In this blog, we answer common questions about migraine in pregnancy that we hear on The Migraine Trust helpline.

Will pregnancy affect my migraine?

Migraine tends to improve during pregnancy, especially during the second and third trimesters. During pregnancy, oestrogen levels increase and progesterone levels decrease but rise again towards the end of the pregnancy. The improvement in migraine during pregnancy may be due to increased oestrogen levels and the increase in endorphins (pain-killing hormones).

These hormones are several times higher during pregnancy and although they provide relief from migraine during the pregnancy, levels return to normal after birth, usually resulting in the migraine returning.

Although migraine can improve in pregnancy this is not the case for everyone, especially in the early weeks of pregnancy. For some women their migraine may be unaffected and remain the same, others may experience an increase in their migraine during pregnancy although this is rare.

Studies show that migraine without aura improves after the first three months of pregnancy for about seven in 10 women. This is likely due to the impact of stable oestrogen levels. If you experience migraine with aura you are more likely to continue to have attacks during your pregnancy.

Can I take migraine medications during pregnancy?

It is preferred to avoid using medicines during pregnancy and breastfeeding. If you are taking any preventive treatments, you should discuss stopping these with your doctor. However, if migraine attacks occur and present a risk to you and your baby, your doctor may offer some safer treatments.

Most of the evidence for the safety of drugs in pregnancy is collected from experience as these drugs cannot be tested on pregnant or breastfeeding women. This means the advice regarding drug treatments for migraine in pregnancy will usually be made with caution.

• Paracetamol is considered safe during pregnancy and breastfeeding. This should be taken in soluble form at the earliest signs of an attack.
• Ibuprofen may be considered in the first and second trimester but avoided in the third due to increased risk of complications.
• Sumatriptan is the preferred triptan in pregnancy and breastfeeding because there has been more experience of its use. A few large pregnancy registries covering more than 3,000 pregnancies have analysed the use of other triptans (including rizatriptan, zolmitriptan and eletriptan), and found no major congenital defects. Specialist advice may be needed, especially if there are other medical problems.
• Aspirin or opiates (such as codeine) for migraine should be avoided during pregnancy and breastfeeding.
• Anti-sickness treatment may be needed for migraine and the following have been used in pregnancy: cyclizine, ondansetron and prochlorperazine.

• Headache clinics may offer a greater occipital nerve block, which is a small injection of a local anaesthetic and steroid that is injected into the back of the head, underneath the skin into the muscle around a large nerve which is involved in headache disorders. This is a quick procedure which can provide relief for weeks or months. It is safe in pregnancy.

Can I use non-drug treatments during pregnancy?

Non-drug treatments can be helpful; massage, acupuncture, relaxation and biofeedback have been found to be useful by some women. Hot or cold compresses to the head can also be helpful.

Some complementary treatments can have an unwanted effect on your pregnancy just as conventional medicines can. For instance, some essential oils (rosemary for example) used in massage need to be avoided. It is important to check any complementary therapies with your GP or midwife before beginning these.

The best advice is to take as few medicines as possible, at the lowest effective dose, if needed. The use of any drugs or herbal remedy to treat your migraine attacks during pregnancy and whilst breastfeeding is a balance of risk and benefits, taken with medical advice. Any medication you do take should be recorded in your pregnancy notes.

Can I take migraine medication while breastfeeding?

When breastfeeding it is still best to avoid medication as much as possible because the baby will be consuming whatever you take through the milk. If non-drug treatment options are not effective, you can discuss treatment options with your doctor and they can review and consider what medications may be safe for you to have.

These can be simple painkillers for when you have a migraine attack such as ibuprofen and paracetamol, which can be taken as normal during breastfeeding although aspirin should be avoided as a painkiller.

Sumatriptan use in breastfeeding is considered safe as very small amounts of the drug are available in the breastmilk. Less evidence has been collected on the other triptans and as such breastmilk may be best discarded if breastfeeding 24 hours after use of these triptans as an extra safety precaution.

If you need to take aspirin or other non-recommended medication, such as the anti-sickness drug metoclopramide, whilst you are breastfeeding it is best not to breastfeed for 24 hours after the last dose. Ideally, keep some expressed milk in the freezer for such occasions; otherwise, you will need to give formula milk. You will need to express and discard any breast milk for 24 hours after the last dose.

If you or a loved one has questions about migraine or is in need of support, you can contact us via our free helpline on 0808 802 0066 or online here. You can also chat to us online through our live chat service at migrainetrust.org.

Read more about migraine in pregnancy here. Find out more about migraine and hormones here.