Abortive and Prophylactic Therapies to Treat Migraine in Pregnancy: A Review

Abstract

Migraine is a common issue during pregnancy, often affected by hormonal changes. More than half of the women affected by migraine experience improvement in or remission of migraine symptoms, particularly during the second and third trimesters, with those having menstrual migraines or migraines without aura benefiting the most. However, a small percentage of women may see a worsening of their migraines, especially those with migraine with aura, and some may even develop migraines for the first time during pregnancy, often in the first trimester. Postpartum, many women experience a recurrence of migraines, likely due to the drop in estradiol and endorphin levels. A literature search was performed in PubMed for articles published from 2013 through 2023, and 80 out of 362 publications were included. When it comes to managing pregnant women with migraine, non-pharmacological treatments are preferred, including lifestyle modifications and avoiding known triggers. When medication is necessary, acetaminophen is the first-line treatment, with nonsteroidal anti-inflammatory drugs and triptans regarded as secondary options, though trimester-specific risks limit their use. Preventive treatments, if required, may include low doses of β-blockers or amitriptyline but should be used cautiously. This article aims to provide a concise overview of the existing research on the acute and prophylactic use of medications to treat migraines in pregnant and lactating women. Furthermore, it presents recommendations for healthcare professionals managing pregnant females presenting with migraine in clinical settings.