Excedrin migraine while pregnant

If you’re pregnant, it may be difficult to keep track of the different drugs you should avoid. Trying to understand the complexities of these substances and what they can do to your body or unborn child can induce stress.

Luckily, the Food and Drug Administration made this process easier by categorizing drugs based on their risk to pregnancies. These categories are labeled A, B, C, D, and X. Category A includes drugs that are safe to take during pregnancy, while Category X contains substances that should never be taken while pregnant.

  • Category A
    • Research indicates that these drugs show no evidence of risk to the fetus throughout a pregnancy. Many multivitamins taken during pregnancy fit into this category.
  • Category B
    • If a clinical need must be met, substances in this category are considered safe to take during pregnancy. These drugs include acetaminophen, found in Tylenol, and amoxicillin.
  • Category C
    • These substances can be risky to take during pregnancy. If these drugs are given to pregnant women, the potential benefits should outweigh the potential risks. Category C drugs include aspirin, saccharine and gentamicin.
  • Category D
    • Studies show that these substances could harm the fetus. Despite these health risks, some pregnant women still take these drugs, which include tetracyclines and ACE inhibitors, for the potential benefits.
  • Category X
    • Because these drugs demonstrate clear risks to the fetus, they are contraindicated in women who are or could become pregnant. Category X substances include Lipitor and oral contraceptives.

Fioricet is a Category C substance. As a Category C drug, Fioricet has caused adverse effects in animal studies but not human studies, or no controlled animal or human studies involving the substance exist.

However, Drugs.com states that an infant could be born dependent on Fioricet because of the presence of butalbital. Babies born dependent on drugs experience painful withdrawal symptoms and often remain in the hospital for several weeks.

When taken during pregnancy, barbiturates like butalbital can also increase the risk for birth defects or bleeding problems in newborns. One study even suggested that barbiturate use during pregnancy can increase the chance of brain tumors in infants.

Some versions of Fioricet contain codeine, an addictive opioid. Fioricet with codeine can result in the mother becoming addicted to the medication and the baby being born with neonatal abstinence syndrome.

Women should be cautious of taking Fioricet during pregnancy. While studies have not indicated harm in humans, more research may be needed on the benefits and risks of taking the medication while pregnant.

Contents

Migraine And Pregnancy: What Moms-to-Be Need To Know

Migraine & Moms-to-Be: Making The Right Treatment Choices For Your Baby

Over 25% of women experience migraine during their lifetime, and hormone fluctuations, especially changes in estrogen levels, can have a big impact on the frequency and intensity of migraine attacks. That’s especially true of the hormonal changes that accompany pregnancy. If you are pregnant or plan to become pregnant soon, what do you need to know?

Pregnancy can have a significant impact on migraine symptoms and how women should treat them. Here’s what experts have to say.

First, the good news: Between 50 and 80% of pregnant migraine patients actually experience a reduction in migraine attacks during their pregnancy, according to David Dodick, a professor of medicine at the Mayo Clinic School of Medicine in Arizona. Many doctors believe rising estrogen levels help reduce migraine frequency and intensity. Hormone replacement therapy that mimics pregnancy’s effect on the body is increasingly being used in migraine treatment plans, especially for those who experience migraines around the time of menstruation. Caution does need to be used however in women who have migraines with aura, as the increased risk of stroke may further be increased by the addition of an estrogen-containing oral contraceptive pill.

However, some women experience migraine for the first time during pregnancy and some experience an increase in migraine symptoms especially during the first trimester. The appearance or worsening of migraine in pregnant women should be taken very seriously: Studies show that migraine symptoms, when accompanied by high blood pressure, can increase the risk of developing preeclampsia or other vascular complications. Women whose migraine symptoms don’t decrease during pregnancy should be particularly vigilant. It’s important to work with your obstetrician and your headache doctor when you have migraine to establish a safe treatment plan.

Although doctors generally advise pregnant women to avoid medications when possible, two-thirds of women take medications during pregnancy, and 50% take them during the first trimester. If you are pregnant or plan to become pregnant, you may need to reevaluate your migraine treatment options. Here’s what some experts recommend:

  1. Identify and avoid your triggers. Experiment by avoiding foods like chocolate, caffeine, and processed foods, to see if it affects your migraines.
  2. Make sleep a priority. Follow consistent sleep and wake times. Purchase and practice using earplugs and a sleep mask, if necessary. Use good sleep hygiene.
  3. Stay hydrated. If you’ve ever gone to the emergency room with a migraine, you’ll remember that the first thing they do is to administer intravenous saline to combat dehydration. Your body needs far more water when you’re pregnant. Keep drinking, and consider incorporating electrolyte-rich supplementary fluids like Pedialyte.
  4. Have a treatment plan—and a backup plan. What medications work for you, and when and how do you take them? What non-pharmaceutical treatments offer you relief? It’s good to become familiar with and discuss pain plans and pain medications with both doctors before you need them.

Migraine Medication and Pregnancy

What migraine medications are safe to take during pregnancy?

The Food and Drug Administration (FDA) sorts migraine treatments into various safety categories. The FDA classifies both prescription and non-prescription drugs into various categories based on each medication’s potential to cause birth defects. will allow you to look up the FDA pregnancy safety of medications that may be used to treat or prevent migraine.

As with any treatment plan, it’s essential that you consult with a doctor before moving forward. If you are a migraine patient and are expecting a child, make an appointment with your physician to discuss the best course of action.

Pregnancy and Migraine Medications

Pregnancy is a step into the unknown. It can be the most wonderful time in a person’s life, but it can also be intimidating. For women living with migraine disease, contemplating pregnancy can be downright frightening.

I always assumed I would not have children. Motherhood and pregnancy seemed like an unthinkable undertaking to someone experiencing daily migraine since the age of four. But very suddenly, after 26 years of perfecting various migraine strategies and medications, I won my personal migraine battle. This was so life-changing for me that after a month without daily migraines I noticed flowers were beautiful for the first time. Four years later, I got up the courage to become pregnant. In truth, I was practically paralyzed with fear.

I had heard a number of rumors about migraine and pregnancy. Many women reported their migraine disease improved, but I was skeptical. The medical literature reports that the vast majority of women (80-90%) experience some relief during pregnancy. For some, their migraine symptoms disappear completely. However, it has been reported that up to 35% of women experience migraine attacks during pregnancy, and 26% of those report that attacks in the first-trimester cause moderate to severe disability. During my first pregnancy with my daughter my migraine attacks got worse; bad enough that my doctors performed a C-section slightly early at 38 weeks. But, something possessed me to go back for more. In my second pregnancy, my migraine disease almost disappeared for the entire nine months, and I had my son.

Last month, in an article on breastfeeding and migraine medications, I pointed out that our culture puts a lot of pressure on breastfeeding mothers to avoid medications. The stigma and cultural pressures are even more prevalent for expectant mothers. Studies have demonstrated that not just pregnant women, but also their healthcare providers tend to overestimate the risks associated with using medications during pregnancy.

In one of the few studies conducted on this topic, it was shown that 70% of pregnant women with migraine use some sort of medication. Nine out of ten pregnant women with migraine deliberately avoid migraine medication despite needing it on one or several occasions. Women also report purposely not adhering to a medication regimen prescribed by their physician for migraine during pregnancy stating concerns about the possible effects on their baby. A recent medical article indicated that many pregnant women who arrived in the emergency room with status migrainosus (a migraine attack lasting longer than 72 hours) had not taken any migraine medication at home to avoid this severe problem. The authors of the paper suggest that this was very likely due to fear of taking medicines in pregnancy.

The simplest rule to follow in pregnancy is to limit medications as much as possible. However, many women force themselves to endure quite a bit of illness, pain, and suffering thinking they are doing what is best for their unborn child. Choosing to avoid treating migraine disease altogether is not a good idea, particularly for women with frequent or severe attacks. Uncontrolled migraine during pregnancy can easily lead to consequences that are bad for both mom and baby. Migraine exacerbates sleep problems, increases stress, and can lead to depression and negative mood. It also causes dehydration and poor nutrition, particularly if nausea and vomiting are involved. Active migraine during pregnancy has actually been associated with certain vascular problems. Never assume that allowing yourself to be sick and in pain is the best scenario for you or your unborn child.

Most often, women are advised to discontinue use of their prophylactic migraine medications when they become pregnant. This keeps the baby from being exposed to medicine while mom determines if pregnancy itself will ameliorate her migraine pattern. This transition can be difficult and is likely different for everyone. What does medical science actually have to say about the dilemma of migraine medicines and pregnancy? If you find that you are unable to stop your preventive medicines, or that your migraines continue in pregnancy, there are options available to you.

NON-PHARMACOLOGICAL STRATEGIES

The diversity of migraine disease makes it impossible to cover all problems, strategies, and medications for migraine during pregnancy in this article. It is important to have a health care provider who understands you and your migraine disease and can openly discuss your options. If you do not have this type of provider, empower yourself to go find one.

It is possibly more important during pregnancy than at other times in your life to maintain all your non-medication anti-migraine strategies. Prepare yourself for excellent self-care and know that the nutritional, behavioral, and mental tricks you’ve always used to keep yourself healthy may need to be updated for a few months. This article will focus on pharmacological migraine treatments for expectant mothers who may need it.

HOW THE FDA RATES THE SAFETY OF MEDICATIONS FOR USE IN PREGNANCY

When contemplating the use of a medication during pregnancy it is important to understand the code the FDA uses to rate the safety of medication during pregnancy. The FDA pregnancy categories 5 (modified for easier reading) are as follows:

Category A

Adequate and well-controlled studies have failed to demonstrate risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).

Category B

Animal reproduction studies have failed to demonstrate risk to the fetus and there are no adequate and well-controlled studies in pregnant women.

Category C

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but Potential benefits may warrant use of the drug in pregnant women despite potential risks

Category D

There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Category X

Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.

MEDICATIONS FOR THE ACUTE TREATMENT OF MIGRAINE

Acetaminophen and NSAIDs

Beginning with the simplest and safest medication options, acetaminophen (or Tylenol, pregnancy category B) is considered the first line of therapy to control pain in a pregnant female. If you are lucky enough to have Tylenol on your list of effective migraine strategies, leave it on the list.

NSAIDs (such as ibuprofen, pregnancy category B during the first two trimesters, category D in the third) have some risks that are dependent on trimester. Mainly, maternal ingestion of NSAIDs during the third trimester of pregnancy has been linked to premature closing of the ductus arteriosus. This is a vessel that allows most of the blood from the fetal heart to bypass the lungs because they are non-functioning and filled with fluid until birth. Data shows that the second trimester is the safest time for women to use NSAIDs, and it is not uncommon for physicians to prescribe treatment plans that include NSAIDs in this timeframe. A number of studies have evaluated a possible effect of NSAID use in the first trimester on miscarriage and congenital malformations. At this time the findings on this topic are not conclusive. If NSAIDs are an important part of your migraine treatment plan, discuss with your healthcare provider the option of using them during only certain timeframes during your pregnancy.

Triptans

Studies on triptan (pregnancy category C) use during pregnancy has been fairly reassuring. For pregnancies where triptan use is needed, sumatriptan (Imitrex) is usually the first triptan to be prescribed. Sumatriptan has been available longest and has the most safety data. Other triptans have not been shown to be harmful, but they have rarely been studied. It has been hypothesized that the vasoconstricting action of triptans could cause harm to an unborn fetus. However, studies have investigated outcomes including miscarriage, congenital malformations (physical defects present at birth), prematurity, and low birth weight and found no conclusive evidence of adverse effects. Sumatriptan is also helpful because it can be used by women with cluster headache during pregnancy.

Opioids and ergot alkaloids

Some people use dihydroergotamine (DHE) as a rescue treatment for their migraines. Unfortunately, ergot alkaloids like DHE are contraindicated in pregnancy (category X) due to their ability to cause vasoconstriction of the uterus. Studies have linked the use of these medications during pregnancy with low birth weight and preterm birth. Opioids are not considered an effective treatment for migraine and are rarely prescribed as a rescue treatment in this setting. A large study found a link between the use of opioids in early pregnancy and certain fetal problems; however, the study had some methodological limitations. If necessary, short-term use of opioids in pregnancy is a possibility. However, this is not are not a common strategy used in migraine.

PREVENTIVE OR PROPHYLACTIC MIGRAINE TREATMENT IN PREGNANCY

Beta-blockers

Beta-blockers have long been considered a good migraine prevention option in pregnancy. There is evidence showing an association between the use of beta-blockers during pregnancy and complications including babies born small for gestational age, preterm birth, and perinatal mortality (fetal death around the time of birth). However, many believe it is underlying hypertension in the mothers that may lead to these associations, not their use of beta-blockers. Women in these studies were more commonly prescribed beta-blockers for hypertension than for migraine. One beta-blocker in particular (oxprenolol) has been associated with orofacial defects (like cleft lip and cleft palate), cardiovascular (of the heart and blood vessels), and neural tube defects (structural problems of the brain and spinal cord). However, oxprenolol is rarely prescribed. If preventive treatment is needed during pregnancy, beta-blocker is commonly chosen as the first line of therapy. The metabolism of some medications is increased in pregnancy and metoprolol (pregnancy category C) is one of these. It may take a higher dose to achieve efficacy in pregnancy than at other times in a woman’s life. Newborns born to moms on beta-blocker therapy should be monitored for possible complications including slow heart rate, low blood pressure, and hypoglycemia. Unfortunately, other anti-hypertensive medications sometimes used for migraine like ACE inhibitors and calcium channel blockers are either contraindicated or not commonly prescribed in pregnancy due to documented adverse effects to the fetus. If these are an important part of your migraine prophylaxis it is best to discuss another option with your prescriber.

Anti-depressants commonly used in the setting of migraine

Amitriptyline (pregnancy category C) is often considered the next choice after beta-blocker for treating migraine in pregnancy and has the most supporting data for treatment of migraine in pregnancy of any of the anti-depressants. Like metoprolol, amitriptyline is a medication that could require a higher dose in pregnancy in order to be effective. There is a very small amount of data on use of this medication during the third trimester that suggests possible associations between amitriptyline and preterm birth, breathing trouble after birth, and hypoglycemia (low blood sugar). But there have not been enough studies to form conclusive evidence.

Anti-epileptic medications used for migraine

Valproate (pregnancy category X) is considered effective in the setting of migraine; however, it is contraindicated in pregnancy. It has been very clearly linked with birth defects like neural tube defects and cleft palate. Its use in late pregnancy has also been associated with autism, impaired cognitive function, and reduced intelligence. For these reasons this medication is often not prescribed for migraine to women of childbearing age even in the absence of pregnancy.

Topiramate (pregnancy category D) use in early pregnancy has been associated with oral cleft abnormalities in newborns. If topiramate is a crucial part of your treatment plan, it is important to have a conversation with your physician about modifications or replacements in your prescribing plan.

Botox

There is not much data available to guide us on the use of Botox (pregnancy category C) in pregnancy. But it has not been associated with any adverse events in the fetus. Well-controlled trials have not been conducted for this medication in pregnancy; however, there is a case report of a woman who started Botox for migraine in her 18th week of pregnancy. Her child was followed for 6.5 years with no adverse events. Botox has been placed in category C predominantly due to the fact that there is so very little data available on its use in pregnancy.

Anti-CGRP Medications

The first anti-CGRP medication (erenumab or Aimovig) has only been available for a year. The pregnancy category for this class of medications is currently listed as “Not Assigned”. At this time, these medications are generally not being prescribed to expectant moms or women who plan to become pregnant. CGRP is a neurotransmitter that research has shown plays a role in blood flow to the uterus and placenta, and is important in fetal development8,9.

Magnesium and Riboflavin

Some women take magnesium or riboflavin supplements as part of their anti-migraine regimen and both have some data showing they can be effective.

Magnesium has been used extensively in pregnancy, particularly in antacids and in the treatment of preeclampsia (a serious condition of hypertension during pregnancy). There is a follow-up of their children extending as long as 11 years. It is considered safe. Riboflavin, on the other hand, has no data on fetal risk and is not recommended in pregnancy.

Treatments for status migrainosis

If possible, it is always best to work out a treatment plan with your healthcare provider for migraines during pregnancy that will help you avoid developing status migrainosis (a migraine lasting over 72 hours). Status migrainosis is stressful on the system and can lead to dehydration. If you do find yourself with this type of severe migraine during pregnancy, a recent paper indicates that the best options for you may be either nerve blocks with lidocaine or intravenous metoclopramide.

Metoclopramide (pregnancy category B) is a medicine that was originally used to treat nausea and vomiting in pregnant patients. However, it was discovered that it also improved pain from migraine.

Feeling anxious about how to treat your migraines while pregnant is normal. It is best to foster a good relationship with your provider and form a pregnancy and migraine plan early on. This can decrease the stress on you and your baby by keeping you healthy.

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  3. Yallampalli C, Chauhan M, Sathishkumar K. Calcitonin gene-related peptides in vascular adaptations, uteroplacental circulation, and fetal growth. Curr Vasc Pharmacol 2013 Sep:11(5):641-54.

MEET THE AUTHOR

Dr. Lindsay Weitzel experienced chronic daily migraine from the time she was four years old until she was thirty. Her constant migraine attacks caused enough damage to give her complex regional pain syndrome (a ceaseless pain like burning fire) down the right side of her face, head, neck, and arm. Lindsay believes that having no memory without daily pain gave her a unique perspective on living with and fighting off her disease.

Lindsay has a Ph.D. in Analytical Health Sciences and a Master’s degree in Nutrition. She works full-time as a Migraine Strategist and has opened a clinic dedicated to improving the lives of people suffering from chronic migraine. She also works as a Migraine Medical Writer and published a graphic novel for kids and adventurous adults with migraine called Super Zoe the Migraine Hero, available on Amazon. Lindsay is the founder of a FaceBook group for migraine patients called MigraineNation, Headquarters For Those With Chronic Migraine. You can also see more about Lindsay on Facebook or contact her through her webpage.

Find more of Lindsay’s blog posts here.

Pregnancy and breastfeeding

Migraine in pregnancy

Hormonal change in women is a common trigger for those prone to migraine. This is often shown in pregnancy when the sex hormone levels show profound changes which has an effect on whether your migraine get better or worse. Oestrogen sometimes reaches one hundred times the normal level, whilst progesterone levels decrease, rising again towards the end of the pregnancy. However, the fluctuation of levels is not as pronounced as during the non-pregnant state, which may be why migraine often improves during pregnancy. This improvement may also be due to the increased levels of natural pain-killing hormones (endorphins). These are several times higher during pregnancy, and though the relief from migraines they provide might last the whole pregnancy, the levels settle back down after delivery, normally allowing migraine attacks to recur.

However, it is not always the case that your migraine will improve, especially in the early weeks of pregnancy. For some women, migraine can go on unchanged, or more rarely even get worse. During breastfeeding, stable oestrogen levels may be protective against having headache again after pregnancy.

Planning a pregnancy

If you are taking regular medication for your migraine and are planning a pregnancy, you should see your doctor for advice on the management of your migraine before and during pregnancy, after the birth and while you breast feed.

Migraine without aura in pregnancy

Studies show that migraine without aura improves after the first three months of pregnancy for about 60-70% of women. This is the case especially if your migraine has been linked to your menstrual cycle.

Migraine with aura in pregnancy

If you experience migraine with aura you are more likely to continue to have attacks during your pregnancy. Also if you experience migraine for the first time while you are pregnant it is likely to be with aura.

If you do think you are experiencing migraine for the first time whilst you are pregnant it is important to visit your GP so the causes for your head pain can be found and treated if necessary. Pre-eclampsia and other more serious causes of headache can have symptoms similar to migraine.

Conventional medication and pregnancy

If you are taking any prophylactic (preventive) treatments you should discuss stopping these or switching to a safer alternative with your doctor. It is advisable to take as few drugs as possible in the lowest effective dose and ideally all drug treatments should usually be avoided whilst you are pregnant.

Most of the evidence for the safety of drugs in pregnancy is circumstantial as drugs cannot usually be tested on pregnant or breast feeding women for ethical reasons. This means the advice regarding drug treatments for migraine in pregnancy will usually err on the side of caution.

During pregnancy and breastfeeding the preferred treatment strategy should always be a non-pharmacological one. Nevertheless, poorly controlled headache can lead to stress, sleep deprivation, depression and poor nutritional intake which in turn can have negative consequences for mother and baby. Therefore, if non-drug options become inadequate, a considered choice should be made concerning the use of medication, taking into account all the benefits and possible risks, in consultation with your doctor. A general rule should be to aim for the lowest effective dose and the shortest duration of treatment.

For treating a migraine attack as it begins, paracetamol is the drug considered safe during pregnancy and breast feeding. This should be taken in soluble form at the earliest signs of an attack, preferably together with something to eat. Aspirin has been used by many pregnant women in the first and second terms of pregnancy. Aspirin should be avoided nearer to the expected time of the birth as it can increase bleeding. Ibruprofen should not be taken in doses over 600mg per day.

Considerable data is available on the use of sumatriptan in pregnancy. A few large pregnancy registries covering more than 3,000 pregnancies, have analysed the use of other triptans, in particular rizatriptan, zolmitriptan and eletriptan and found no major congenital defects. The risk of major malformations has been reported as similar to the risk in the general population.

If you need anti-sickness drugs for your migraine, the following have been widely used in pregnancy without evidence of harm: buclizine, chlorpromazine and prochlorperazine. Domperidone and metoclopramide are safe in pregnancy, but they are probably best avoided in the first three months. Again, you will need advice from your doctor on what is best for you.

If none of these approaches work, it would be worth speaking to your doctor about a greater occipital nerve injection, which is a small injection of a local anaesthetic and steroid which is injected into the back of the skull, underneath the skin into the muscle around a large nerve which is involved in headache disorders. This is a quick procedure which can provide short to medium term relief, and can be organised through a headache neurologist. It is safe in pregnancy.

For preventive treatment, the lowest effective dose of propranolol is considered to present the lowest risk in pregnancy and breast feeding. Prolonged use may have adverse effects on the baby. Amitryptiline is a safe alternative, and there are no reports of adverse outcomes using pizotifen in pregnancy and breast feeding. Increasingly transcranial magnetic stimulation using the SpringTMS device is being used for migraine treatment and prevention, and has been deemed safe during pregnancy and breastfeeding by the European and American bodies.

The first three months of pregnancy

During the first three months the symptoms of pregnancy can make your migraine worse. Morning sickness can mean that you feel like eating and drinking less which can cause low blood sugar and dehydration. If you are not careful this can make your migraines worse. You should try to eat small frequent meals and drink frequent small amounts of water to prevent this. You will also be helping reduce any pregnancy sickness.

After the birth

For some women migraine returns with the return of their periods (see our menstruation information). Some mothers find they have a bad attack within a couple of days of giving birth. This may be due to the sudden drop in oestrogen levels after the birth. Exhaustion, dehydration, erratic sleep and low blood sugar after giving birth may all play a part.

Migraine and your baby

There is no evidence that migraine (with or without aura) has an effect on the outcome of the pregnancy. Migraine in a mother does not harm or endanger her baby.

Breastfeeding

If you breast feed your baby it is still best to avoid medication as far as possible because the baby will be taking whatever you take through the milk. The same drugs used in pregnancy can be taken whilst breastfeeding with the exception of aspirin. The aspirin which enters the breast milk could impair blood clotting in susceptible babies and so is best avoided.

If you need to take aspirin or other non recommended medication, such as the anti sickness drug metoclopramide, whilst you are breastfeeding it is best to not to breastfeed for 24 hours after the last dose. Ideally, keep some expressed milk in the freezer for such occasions; otherwise you will need to give formula milk. Although you may feel too unwell to do so, it is best to express milk at the usual feeding times but this will need to be thrown away. This can help ease discomfort as the breasts become engorged with milk and will help to prevent milk production diminishing.

Sumatriptan use in breastfeeding is considered safe as minimal amounts of the drug are available in the breastmilk. Less evidence has been collected on the other triptans and as such breastmilk may be best discarded if breastfeeding 24 h after use of these triptans as extra safety precaution.

Complementary and alternative medicine

Many women prefer to take complementary and alternative medicines such as homoeopathic and herbal remedies rather than traditional medicines whilst they are pregnant, considering them to be milder. It is important to remember some complementary treatments can have an unwanted effect on your pregnancy just as conventional medicines can. For instance, some women find aromatherapy massage very helpful, and may be unaware that some essential oils (rosemary for example) need to be avoided. Reflexology treatment is not always advisable during pregnancy, and all complementary medicines should be taken under supervision of a qualified practitioner. Feverfew should not be used during pregnancy.

Non-drug treatments certainly can be helpful, and massage, acupuncture, relaxation and biofeedback have been found to be useful by some. Some women also find applications of heat or cold to the head can be useful.

Conclusion

The best advice is to take as few drugs as is practically and realistically possible for you, and at the lowest effective dose. The use of any drugs or herbal remedy to treat your migraines during pregnancy and whilst breast feeding is a balance of risk and benefits. Always remember that if you are getting more than 2 or 3 headaches a week you should discuss this with your doctor rather than take over the counter painkiller as it is possible to develop a condition known as ‘medication overuse headache’. Any medication you do take should be recorded in your pregnancy notes.

As far as you can: rest and that way avoid becoming over-tired. Not everyone is able to stop and go to bed, but planning ahead, setting a regular routine and delegating work or household tasks whenever possible can often help.

Useful contacts

  • The Breastfeeding Network www.breastfeedingnetwork.org.uk

Can You Take Excedrin When Pregnant?

Find Out Which Headache Medicine Is Right for You

AndreyPopov/iStock/GettyImages

When a bad headache—or worse, a migraine—afflicts you when you’re pregnant, you may wonder if relief is even possible. Medications do exist that are safe to take while pregnant, but experts debate as to whether Excedrin is one of them. A popular pain reliever, Excedrin comes in several different varieties, including Extra Strength Excedrin, Excedrin Migraine and Excedrin Tension Headache. Each variation of Excedrin contains some or all of the following ingredients: acetaminophen, aspirin and caffeine. Find out which, if any, Excedrin products are OK for you.

To Take or Not to Take

Acetaminophen is regarded by physicians as safe to take during pregnancy. However, aspirin, which is also found in Excedrin varieties, is associated with Reye’s syndrome. Reye’s syndrome is a rare disorder that most typically affects children, causing brain and liver damage. While aspirin is placed in category C by the FDA for pregnancy, which means that not enough testing has occurred to rule out negative effects, occasionally, your doctor may recommend a category C medication when the benefits outweigh the risks. However, the aspirin found in Excedrin is considered to be in pregnancy category D if taken during the third trimester, which means testing has revealed a proven risk to the developing baby. Therefore, doctors recommend not taking Excedrin products that contain aspirin, particularly in the third trimester.

Alternative Medications

Instead, consider unadulterated acetaminophen for headaches or Excedrin Tension Headache, which omits aspirin as an ingredient altogether. Caffeine is still present in Excedrin products, and while pregnant women should limit their intake of caffeine, in small amounts, it’s considered acceptable. Consult your doctor as to whether she recommends any form of Excedrin given the potential—and even serious—drawbacks.

Natural Approaches

You can also combat headache and migraine pain by using a natural approach. Try a cold ice pack, which works better than heat on migraines. Additionally, massage and other relaxation techniques such as tai chi can work wonders in reducing stress associated with tension headaches. Peppermint and lavender oil offer added benefits when used in conjunction with a gentle massage. Finally, consult your doctor about taking supplements, such as magnesium, and herbs like feverfew and butterbur, as natural alternatives during pregnancy.

It can be tough to navigate all the aches and pains of pregnancy while also keeping your growing baby safe. Here’s what to know when your head is throbbing and you’re desperately searching for relief.

What could be causing your headache

“It’s absolutely essential to figure out the cause of the headache before attempting to treat it,” said Dr. James Bernasko, Director of the Regional Perinatal Center at Stony Brook Children’s Hospital. Pregnancy headaches can range from “the merely inconvenient to the actually life-threatening,” so context is particularly important, Bernasko added.

Possible causes include:

  • Fatigue
  • Stress
  • Eye strain
  • Dehydration
  • Nasal congestion
  • Hormonal fluctuations
  • Caffeine withdrawal
  • Migraine
  • Preeclampsia

If you have a family history of high blood pressure, stroke, or aneurysms, or you are experiencing the “worst headache of your life,” call your provider immediately, Bernasko said.

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What could help your headache

Non-pharmacological options

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“Sometimes, something as simple as chocolate can trigger a headache” during pregnancy, so it’s worth testing out a few non-pharmacological remedies first, Bernasko said. If you’re suffering from chronic headaches, consider acupuncture or biofeedback, a technique that allows you to channel and dissipate your pain.

Things to try:

  • Warm compress on the face (sinus headache)
  • Cold compress on the back of the neck (stress headache)
  • Meditation
  • Massage

Over-the-counter medication options

Tylenol

Tylenol, sold as the generic acetaminophen, is “the safest headache medication” during pregnancy and is not associated with any known birth defects, according to Bernasko. However, you should avoid taking more than 1500 milligrams within 24 hours as overuse can damage your liver.

Ibruprofen, aspirin, naproxen (NSAID)

This group of pain relievers is known as NSAIDs (non-steroidal anti-inflammatory drugs). They should only be taken after consulting with your doctor, as prolonged use can irritate the stomach and affect blood flow in the baby’s heart, Bernasko said.

However, “if Tylenol hasn’t worked for you in the past… you can take one pill of any of and then reach out to your provider,” Bernasko said. The bottom line: NSAIDs are “not something you should take multiple times without your provider knowing.”

Caffeine

“During some types of headaches your blood vessels enlarge… Caffeine can help stop this action” because it constricts your blood vessels, wrote Dr. Talia Gates, an OB/GYN in Jasper, Alabama, in an email to TODAY. Gates recommends combining Tylenol and a caffeinated drink for dual relief.

Yet as Bernasko points out, caffeine withdrawal or overdose could have caused your headache in the first place, so make sure to factor in how much you’ve already consumed.

Prescription options

Narcotics, also known as opioids, are “everywhere now,” Bernasko said, so it can be tempting to pop one for a headache. However, these medications can be addictive and “should only be taken under direct medical supervision,” Bernasko explained. Additionally, prolonged use of narcotics can cause your baby to develop neonatal abstinence syndrome and undergo a painful withdrawal process after birth.

Narcotic analgesic combinations, which contain acetaminophen or an NSAID in addition to an opioid, pose similar risks. Yet if your over-the-counter options are falling short, your doctor may suggest one of the “safe medications” within this group, said Gates.

Triptans (migraine medication)

If you’ve already been prescribed a triptan for migraines, it’s safe to continue using during pregnancy, Bernasko said. Otherwise, consult your doctor to find the right medication for your symptoms.

Migraine drugs don’t up birth defect risk: study

NEW YORK (Reuters Health) – A study in nearly 70,000 pregnant women has found no link between migraine drugs called triptans and the risk of birth defects.

However, the researchers did find a “slight increase” in the risk of excessive bleeding during labor, and the failure of the uterus to contract normally after delivery, for women who used the drugs while pregnant.

Triptans are among the most powerful drugs used for migraine; others include aspirin, Excedrin, and ibuprofen.

While as many as three in 10 women may develop migraines during their childbearing years, women often shy away from using such drugs during pregnancy because of safety concerns, according to study co-author Katerina Nezvalova-Henriksen of the University of Oslo in Norway and her colleagues.

However, the authors of the study in Headache note, untreated migraine may itself carry risks for mother and child; some studies have linked it to pre-eclampsia, a potentially deadly pregnancy complication.

“While it is important to exert caution when using any medications during pregnancy, this study indicates” that pregnant women can either start or continue taking triptans without “any major risk” of miscarriage, premature delivery, or other bad outcomes, the authors conclude.

Less than one percent — 373 women — had used the drugs before getting pregnant but not during pregnancy.

The overall birth defect rate, which encompasses everything from large birthmarks to serious heart problems, was the same among women who had taken triptans during pregnancy and those who didn’t have migraines: 5 percent. Among those who had used triptans in the past but not during pregnancy, it was slightly higher: 6 percent.

The women who used triptans were also more likely than non-triptan users to take other drugs during pregnancy, including acetaminophen (Tylenol) with codeine and non-steroidal anti-inflammatory drugs such as ibuprofen.

However, the rate of major birth defects – such as serious problems of the limbs or internal organs — was 3 percent for all three groups. That rate – about one in 33 births – is about what would be expected for all birth defects in the general population.

The researchers did find that women who used triptans in their second or third trimester were more likely to develop a condition called atonic uterus, in which the uterus fails to contract back to its normal size after delivery. This is the leading cause of excessive bleeding after delivery. They were also more likely to lose significant amounts of blood during labor and delivery.

And during pregnancy, they were more likely to suffer from vomiting than women who had never used the drug; they were also more likely to develop pre-eclampsia or eclampsia, and more likely to have deficiencies in the B-vitamin folate.

While many women who suffer migraines will experience improvements in their symptoms after their first trimester, Nezvalova-Henriksen and her team note, those whose symptoms don’t improve by then aren’t likely to get better.

“Although the findings are reassuring, confirmation in independent studies is warranted,” the researchers conclude.

SOURCE: Headache, online January 28, 2010.

Our Standards:The Thomson Reuters Trust Principles.

Headache and migraine remedies that are safe during pregnancy

Most women deal with headaches at some point in their lives. Data from the Centers for Disease Control and Prevention suggest that one in five women had a severe acute headache or migraine in the previous three months. Additionally, migraines are more common in women than men – approximately 18 percent of women have them compared to 6.5 percent of men.

Because headaches and migraines are so common, it’s probably no surprise that many women deal with them during pregnancy. For the majority of pregnant women, occasional headaches or migraines are no cause for alarm, and most standard treatments are safe. However, suffering a severe headache at key times during or after pregnancy can indicate a serious medical emergency.

Common types of headaches and treatment options

Primary headaches

Primary or acute headaches arise once in a while and typically pass after a few hours. Tension headaches are the most common type and are characterized by muscle tightness and localized pain in the head and neck.

Primary headaches in pregnant women usually can be treated at home. Rest, a neck or scalp massage, hot or cold packs, and over-the-counter anti-inflammatory drugs such as Tylenol, aspirin, or ibuprofen can reduce the pain. However, if you start to have frequent or severe headaches, talk to your doctor to determine the cause.

Migraines

Migraines tend to be episodic (frequent and long-lasting) and typically cause additional neurological symptoms, such as:

● Blurred or tunnel vision

● Hallucinations

● Light sensitivity

● Nausea and vomiting

Studies have shown that migraines can be triggered by hormonal changes, including right before your period or as a result of taking oral contraceptives. Interestingly, some women who have migraines find that the frequency or intensity of their symptoms decreases during pregnancy. Research does not suggest, however, that pregnancy triggers the onset of migraines – if you have your first migraine during pregnancy, it’s likely coincidental.

Treatment during pregnancy is fairly similar to standard treatment. Anti-inflammatory drugs are generally safe and effective during pregnancy when used in a limited manner. Midrin is a commonly prescribed headache medication that contains acetaminophen along with a mild sedative. Midrin also has vasoconstrictive properties, which means it narrows the blood vessels, thereby reducing blood flow and pain.

Sumatriptan, commonly known as Imitrex, is another medication that reduces blood flow to the brain. It works best to stop a migraine if it’s taken as soon as symptoms present. Most nausea medications prescribed to women with migraines are safe to use during pregnancy, but I suggest reviewing the medications you take for migraine relief with your obstetrician at your first prenatal visit, just to be safe.

Certain drugs called ergotamines have a stronger vasoconstrictive effect and can adversely affect fetal growth. They also can stimulate uterine activity. Because of this, they absolutely should not be used during pregnancy.

Severe migraines might require hospitalization so you can receive fluids, pain medication, or anti-nausea medication through an IV if you are unable to keep medications down.

Migraines During Pregnancy

Migraines During Pregnancy: Symptoms, Treatment & Medication

Migraine headaches are a type of vascular headache that results from blood vessels dilating in the brain. These are different from stress or tension headaches.

Migraine headaches are like the lottery when it comes to pregnancy. If you were prone to getting migraines before getting pregnant, you may experience stronger headaches, or you may find that they diminish during pregnancy.

It is also normal to experience your first migraine when you are pregnant. Some studies have found a slight correlation between migraines and hormones. Women tend to get migraines more often than men.

What are the symptoms of a migraine headache?

A migraine usually starts out as a dull ache and then eventually becomes a throbbing, constant, and pulsating pain in the temples, in front of the head, or base of the head.

Migraines are sometimes accompanied by nausea and vomiting. Some people may experience an aura as well. An aura is wavy or jagged lines or dots of flashing lights. You may also experience tunnel vision or blind spots.

Is it dangerous for a pregnant woman to have migraines?

The only danger is when your headache may be a sign of something else. You should ALWAYS call your health care provider when:

  • Your headache is accompanied by a fever
  • Your headache persists for more than a few hours or returns frequently
  • You are experiencing blurred vision

It is ALWAYS important to let your health care provider know when you are experiencing any headaches and the details about them.

How can a pregnant woman treat a migraine headache?

Keep a headache diary: This diary should include when the headache happened, what “triggered” it, and how long it lasted. If you keep a log of your headaches, you can learn what triggers them and therefore avoid those things.

Common triggers may include but are not limited to:

  • Stress
  • Chocolate
  • Cheese
  • Coffee
  • Weather
  • Hormones

Triggers are different for everyone. This is why it is important for you to keep a headache diary.

Common home remedies for migraine headaches include:

  • Apply a cold towel on your head
  • Take a cold shower
  • Take a nap
  • Exercise
  • Biofeedback (ask your doctor)
  • Relaxation techniques such as meditation or yoga

Applying heat or cold to the sides of the head, the eyes, or along the back of the neck is one of the best ways to relieve the pain associated with a migraine.

Heating pads and cold packs come in a variety of shapes and sizes. Most of these require using a microwave or the freezer before using.

Medications for Migraine Relief

Most health care providers consider acetaminophen (Tylenol) to be the pain relief medication of choice during pregnancy, but you should always talk with your doctor before taking any medication.

Pregnant women should NOT take anything containing aspirin or ibuprofen (e.g., Advil, Motrin) unless prescribed by a health care provider. Consult your doctor about the best form of pain relief for your migraines.

Last Updated: 07/2015

Compiled using information from the following sources:

Williams Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 55.
National Headache Foundation, www.headaches.org

Migraine Headaches During Pregnancy

If a woman has a history of migraine headaches, and there are no other health problems, migraines during pregnancy are not usually a concern. However, if a first-time migraine-like headache occurs in pregnancy, it is important to rule out any other type of condition that may be dangerous, such as bleeding in the brain, meningitis (infection in the brain tissues), or tumors. Further testing may be needed to determine the cause of the headache.

Treatment of migraines in pregnancy may include soothing and nondrug measures, such as cold packs, a darkened room, and sleep. Avoiding triggers, such as certain foods and stress, may also be helpful. Medications must be carefully chosen because many drugs pass through the placenta to the developing fetus. Small doses of caffeine and acetaminophen are generally safe, but only as advised by your doctor. Avoid nonsteroidal anti-inflammatory drugs. Drugs that can be used include acetaminophen, promethazine, and opioid pain relievers, such as morphine. However, limit the use of opioid pain relievers because of the potential for addiction of the mother and baby. Consult your doctor for more specific information regarding treatment for migraines during pregnancy.

Announcement

MeriH,
Rizatriptan:
In a general reproductive study in rats, birth weights and pre- and post-weaning weight gain were reduced in the offspring of females treated prior to and during mating and throughout gestation and lactation with doses of 10 and 100 mg/kg/day. Maternal drug exposures (AUC) at these doses were approximately 15 and 225 times, respectively, the exposure in humans receiving the maximum recommended daily dose (MRDD) of 30 mg. In a pre- and post-natal developmental toxicity study in rats, an increase in mortality of the offspring at birth and for the first three days after birth, a decrease in pre- and post-weaning weight gain, and decreased performance in a passive avoidance test (which indicates a decrease in learning capacity of the offspring) were observed at doses of 100 and 250 mg/kg/day. The no-effect dose for all of these effects was 5 mg/kg/day, approximately 7.5 times the exposure in humans receiving the MRDD. With doses of 100 and 250 mg/kg/day, the decreases in average weight of both the male and female offspring persisted into adulthood. All of these effects on the offspring in both reproductive toxicity studies occurred in the absence of any apparent maternal toxicity. In embryofetal development studies, no teratogenic effects were observed when pregnant rats and rabbits were administered doses of 100 and 50 mg/kg/day, respectively, during organogenesis. Fetal weights were decreased in conjunction with decreased maternal weight gain at the highest doses (maternal exposures approximately 225 and 115 times the human exposure at the MRDD in rats and rabbits, respectively). The developmental no-effect dose in these studies was 10 mg/kg/day in both rats and rabbits (maternal exposures approximately 15 times human exposure at the MRDD). Toxicokinetic studies demonstrated placental transfer of drug in both species.There are no adequate and well-controlled studies in pregnant women; therefore, rizatriptan should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Sumatriptan:
Sumatriptan does not appear to increase the risk of congenital malformations but one study found a small increased risk for premature birth and another found a slight increase in atonic uterus and hemorrhage; therefore, as with all medications during pregnancy should only be used if the benefit to the mother outweighs the risk to the fetus. Some authors recommend triptans not be given during pregnancy due to the vasoconstricting effects of this category of medications.
Sumatriptan is an antimigraine medication used in the treatment of acute migraine headache and cluster headaches. Several small studies have revealed no increased risk for congenital malformations. In a study by Kallen et al, there was a small increased risk for premature birth. Pfaffenrath et al stated that triptans should not be given during pregnancy but recommended nonpharmacologic therapies such as sleep, relaxation, and ice packs first, followed by 1000 mg of acetaminophen, then ibuprofen or aspirin (excluding the third trimester) for acute migraine headaches. In summary, sumatriptan does not appear to increase the risk of congenital malformations but one study found a small increased risk for premature birth and another found a slight increase in atonic uterus and hemorrhage; therefore, as with all medications during pregnancy should only be used if the benefit to the mother outweighs the risk to the fetus. Some authors recommend triptans not be given during pregnancy due to the vasoconstricting effects of this category of medications.
Sandra Lovato R.N.
InfantRisk Center
806-352-2519

Is it safe to take migraine medication during pregnancy?

Migraine medication must be used with caution in pregnant women.

Narcotics, such as codeine (paired with Tylenol), are generally considered low risk, and acetaminophen (also sold under the brand name Tylenol) has a long history of safe use during pregnancy. But most of the other medications used for migraines are problematic.

There’s not a lot of data on the safety of migraine medications in pregnancy. (For safety reasons, few studies are conducted on pregnant women.) For example, we don’t have sufficient data on triptans (such as Imitrex or Maxalt) to say that they’re safe or low risk.

Here’s what we know about other migraine medications:

Ibuprofen and other nonsteroidal anti-inflammatories (NSAIDS) are not considered safe during pregnancy, especially in the third trimester.

And I wouldn’t recommend any medications that contain caffeine (migraine medications typically do), because each pill is equal to a cup of coffee. If you take more than two a day, that’s more caffeine than you should have during pregnancy.

Doctors often prescribe Fiorinal for migraines, but that not only has caffeine, it also contains a barbiturate that shouldn’t be used in pregnancy.

I’d also steer clear of divalproex sodium (Depakote) since it’s been shown to cause neural tube defects, such as spina bifida.

Finally, you’ll want to avoid beta-blockers during pregnancy since they can cause reduced blood flow to the placenta and baby. Daily use of beta-blockers can result in intrauterine growth restriction (IUGR).

It’s always a good idea to call your doctor before taking any over-the-counter medicine during pregnancy to make sure it’s safe for you and your baby.

Read more about managing headaches during pregnancy.

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