If you are a female migraineur – a woman who suffers from migraine headaches – and you are worried about migraines during pregnancy, you are not alone. About 15 percent of women with migraines are in their childbearing years. You probably want to know if your migraines will get worse. You should also know how migraines are treated during pregnancy and breastfeeding. [1,2]
Migraines and Pregnancy
Migraines are more common in women than men. One reason is female hormones. There seems to be a link between changes in female hormones and migraine attacks. That’s why migraines may be more common when hormone changes occur with menstrual cycles. [1,2]
Estrogen goes up by about 100 times normal during pregnancy. You might expect that means a big spike in migraine attacks. The good news is that the opposite is true. About 90 percent of women experience less severe and less frequent migraines during pregnancy, especially in the second and third trimester. [1,2]
The reason migraines get better is that although estrogen goes up, it remains steady. Less change means less headaches. A natural increase in pain relieving endorphins that occurs with pregnancy may also help reduce migraines.  Here are some other things to know about migraines and pregnancy: [1-3]
- Migraines usually come back once you start periods again after childbirth.
- A small percentage of women have worse migraines during pregnancy. This is more likely if you have auras with your migraines. Auras are visual or other changes in sensation that warn of a migraine attack.
- Some women have their first migraine attack during pregnancy.
- Having migraines does not increase the risk of pregnancy loss, complications, or birth defects.
What About Treatment During Pregnancy and Breastfeeding?
Migraines do not cause problems with pregnancy, but they can make pregnancy more difficult, so treatment is still important. Untreated migraines can lead to loss of sleep, poor nutrition, dehydration, stress, and depression. Those conditions could affect your pregnancy or breastfeeding. 
Treatments for migraine include lifestyle changes, non-medication treatments, preventive medications, pain medications, and medications that stop an attack (abortive medications).
Always let your doctor know as soon as you become pregnant. You may need to change or taper your medications. Better yet, have this discussion with your doctor before you become pregnant. Like all medications during pregnancy, your doctor will want to err on the side of caution. [1-3]
Non-Medical Treatments and Lifestyle Changes
These are the first choices for treatment during pregnancy and breastfeeding. They include: [1-3]
- Avoiding migraine triggers
- Getting enough sleep
- Not skipping meals
- Taking a cool shower or using a cool or warm compresses on your head to sooth a headache
- Taking a nap when a headache starts
- Avoiding stress and using stress reduction techniques
- Getting some exercise every day
- Massage therapy
This is a gray area. These medications are usually tapered and stopped. There are some preventive medications that are safer than others, but most doctors prefer to hold preventive medications until after pregnancy and breastfeeding. [1-3]
The only safe pain medication is acetaminophen (Tylenol). Acetaminophen is the drug of choice for migraines during pregnancy and breastfeeding. Do not take other over-the-counter medications or herbal remedies unless you check with your doctor first. [1-3]
If you have nausea and vomiting along with your headache, your doctor may prescribe a medication called ondansetron. This will not help pain but is safe to use for nausea and vomiting during pregnancy. 
If non-medical treatments and Tylenol are not helping you, your doctor might consider using an abortive medication called a triptan. These medications – there are several types – work better than acetaminophen because they change brain chemicals that are causing a migraine attack. 
The triptan that has been studied most during pregnancy has been around for about 20 years. It is called sumatriptan. The most common brand name is Imitrex. Several studies have compared pregnant women on sumatriptan to women not on sumatriptan. These studies did not find that women on sumatriptan had any higher risk for birth defects or other adverse fetal outcomes. One large Norwegian study included over 1,500 pregnant women taking this drug during pregnancy. 
The American Academy of Pediatrics has approved sumatriptan during breastfeeding. Some sources suggest not taking the drug for 24 hours before breastfeeding. If your doctor suggests this approach, you can pump and save breast milk to use in case you need to take the drug to abort a migraine attack. [2-3]
If you are struggling with migraines despite other treatments, there are two other options to consider.
Occipital nerve block is a treatment that is safe during pregnancy or breastfeeding. A doctor injects a numbing medication in the back of your neck to block nerve signals that cause migraine. [2,3]
Transcranial magnetic stimulation (TMS) is a newly approved treatment for migraine. Studies suggest it may reduce pain and frequency of attacks. It is a device placed on your head that gives of magnetic pulses. It has no side effects, so it is safe to use during pregnancy or breastfeeding. [2,3]
Migraine does not have any ill effects on your pregnancy or your baby. There is a good chance your migraines will get better. Talk to your doctor about treatment options before you get pregnant. If you get pregnant unexpectedly, let your doctor know right away. With the options available, you should be able to get through pregnancy and breastfeeding without major problems. [1-3]
- Canadian Family Physician, Safety of triptans for migraine headaches during pregnancy and breastfeeding.
- The Migraine Trust, Pregnancy and breastfeeding.
- American Pregnancy Association, Migraines During Pregnancy.
- American Headache Society, Pregnancy and Lactation – Migraine Management.