Congratulations! Pregnancy can be a wonderful time for migraine sufferers as many women notice their migraines significantly diminish during their second and third trimesters. Unfortunately, an estimated 15% of women also notice an increase in migraines in the first trimester. This increase is due primarily to rapidly escalating levels of estrogen and other metabolic changes within the body. If you are planning a pregnancy, make sure your doctor knows right away.
Why is this? Most medications are simply not safe to take if you may be pregnant - especially those for the treatment of migraines like triptans (prescription medications which can stop migraine attacks.) If you are currently taking prescription medications for the treatment of migraines and become pregnant - your baby could be at risk. Before you plan on trying to get pregnant, it is very important to have a sit-down discussion with your doctor to determine which if any of the drugs and supplements you take are not safe for your baby.
Do not make the mistake of assuming that over-the-counter medications are safe just because they do not require prescriptions. Even over-the-counter drugs like Aspirin and Advil (lung development) carry risks of birth defects. Tylenol (acetaminophen) is approved for periodic use (unless told otherwise by your doctor), which is an option, but in general over-the-counter pain medications are seldom effective at reducing migraine pain. Over-the-counter pain medications have a better track record with tension headaches and body aches. No matter what, be sure to limit use and follow all recommendations on the product label. Acetaminophen is toxic in high doses and people die every year from over dosing on a medication they assume to be unconditionally safe.
The best course of action is to be very diligent when it comes to trigger avoidance, as this is your best chance at avoiding a migraine. This means you will want to be extra strict about managing stress, eating regular healthy meals (without triggers,) and keeping a regular sleep schedule. Go ahead and use herbal tea such as ginger for your nausea but make sure you absolutely avoid feverfew as it is not safe for pregnant or breastfeeding women. Also, this may be a time to consider trying acupuncture or biofeedback, as these treatments are considered safe for pregnant women.
Any women who is pregnant should know that all medications on the market are divided into a "pregnancy risk" category ranging from A, B, C, D, and X by the Federal Food and Drug Administration (here in the United States.) Only drugs in category A have been proven to be safe. Drugs in categories B and C show uncertainty either towards the positive or negative, and categories D an X show positive evidence of fetal risk. This information is updated all the time. Be sure to research any medications you are using or thinking about using for the latest information.
Some abortive medications like Fioricet and Lortab can still be used sparingly. Triptans should not be taken at all during pregnancy (unless prescribed by your personal doctor and only if he or she knows you are pregnant or trying to get pregnant) as the effects of these drugs on developing babies are still unknown. Be sure to speak with your doctor and see if the two of you can work out a plan that works for both of you.
Note: Women who experience severe morning sickness may also experience more migraines due to dehydration. Your doctor may be able to write you a prescription for intravenous fluids, which can be administered for you if needed.
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