Migraines are very common in women of childbearing ages and can range from mild to debilitating. Many women feel that if they become pregnant or decide to breastfeed, that their options will be limited and they will have to live in severe pain for the safety of their baby. While some classes of medications can be problematic, there are many that can still be helpful and are safe during pregnancy and lactation. Below, you will find quick and concise information about your options.
Non-Pharmacological Options
Keeping a headache dairy is helpful in identifying triggers of migraines and determining if prophylactic medications are necessary. Non-pharmacological preventative measures that are simple should be considered for migraine prevention include:
- Prioritizing good sleep
- Eating regular meals and staying hydrated
- Daily walks/Exercise
- Wear presciption glasses if you are supposed to (avoid eye strain)
- Avoiding known triggers (including common dietary triggers)
- Migraine diary app (free: Migraine Buddy)
- Stress management and/or biofeedback daily (Insight Timer - free; Headspace – 14 day free app trial, also available on Netflix)
- Sunglasses with FL-41 tint ($50: Somnilight Migraine Relief Glasses)
- Pressure filtering earplugs if sensitive to barometric pressure changes (<$20: WeatherX. Use code campbell25 for 25% off)
- Nerve stimulator: Cefaly ($400) or Nerivio (Rx only, $50+, may be covered by medical or pharmacy insurance)
- Limiting the use of abortive medications to no more than 12 times per month to avoid the risk of medication overuse headaches/rebound headaches.
*These are non-sponsored recommendations. We have no financial affiliation with these companies.
Abortive medication options:
- Tylenol/acetaminophen (P2) OTC
- Reglan/metoclopramide (P2)
- Zofran/ondansetron (P2)
- Caffeine (limit to 200-300 mg daily) (P3) OTC
- Magnesium Sulfate (P2) OTC
- Lidocaine nerve blocks and trigger point injections (P2) (do not use bupivacaine in pregnant women)
Avoid triptans due to fetal malformations and adverse pregnancy outcomes. Fioricet/Butalbital is also not recommended.
Prophylactic medication options:
- Prozac/fluoxetine (P3)
- Labetalol (P3)
- Verapamil (P3)
- Magnesium Sulfate (P2)
Most OBGYNs or Family Medicine physicians will treat migraines proficiently. For additional resources and a list of providers who have added qualifications in headache medicine, visit https://headaches.org/resource-cat/headache-tools/.
Nichole Campbell, MSN, APRN, NP-C, AQH
Kaytlin Krutsch, PharmD, BCPS
