Clinical Edge

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Is Migraine Medication Safe During Pregnancy?

BMJ Open; ePub 2019 Feb 27; Amundsen, et al

Women with migraine severely overestimated the risk associated with migraine pharmacotherapy in pregnancy, a recent study found. Therefore, more attention should be focused on women’s beliefs and concerns regarding migraine pharmacotherapy during pregnancy and breastfeeding in order to improve management of disease, reduce unfounded concerns, and enhance adherence to needed treatment. Researchers conducted a cross-sectional study from October 2013 to February 2014. Data were collected via an anonymous, electronic questionnaire. They found:

  • The cohort included 401 women with migraine, of which 140 were pregnant and 261 were new mothers.
  • >70% of the women reported use of migraine medications during pregnancy.
  • Still, the majority severely overestimated the risk associated with migraine medications and were concerned about using medications to manage their migraine during pregnancy and breastfeeding.
  • Almost 9 out of 10 women had at some point deliberately avoided using migraine medications during their pregnancy.
  • Women reporting use of migraine medications, however, were more positive and overestimated to a lesser extent the risks of using such medications in pregnancy compared with their counterparts.

Amundsen S, Øvrebø TG, Amble NMS, Poole AC, Nordeng H. Risk perception, beliefs about medicines and medical adherence among pregnant and breastfeeding women with migraine: Findings from a cross-sectional study in Norway. [Published online ahead of print February 27, 2019]. BMJ Open. doi:10.1136/bmjopen-2018-026690.


This study was the first to explore “risk perception, beliefs about migraine medications and medical adherence in pregnant and breastfeeding women with migraine.” Women rated 14 drugs and other substances including: 1) analgesics and other medications commonly used in acute treatment of migraine (acetaminophen, ibuprofen [in third trimester], triptans and metoclopramide); 2) herbal medicines (ie, feverfew); 3) alcohol (in first trimester) and tobacco (smoking); and 4) thalidomide. They were asked to rate these 1-10 (very harmful). The concerning findings were that probably due to severe overestimation of risk, a significant number of pregnant and breastfeeding women were non-adherent with migraine treatment. The authors point out two important take home messages: 1) it is necessary to understand women’s perceptions on risks and benefits of treatment to optimize care during these reproductive times, and 2) providers need to provide more education and information about the risks and benefits or available migraine therapies to help patients make more reasonable choices. —Stewart J. Tepper, MD, FAHS, Professor of Neurology, Geisel School of Medicine at Dartmouth, Director, Dartmouth Headache Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH