Many women with migraine are of reproductive age, and several preventive drugs carry pregnancy risks. Valproate is teratogenic and should not be used for migraine in women who could become pregnant. Topiramate is associated with fetal harm and reduces the effectiveness of some hormonal contraceptives. Propranolol has the longest safety record in pregnancy among preventives.
Ask about pregnancy plans and contraception at the start of any preventive treatment and at review, because unplanned exposure in early pregnancy is when most of the risk is taken on.
- Ask about pregnancy plans and contraception before starting any migraine preventive.
- Avoid valproate for migraine in anyone who could become pregnant.
- Topiramate can reduce the effect of some hormonal contraceptives; advise on reliable methods.
- Propranolol is generally the preferred preventive when pregnancy is planned or possible.
- Many women's migraines ease in the second and third trimesters; review the need for prevention then.
Why it matters
Most drug exposure in pregnancy happens before the pregnancy is recognised.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for neurology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free