How is a severe acute migraine (status migrainosus) treated during pregnancy?

Updated: Nov 08, 2018
  • Author: Carmel Armon, MD, MSc, MHS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
  • Print
Answer

Answer

Treatment options for a severe acute attack (status migrainosus) include intravenous hydration, antiemetics, analgesics, and steroids.

Ergotamines are contraindicated (risk category X), and triptans are not recommended (risk category C; risk cannot be ruled out), but as of 2011, the sumatriptan and naratriptan registry had not found an increased risk of first-trimester birth defects. [14]

In addition, various medications may be used to prevent migraines, and these are also associated with varying levels of pregnancy and breastfeeding risk (see Table 2 below).

Table 2. Pregnancy and Breastfeeding Risk for Medications Used to Prevent Migraine (Open Table in a new window)

Drug Class

Generic Name

level of Risk in Pregnancy

Breastfeeding

Beta blockers

Atenolol

D

Caution

Metoprolol

C (D at term or prolonged use)

Compatible

Nadolol

C (D at term or prolonged use)

Compatible

Propranolol

C (D at term or prolonged use)

Compatible

Timolol

C (D at term or prolonged use)

Compatible

Antiepileptics

Gabapentin

C

Probably compatible

Topiramate

C

Caution

Valproate

D

Compatible

Calcium channel blocker

Verapamil

C

Compatible

Tricyclics

Amitriptyline

C

Concern

Imipramine

C

Concern

Nortriptyline

C

Concern

Serotonin antagonist

Methysergide

D

Contraindicated


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!