Acute Migraine Therapy During Pregnancy: A Primer

Anna Pace, MD

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February 15, 2019

Editorial Collaboration

Medscape &

In general, preconception counseling is very important for patients with migraine. Treating migraine during pregnancy can occasionally be difficult, as each medication, though seemingly safe, has the potential for teratogenicity. Acetaminophen and metoclopramide can be used for the acute treatment of migraine during pregnancy; they were previously labeled category B by the US Food and Drug Administration (FDA), though this classification is slowly being phased out.

Acetaminophen has recently been implicated in potentially leading to attention-deficit/hyperactivity disorder in the children of mothers exposed to acetaminophen during pregnancy. Metoclopramide, while often used for hyperemesis gravidarum as well as for migraine, may be linked to extrapyramidal effects in children born to mothers exposed to this antepartum.[5] Opiates are generally not indicated for acute therapy for migraine; if used during pregnancy they may lead to neonatal sedation and withdrawal after delivery. If opiates are necessary, the only option for acute therapy, oxycodone, is likely the safest of the class.[3,5] Usage should be limited to no more than 2 days a week, maximum 10 days a month, to avoid rebound.

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