Acute migraine therapy in pregnancy – triptan is the safest choice.
Two out of three women stop having migraines during pregnancy, especially in the second and third trimester. The difficult question is how to treat migraines in the first trimester and in women whose migraines do not improve or get worse in pregnancy.
Acetaminophen (Tylenol, paracetamol) is considered safe in pregnancy and that is what many women take for migraines and other pains. Unfortunately, acetaminophen is usually ineffective for severe migraines. It is also not as safe as many physicians and the general public thinks. Several studies indicate that acetaminophen increases the risk of attention-deficit hyperactivity disorder (ADHD) and with heavy use, possibly even autism spectrum disorder.
Some obstetricians strongly advise against taking any migraine medications. However, the stress of an acute migraine attack with severe pain, vomiting, and dehydration is likely to have a deleterious effect on the fetus. A Danish study of 22,841 pregnancies among women with migraine showed that untreated migraine leads to an increased risk of low birth weight, preterm birth, and cesarean delivery.
The study used the data from the Norwegian Mother, Father and Child Cohort Study, linked to the Medical Birth Registry of Norway, the Norwegian Patient Registry, and the Norwegian Prescription Database using the mother’s personal identification number. The conclusion of this large and rigorous study was: “This cohort study found no association between prenatal triptan exposure and ADHD diagnosis or ADHD symptoms at 5 years of age. This study adds to the growing literature on the safety of triptan use during pregnancy and expands it to an important neurobehavioral outcome.”
Triptans have been available without a prescription in all European countries for over a decade. In the US, triptans are available only by prescription. This is one of the reasons for the perception of acetaminophen as being more benign than sumatriptan and other triptans. The opposite is likely to be true. If you are a pregnant woman suffering from severe migraines, ask your doctor for a prescription for sumatriptan.
Unfortunately, we don’t know what amount is safe in pregnancy. We do know that medication overuse from triptans is much less common than most doctors believe. Here is one of my several blog posts on this issue.
Hi,
Thank you for writing this. I am currently 12 weeks pregnant and unfortunately suffering very frequent and severe migraines. In my last pregnancy, I had my migraines, which are usually chronic, disappeared entirely for the entire nine months. I was hoping that would happen this time, but it hasn’t sadly. Im wondering – what is the limit on how much imitrex is safe in pregnancy? My neurologist limits me to twice per week but said this is due to medication overuse, not for the safety of my baby.
Thank you for your comment. I’ve had patients buying eletriptan without a prescription in Italy. One woman went from pharmacy to pharmacy buying it up because it is a lot less expensive than in the US. In different countries, different triptans are available without a prescription.
Good morning,
Chronic migraine sufferer, I appreciate your site tremendously. It gives a solid basis for my discussions with my general practitioner and neurologist. I live in France and I must say the French neurologists are very much not interested in migraine, the last one I saw looked up a reference about candesartan in her old university textbook, that dated from at least ten yers ago! In France the CGRP inhibitors are considered as not providing a significant progress compared to the usual prophylaxis suspects as propranolol, topiramate etc. Desperate French migraineurs go to Belgium and Switserland and pay their travel and very expensive medication themselves, as no insurance covers the costs in France.
I rely heavily on relpax myself, and luckily I still get relief after more than 20 years of 6to 14 relpax per month..
but the reason I picked up my pen is the following in fact : I just want to put to your attention, regarding your remark that triptans are freely available all over Europe, that triptans are not an over the counter medication. In France, the Netherlands and Italy my experience is that you definitely need a prescription.
My sincerest thanks for your very useful website, it is great help for me.
Kindest regards