Migraine in pregnancy

How pregnancy affects migraine

Migraine often improves during pregnancy, especially in the second and third trimesters. Up to 9 in 10 women experience an improvement in their migraine by the end of their pregnancy. You might even find your migraine stops altogether. This isn’t the same for everyone though. You may find your migraine doesn’t change. It’s also possible that your migraine gets worse during pregnancy. This is more likely if you have migraine with aura.

You may also experience migraine for the first time during pregnancy. If you do, this will most often be migraine with aura. If you experience a severe headache or migraine for the first time while you are pregnant, see your GP. They can assess you and arrange a referral or treatment if necessary.

Migraine and hormones during pregnancy

The improvement in migraine you may experience during pregnancy is due to changes in your hormone levels. Migraine and hormones are closely linked. A drop in levels of the hormone oestrogen often triggers migraine attacks. During pregnancy, your levels of the hormones oestrogen and progesterone rise. You may also have increased levels of natural pain-killing hormones, called endorphins. These changes can lead to your migraine improving.

Migraine and fertility treatment

If you are having fertility treatment with IVF (in vitro fertilisation), it’s important to be aware how this can impact migraine. The high levels of hormones needed during IVF may trigger or worsen migraine attacks. Your IVF clinic may ask for clearance from your neurologist before they can go ahead.

Early pregnancy and migraine

Sometimes, early pregnancy symptoms can trigger migraine attacks. Morning sickness can mean that you feel like eating and drinking less. This can lead to low blood sugar and dehydration, which can make your migraine worse. If you are affected by morning sickness, try to eat and drink small amounts, more frequently. This may help to prevent migraine as well as reduce any sickness. It’s worth speaking to your GP about anti-sickness medicine too. This may help with your migraine as well as any sickness.

Migraine after pregnancy and birth

Your migraine will usually return after you have given birth. This may not happen until you restart your periods. But you may find that you experience a migraine attack within a few days of giving birth. This may be due to the sudden drop in oestrogen levels after the birth. You may also be exhausted and out of your usual routine with sleep and eating following birth. This can also increase your risk of a migraine attack.

If you choose to breastfeed, you may find it takes longer for your migraine attacks to return. This is because your levels of oestrogen remain stable while you are breastfeeding.

How migraine affects pregnancy

Most women with migraine have a healthy pregnancy and birth with minimal complications. But if you have migraine, your risk of certain pregnancy complications may be slightly higher. These include premature birth, having a baby with a low birth weight, and pre-eclampsia. Pre-eclampsia is a condition where you develop high blood pressure during your pregnancy. It can cause problems both for you and your baby.

Some studies have also reported an increased risk of miscarriage in women with migraine. It’s unclear whether this is due to migraine itself or the medicines that these women were taking.

Your risk of developing these complications is still low if you have migraine. Most women with migraine who get pregnant won’t have any issues. But knowing that there is a slight increase in risk means your midwife or GP may monitor you more closely. They can also let you know what signs to look out for. Talk to your midwife or doctor if you have any concerns.

Migraine treatment in pregnancy

If you are taking regular migraine medicine and you get pregnant or are planning a pregnancy, see your doctor for advice. This also includes if you are preparing for fertility treatment with IVF (in vitro fertilisation). Ideally, it is best to avoid using migraine medicines during pregnancy when possible. This is because they may cause harm to your baby, or there may not be enough evidence to say whether they are safe.

Sometimes though, the benefits of taking medicines might outweigh any potential risks. This may be the case if migraine is having a significant impact on your health or wellbeing. Your doctor can advise you on what medicines are safest during pregnancy and help you to decide what is best for you.

Acute medicines

You may be able to take the following acute medicines to help with migraine attacks during pregnancy.

• Paracetamol – this is considered to be the safest painkiller to take during pregnancy.
• Ibuprofen – this might be appropriate if paracetamol is not helping. It’s best to avoid it after 20 weeks of pregnancy. If you take it after this time, you should use the lowest effective dose for as short a time as possible.
• Triptans – these can be an option in pregnancy if paracetamol isn’t helping enough. Sumatriptan is the preferred triptan in pregnancy. This is because there has been more experience with its use. However, other triptans are also likely to be safe in pregnancy.
• Anti-sickness medicines, such as metoclopramide and domperidone. These are generally considered safe to use in pregnancy.

You should not take aspirin or opiate painkillers, like codeine, if you are pregnant or breastfeeding.

Preventive medicines

It’s possible that you need preventive medicines for migraine during pregnancy. Your doctor will review what treatment is best and safest for you. Your GP may refer you to a specialist to advise on your treatment options.

There are certain medicines that you should not take if you are pregnant or trying to get pregnant. This is because they can cause harm to your baby. These include sodium valproate, topiramate and candesartan.

Following discussion with your doctor, other preventive treatments may be suitable. These include propranolol and amitriptyline. You may also be able to have a greater occipital nerve (GON) block. This is an injection of local anaesthetic and steroid into the back of your head. It can provide longer-term relief from symptoms and is safe in pregnancy.

Botox injections are not usually recommend during pregnancy, unless there is no other suitable alternative. This is because there is not much data about the use of Botox for migraine during pregnancy.

There has not yet been enough safety data for CGRP monoclonal antibodies and gepants to say whether they are safe during pregnancy. For this reason, you will need to avoid them if you are pregnant.

Non-drug treatments

Your doctor may suggest you try non-drug treatments for migraine. These include relaxation and behavioural therapies. You could also try acupuncture and migraine devices. Check with your doctor first before trying any of these treatments.

If you can, taking measures to reduce any known triggers may also help. This may include trying to keep to a regular sleep pattern and not missing meals. A headache diary may help you to keep track of any triggers.

Ask your doctor or pharmacist what supplements you can take during pregnancy. You should not take the herb feverfew when pregnant, as it’s not considered safe. The supplement coenzyme Q10 is also not recommended during pregnancy, due to a lack of safety data. Riboflavin is generally considered safe to take during pregnancy. But there is no safety data for the high doses used for migraine. Your doctor may advise taking a lower dose than normally recommended.

Migraine medicines and breastfeeding

When you breastfeed, small amounts of medicines can transfer to your baby in breast milk. But for many migraine medicines, the amount is too small to be harmful. If you are breastfeeding or planning to breastfeed, speak to your doctor about what treatment is safest for you. When needed, it’s usually possible to find a way to manage your migraine while breastfeeding.

If you do need to take migraine medicines when breastfeeding, paracetamol and ibuprofen are safest. You should not take aspirin or medicines containing codeine when breastfeeding. Sumatriptan is considered safe to take when breastfeeding. It’s likely that other triptans are safe too, but there is less data to be able to say for sure.

Certain preventive medicines are also considered safe to take when breastfeeding if needed. There is very limited information about CGRP monoclonal antibodies and gepants in breastfeeding. If you need preventive medicines for migraine when you are breastfeeding, your doctor can tell you which ones are best to take.

Your doctor may advise delaying breastfeeding for a certain amount of time after taking some medicines. This can help to avoid peak levels in your breast milk. You can use expressed milk or formula during these times.

Further information and support

• BUMPS (Best Use of Medicines in Pregnancy)
  www.medicinesinpregnancy.org
• The Breastfeeding Network
  Helpline: 0300 100 0212
  www.breastfeedingnetwork.org.uk

About our information

This information has been written by The Migraine Trust Information and Support Services team. It has been reviewed by our panel of expert health professionals and people affected by migraine.

Our information has been awarded the PIF TICK quality mark for trustworthy health information.

If you have feedback on our information, please get in touch at: feedback@migrainetrust.org

References for our information are available on request.

Last reviewed: May 2025 | Next review due: May 2028