MIGRAINE AND PREGNANCY

Migraine is an episodic headache disorder that occurs in four percent of children, six percent of men, and 18 percent of women. Most women with migraine improve during pregnancy. Some women have their first attack during pregnancy. Migraine can recur postpartum; it can also begin at that time. Despite their drug use, migraineurs do not differ from nonmigraineurs in their incidence of miscarriages, toxemia, congenital anomalies or stillbirths. Drugs are commonly used during pregnancy and, although medication use should be limited, it is not absolutely contraindicated. Most drugs are not teratogenic. Adverse effects such as spontaneous abortion, developmental defects, and various postnatal effects depend on the dose and route of administration and the timing of the exposure relative to the period of fetal development. In migraine, the risk of status migrainosus to the fetus may be greater than the potential risk of the medication used to treat the mother. Nonpharmacologic treatment is the ideal solution; however, analgesics such as acetaminophen and opioids can be used on a limited basis. Preventive therapy is a last resort.