Chapter 7, Episode 1: Treating Migraine During Preconception, Pregnancy & Breastfeeding
This content has been medically reviewed by Ashley Holdridge, DO, and Andrea Murphy, MSN, APRN, ANP-BC, NEA-BC, AQH.
If you have migraine and are planning for pregnancy, it’s important to talk with your healthcare provider as early as possible. Together, you can review your current treatments, make any necessary changes, and create a care plan that is safe before, during, and after pregnancy.
Some treatments may need to be tapered, stopped, or switched before trying to conceive. For example, CGRP monoclonal antibodies and topiramate must be discontinued beforehand.
Be sure to tell your provider about all treatments you use, including prescription drugs, over-the-counter medications, and supplements, because some may not be safe during pregnancy or only safe during certain trimesters.
One important strategy for managing migraine is making lifestyle changes. Recommendations may include:
- Getting 7 to 9 hours of sleep each night
- Eating regular, balanced meals
- Drinking plenty of water
- Cutting back on caffeine
- And reducing stress whenever possible
These changes become even more important during pregnancy since treatment options are limited.
Even with these limitations, there are safe options, and your healthcare provider can help determine what’s best for you.
For acute treatment, potential options include acetaminophen, caffeine, diphenhydramine, neuromodulation devices, nerve blocks with lidocaine, or certain triptans. Anti-nausea medications may also be prescribed.
For prevention, possible options include magnesium, riboflavin, propranolol, amitriptyline, nortriptyline, nerve blocks with lidocaine, neuromodulation devices, cognitive behavioral therapy, and onabotulinumtoxinA injections.
Try to use acetaminophen on as few days as possible, no more than 10–15 days per month, and limit triptan use to fewer than 8–10 days per month. If it’s difficult to stay within those limits, your provider may recommend preventive strategies to help reduce the frequency of attacks and prevent medication overuse.
If you plan to breastfeed, check with your provider before starting or resuming any treatments you used prior to pregnancy.
Acute treatment options commonly recommended during breastfeeding include acetaminophen, ibuprofen, certain triptans, nerve blocks with lidocaine and neuromodulation devices. Metoclopramide may also be prescribed to help with nausea.
For prevention, commonly recommended options include magnesium, riboflavin, metoprolol, propranolol, and nortriptyline. Other possibilities for some patients include amitriptyline or onabotulinumtoxinA injections. Nerve blocks with lidocaine can also be continued after pregnancy if they were helpful.
With the right plan and help from your healthcare provider, you can manage migraine safely through preconception, pregnancy, and breastfeeding.
For more information, visit migrainedisorders.org
*The contents of this video are intended for general informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. AMD does not recommend or endorse any treatment, products, or procedures mentioned. Reliance on any information provided by this content is solely at your own risk.