Managing migraine during pregnancy and lactation

According to doctors at Wake Forest Baptist Medical Center, medications and treatments long considered safe to treat pregnant women with migraines may not be.

"We hope this review of medical treatments will serve as a guide for doctors and patients on how to interpret new findings, especially regarding four treatment options that doctors have commonly used for their pregnant patients with migraines," said Rebecca Erwin Wells, M.D., assistant professor of neurology at Wake Forest Baptist and lead author of the paper.

"Patients and doctors need to be aware that concerns exist and they should carefully weigh the risks and benefits of these treatments."

The review is published in the online issue of the journal Current Neurology and Neuroscience Reports.

The four treatment options of concern are:

• Magnesium. Previously considered one of the safest supplements that could be used during pregnancy it is now rated at level D by the Food and Drug Administration (FDA), meaning that it may not be safe.
• Ondansetron. It is not FDA approved for migraines but is frequently used off-label to treat the nausea and vomiting of pregnancy and migraines. Use during pregnancy has recently become a controversial issue due to concerns over fetal and maternal safety, but the data is not conclusive.
• Acetaminophen. More than 65 percent of pregnant women in the United States report using it, but recent evidence suggests possible links between maternal acetaminophen use and pediatric development of attention deficit hyperactivity disorder.
• Butalbital. A barbiturate used to treat headache in combination with caffeine, acetaminophen, aspirin and/or codeine, it is routinely prescribed for migraines in pregnancy. A small study suggests a potential increased risk of congenital heart defects.

Most women with migraines actually experience fewer headaches during pregnancy, especially during second and third trimesters, Wells said. And there are safe treatment options for women who keep having migraines during pregnancy and lactation. Headaches during pregnancy and lactation need to be taken seriously, and not all are migraines and may be due to a serious underlying condition.

"The most important thing is to talk to your doctor about your headaches during pregnancy and lactation. He or she can guide you on the available treatments and their safety, including non-pharmacologic options, such as healthy lifestyle habits, relaxation training, stress management, biofeedback, and possibly even meditation and yoga," she said.

"There are many available treatment options for migraine during pregnancy and lactation, so patients can be assured that they will not suffer during this important time in their lives."