There seem to be many opinions on the effect of pregnancy on migraines.
The general rule is that the effect is individual.
Practical experience suggests that migraines may be more challenging during the first trimester of pregnancy, when many changes occur in hormone function.
For many, the latter part of pregnancy can be an easy time regarding migraines.
Migraines with aura may even worsen.
As a completely unscientific observation, it can be stated that for some people, between the first and last child, even outside of pregnancies, migraines can be very calm.
Many report this.
Migraine treatment during pregnancy planning
New-generation subcutaneous biological migraine medications are long-acting.
Complete elimination from the body takes 4–7.5 months, depending on the medication.
Tablet-form medications (rimegepant and atogepant) are eliminated from the body within three days.
The difference is significant when considering stopping migraine medication and contraception.
Adjusting with conventional preventive medications is relatively simple – with the exception of valproate and topiramate, which should not be used in women of childbearing age.
Candesartan should be stopped at the same time as contraception.
Before stopping contraception, discuss your current medication with your doctor.
Migraine treatment during pregnancy
During pregnancy, the most recommended migraine treatment is non-pharmacological.
This includes regular meals, sufficient sleep, and exercise.
Massage or other manipulations of the neck and shoulder area and scalp do not harm the developing fetus.
Paracetamol has not been found to have adverse effects on the fetus.
A combination of paracetamol and codeine is used to some extent, but opiate-containing drugs are not ideal during pregnancy.
There is extensive experience with sumatriptan in the acute treatment of migraine during pregnancy, and no problems have been observed during over 30 years of use.
Ibuprofen is permitted after the first trimester, but it should not be used close to delivery, as it can hinder the development of pulmonary and arterial circulation.
Acetylsalicylic acid should not be used during pregnancy due to the risk of bleeding.
Preventive medications should not be used during the first trimester of pregnancy.
During the second and third trimesters, metoprolol and propranolol have proven safe, and metoprolol is better tolerated.
Migraine treatment during breastfeeding
All non-pharmacological treatments are permitted.
Sumatriptan is excreted into breast milk only in small amounts, so it can also be used during breastfeeding.
For preventive treatment, it is important to discuss suitable options with your doctor.
Summary
Especially for difficult-to-treat migraines, combining them with pregnancy can feel challenging, but fortunately, for most, pregnancy proceeds tolerably regarding migraines.
Markku Nissilä, specialist in neurology
Frequently asked questions about migraines during pregnancy
Does pregnancy affect migraines?
For most, migraines ease during pregnancy, but for some, symptoms may worsen, especially in early pregnancy.
Can migraines be treated during pregnancy?
Yes. Non-pharmacological treatment is primary. Paracetamol and sumatriptan are proven safe options.
What medications should be avoided during pregnancy?
Ibuprofen is not recommended in late pregnancy, and acetylsalicylic acid should not be used due to the risk of bleeding.
Is migraine prevention possible during pregnancy?
Preventive medications are not recommended during the first trimester. In later stages, metoprolol is a safe option.
Can sumatriptan be used during breastfeeding?
Yes, it can. It is excreted into breast milk in very small amounts.
Read more and find natural help
Many factors affect migraines – including neck muscle tension and stress.
Learn about the Atlas Care device, which relaxes the muscles at the base of the skull and alleviates symptoms of migraine and tension headaches.