonal changes and increased blood volume,” says Dr. Crystal, “the first trimester is often a time of increased headaches for women with migraine.”
Luckily, they can get better in the second trimester, “though for some patients the turning point does not occur until around week 20.”
For some women, migraines can come back near the end of pregnancy, possibly because the discomforts of late pregnancy can impact your sleep.
The bad news? Even if your migraines got better during pregnancy, they might come back after you have your baby, cautions Dr. Crystal. On the plus side, breastfeeding might be able to delay the return of your migraines.
If you’re breastfeeding, you’ll need to avoid the medications that are known to make it into your breastmilk (and to your baby).
When it comes to your acute medications for treating migraines when they strike, “sumatriptan is generally considered safe,” Dr. Crystal notes, “but eletriptan is preferred due to minimal excretion into breast milk.”
In terms of preventive medications, propranolol and amitriptyline are generally considered safe, says Dr. Crystal, though there’s not enough data about topiramate for doctors to assess how safe it is.
To be safe, you’ll want to discuss your migraine treatment with your doctor to be sure it’s safe for breastfeeding mothers. In the meantime, check out TOXNET, a database on which medications are safe to use while breastfeeding.
During pregnancy, you’re juggling a million things, and dealing with migraines can add to the stress. And, since other types of headaches could crop up during pregnancy, like tension headaches, you may need extra guidance on how to handle headaches during pregnancy.
To make it easier on you and to keep your baby safe, make a plan for treating your headaches early in your pregnancy, and always check with your doctor before taking a medication or starting a treatment.
The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
Sumatriptan is an oral medication indicated for the acute treatment of migraine with or without aura in adults and not for the prophylactic therapy of migraine attacks or for the treatment of cluster headache. Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using either of these drugs while you are pregnant. Tell your doctor if you are breast-feeding. Call your doctor right away if you have chest, throat, neck, or jaw tightness, pain, pressure, or heaviness; break out in a cold sweat; shortness of breath; a fast heartbeat; a heartbeat that does not feel normal; or very bad dizziness or passing out. Very bad and sometimes deadly brain blood vessel problems like stroke have rarely happened with this drug. Call your doctor right away if you have weakness on 1 side of the body, trouble speaking or thinking, change in balance, drooping on 1 side of the face, or change in eyesight. You can read more about sumatriptan’s side effects, warnings, and precautions here. Full prescribing information for sumatriptan is available here.
Metoclopramide is used to treat or prevent upset stomach and throwing up. Some people who take this drug may get a very bad muscle problem called tardive dyskinesia. This muscle problem may not go away even if this drug is stopped. Sometimes, signs may lessen or go away over time after this drug is stopped. The risk of tardive dyskinesia may be greater in people with diabetes and in older adults, especially older women. The risk is also greater the longer you take this drug or with higher doses. Muscle problems may also occur after short-term use with low doses. Call your doctor right away if you have trouble controlling body movements or if you have muscle problems with your tongue, face, mouth, or jaw like tongue sticking out, puffing cheeks, mouth puckering, or chewing. Avoid taking this drug for more than 12 weeks. You can read more about metoclopramide’s side effects, warnings, and precautions here. Full prescribing information for metoclopramide is available here.
Ondansetron is a medication used to treat or prevent upset stomach and throwing up. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect: signs of an allergic reaction, chest pain or pressure, slow heartbeat, numbness and tingling, belly pain, trouble passing urine, trouble controlling body movements, change in eyesight, feeling very sleepy, seizures, dizziness, fever or chills, allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue; breathing problems; confusion; dizziness; fast or irregular heartbeat; feeling faint or lightheaded, falls; fever and chills; loss of balance or coordination; seizures; sweating; swelling of the hands and feet; tightness in the chest; tremors; unusally weak or tired. A type of abnormal heartbeat (prolonged QT interval) can happen with this drug. Call your doctor right away if you have a fast heartbeat, a heartbeat that does not feel normal, or if you pass out. A very bad and sometimes deadly health problem called serotonin syndrome may happen. The risk may be greater if you take this drug with drugs for depression, migraines, or certain other drugs. Check with your doctor or health care professional as soon as you can if you have any sign of an allergic reaction. Tell your doctor if you have any of these conditions: heart disease; history of irregular heartbeat; liver disease; low levels of magnesium or potassium in the blood; an unusual or allergic reaction to ondansetron, granisetron, other medicines, foods, dyes, or preservatives; pregnant or trying to get pregnant; breast-feeding. Call your doctor right away if you have agitation; change in balance; confusion; hallucinations; fever; fast or abnormal heartbeat; flushing; muscle twitching or stiffness; seizures; shivering or shaking; sweating a lot; very bad diarrhea, upset stomach, or throwing up; or very bad headache. Full prescribing information for ondansetron is available here, and for ondansetron ODT is available here. You can read more about ondansetron side effects, warnings, and precautions here.
Propranolol and metoprolol are used to treat high blood pressure and prevent migraine headaches. Do not stop taking these drugs all of a sudden. If you do, chest pain that is worse and in some cases heart attack may occur. The risk may be greater if you have certain types of heart disease. To avoid side effects, you will want to slowly stop this drug as ordered by your doctor. Call your doctor right away if you have new or worse chest pain or if other heart problems occur. You can read more about propranolol side effects, warnings, and precautions here. Full prescribing information for propranolol is available here. You can read more about metaprolol side effects, warnings, and precautions here. Full prescribing information for metoprolol is available here.
Amitriptyline is used to treat low mood (depression). It may be given to you for other reasons. Do not stop taking this drug all of a sudden without calling your doctor. You may have a greater risk of signs of withdrawal. Drugs like this one have raised the chance of suicidal thoughts or actions in children and young adults. The risk may be greater in people who have had these thoughts or actions in the past. All people who take this drug need to be watched closely. Call the doctor right away if signs like low mood (depression), nervousness, restlessness, grouchiness, panic attacks, or changes in mood or actions are new or worse. Call the doctor right away if any thoughts or actions of suicide occur. This drug is not approved for use in children. You can read more about amitriptyline’s side effects, warnings, and precautions here. Full prescribing information for amitriptyline is available here.
Topiramate is an oral medications used used to prevent migraine headaches. Call your doctor right away if you have a fever or you do not sweat during activities or in warm temperatures. Patients who take this drug may be at a greater risk of having thoughts or actions of suicide. The risk may be greater in people who have had these thoughts or actions in the past. Call the doctor right away if signs like low mood (depression), nervousness, restlessness, grouchiness, panic attacks, or changes in mood or actions are new or worse. Call the doctor right away if any thoughts or actions of suicide occur. Very bad and sometimes deadly liver problems have happened with this drug. Call your doctor right away if you have signs of liver problems like dark urine, feeling tired, not hungry, upset stomach or stomach pain, light-colored stools, throwing up, or yellow skin or eyes. This drug may cause very bad eye problems. If left untreated, this can lead to lasting eyesight loss. You can read more about topiramate’s side effects, warnings, and precautions here. Full prescribing information for topiramate is available here.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch: https://www.fda.gov/Safety/MedWatch/default.htm or call 1-800-FDA-1088.