Migraine in pregnancy: what changes and what you can take

Migraine in pregnancy often improves, especially from the second trimester, because hormone levels become more stable. Not everyone gets this relief, and attacks often return soon after the birth, when oestrogen levels fall and fluctuate again. Treatment during pregnancy needs extra care, but there are options for treating an attack.

Why does migraine change during pregnancy?

Changes in hormone levels play an important role in migraine. Many women notice a link between their migraine and their menstrual cycle, and pregnancy changes that pattern. During pregnancy, hormone levels are generally steadier, which for many women means migraine attacks become less frequent or less intense. For others, especially women who have migraine with aura, attacks may stay the same, and some people have their first aura during pregnancy.

How is migraine treated during pregnancy?

Treating migraine during pregnancy calls for extra caution. Always discuss any medicine with your GP, midwife or migraine specialist before you take it, and tell them if you are pregnant or planning a pregnancy.

Treating an attack

• Paracetamol is the painkiller most commonly used in pregnancy. This is general information: we do not prescribe painkillers, and your GP or midwife can advise on the right dose.
• Triptans: sumatriptan is the best-studied triptan in pregnancy. Whether it is right for you should be agreed with your migraine specialist or GP and your midwife.
• Ibuprofen and other anti-inflammatory painkillers are generally avoided in pregnancy unless a doctor advises otherwise.

Preventive treatment

Most preventive migraine medicines are not suitable during pregnancy. This includes the newer CGRP-targeted medicines: the gepants atogepant and rimegepant, and the CGRP antibodies erenumab, fremanezumab and galcanezumab are not recommended in pregnancy. If you are taking one of these and are planning a pregnancy, talk to your migraine specialist about when to stop. Do not stop or start any medicine without advice.

Things that may help

Some people find that regular meals, enough fluids, a steady sleep routine and rest in a dark, quiet room during an attack make a difference. A headache diary can help you and your midwife or GP see how your migraine is changing.

Can migraine harm my baby?

Migraine itself is not thought to harm your baby. What matters most is choosing medicines carefully and getting checked if your headaches change. If you have migraine with aura, or your attacks become more frequent or feel different from usual during pregnancy, tell your midwife or GP so they can take this into account in your care.

What about migraine after the birth?

Attacks often come back in the first weeks after the birth, as hormone levels drop and sleep is disrupted. If you are breastfeeding, ask your GP, midwife or migraine specialist which medicines are suitable, as this differs from pregnancy.

When to get urgent help

A headache in pregnancy is not always migraine. Contact your midwife or maternity unit straight away if, especially after 20 weeks, you have a severe headache together with problems with your vision (such as blurring or flashing lights), sudden swelling of your face, hands or feet, or pain just below your ribs. These can be signs of pre-eclampsia.

Call 999 or go to A&E if you have:

• a sudden, severe headache that is the worst you have ever had
• weakness or numbness on one side of your body or face
• slurred speech
• loss of vision that does not return
• a headache with a fever and a stiff neck

If you are worried but it is not an emergency, call NHS 111.

Getting support

At The Migraine Clinic, our migraine specialists understand that migraine is more than a headache. Read about acute medication and preventive medication, take the migraine test, or see how to start.