Nearly 33 million Americans suffer from migraine, and the majority of those are women. It stands to reason that many women in their childbearing years will suffer from migraine disease. What does a pregnant mother-to-be do to treat her disease?
An automatic and immediate response may be to reach for some medication, but expectant mothers and their doctors should do careful research of any medication used for migraine in order to protect the developing baby.
Migraine attacks can change during pregnancy, and there is some good news right from the start; 60 to 80 percent of expectant mothers will see an improvement in their migraine patterns during their pregnancies, says Timothy R. Smith, MD, RPh. Smith is the director of the Ryan Headache Center in St. Louis, Missouri.
Hormonal changes in pregnancy probably account for the relief many pregnant women realize. Migraine relief will usually last until shortly after the birth of the baby, unless the mother chooses to breastfeed; then her relief may last until the baby weans (See: Breastfeeding with Head Pain Disorders). However, Smith cautions, there are some women who will have worsening symptoms of their migraines, especially during the first trimester.
If an expectant mother does not get relief from migraine attacks during her pregnancy or the migraine attacks worsen, with careful consideration, there are several ways to address the situation.
“Migraine management during pregnancy presents special problems because of limitation on medication use,” says Smith. Smith encourages his female patients to postpone pregnancy until their migraines are stable and manageable. Then, preventive medications can be slowly discontinued prior to pregnancy.
“In the ideal situation, the pregnant mother would not require medications of any kind,” Smith explains. Non-pharmacologic measures should be encouraged as a first-line treatment for migraine in pregnant women – measures such as trigger identification, lifestyle change, ice, rest, biofeedback and relaxation.
But, if a pregnant mother needs medication, the doctor should use medications with a high degree of safety and avoid one with a known risk or unknown risk. Depending on the severity and frequency of the expectant mother’s migraines, medications would be used for relief or for preventive measures.
Debbie was 29 and pregnant with her first child when she consulted with her OB/GYN about what to do if she experienced a migraine attack while pregnant. The doctor told her Tylenol was the only medication she could use. “Luckily, I had only a few migraines while pregnant, but the Tylenol did not help at all,” Debbie says. Debbie adds that she now knows it’s important to get the most information you can while pregnant in order to avoid needless suffering.
Angela, 25, is an expectant mother who has more options available to her to treat her migraines, but is cautious in using the medications prescribed. “Since I’m pregnant, I’m on pain relief as needed only. My doctor has said that Fioricet and Lortab are fine while pregnant for pain relief. I only take them when I can no long handle the pain,” she says.
Medications on the market today are assigned a pregnancy risk category; they are split into five categories – A, B, C, D, and X. Category A drugs are the least risky and have been proven in human studies be safe.
“It’s always easier to do without preventive medications than to stop acute abortive medications,” Smith says. In the case of expectant mothers, it’s best to go with simple, non-analgesic medications. Tylenol is first on this list. Because of the risk of bleeding or uterine contractions, doctors avoid having their patients take aspirin or non-steroidal anti-inflammatories such as ibuprofen or naproxen. Use of narcotic analgesics, such as Tylenol with codeine, is condoned because of their long history of safe use in pregnancy.
Triptan drugs, such as Imitrex, Amerge and Relpax, should be avoided in pregnancy except in extreme cases and then only with a physician’s approval. Triptans are designated category C and have only been in use a short time; too short a time to determine their safety for use during pregnancy.
Some women may need more aggressive treatment of their migraine attacks during pregnancy and the expectant mother and her doctor may have to consider using a preventive medication that is safe for the baby.
