Acute Migraine Therapy During Pregnancy: A Primer

Anna Pace, MD


February 15, 2019

Editorial Collaboration

Medscape &

Ergotamine is rated as category X in pregnancy by the FDA, and can lead to fetal distress, premature uterine contractions, and miscarriage. Ergotamine must not be used at any point for acute migraine therapy during pregnancy. Butalbital, once thought safe to use during pregnancy, has recently been linked to reports of cardiac defects and is generally not recommended for use in pregnancy. Aspirin, as well as other nonsteroidal anti-inflammatory medications (like ibuprofen or naproxen), if taken during the third trimester, can facilitate the premature closing of the ductus arteriosus, which can have negative effects on the fetal cardiovascular system, and therefore should be avoided unless discussed with the patient's obstetrician.[3]

Sumatriptan is generally thought to be safe to use in pregnancy. Triptans have previously been labeled category C by the FDA. Data from a nationwide registry showed that inadvertent exposure to triptans during pregnancy is generally not associated with an increased risk for adverse outcomes.[6] The sumatriptan registry showed that the risk rates for major birth defects are similar to the baseline risk rates in the general population (4.2% for sumatriptan versus 3%-5% for the general population).[6] Further studies should be conducted to fully elucidate the effect of triptan exposure in pregnancy on childhood development.


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