Acute Migraine Therapy During Pregnancy: A Primer

Anna Pace, MD


February 15, 2019

Editorial Collaboration

Medscape &

The patient should be counseled about the natural course of migraine during pregnancy. Overall, the majority of patients with migraine without aura tend to experience improvement when pregnant, which is probably due to increased estradiol levels during pregnancy, with no withdrawal or hormonal cycling as seen with menses. In one study, improvement in migraines during pregnancy was seen in almost 47% of women without aura during the first trimester, in 83% during the second trimester, and in 87% during the third trimester.[1] Women with migraine with aura are less likely to show improvement during pregnancy when compared with women without aura.[2,3,4] Some women will also have new-onset aura during pregnancy, or, if they have prior aura, may have a worsening of their aura during pregnancy.[1]

Given her current frequency of headache, the patient is concerned that she may continue to get migraines during her first trimester, especially, and wants to know if she can continue her naproxen and sumatriptan as rescue therapy or if she should change to a different medication.


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