Use of antimigraine medication before pregnancy and in the first trimester: A cross-sectional study

Migraine is common among women, particularly during their reproductive years. There is limited research on the use of antimigraine medication before and during pregnancy. This study was undertaken to describe the use of antimigraine medication 3 months before pregnancy and in the first trimester among women with migraine and to evaluate maternal characteristics associated with continued use in the first trimester.

In this cross-sectional study, we used patient-reported data from the Copenhagen Pregnancy Cohort from October 2013 to May 2019 and included all women with migraine before pregnancy. The use of antimigraine medication before pregnancy and during the first trimester was assessed descriptively.

Among women with migraine (N = 1586), 1241 of 1586 (78.2%) reported use of any antimigraine medication before pregnancy, and 347 of 1586 (21.8%) in the first trimester. Before pregnancy, paracetamol was the most used medication (793/1586, 50.0%), followed by ibuprofen (417/1586, 26.3%) and sumatriptan (191/1586, 12.0%). In the first trimester, paracetamol remained the most common medication (271/1586, 17.1%), followed by sumatriptan (49/1586, 3.1%), whereas the use of ibuprofen declined to 11 of 1586 (0.7%). A total of 278 of 1586 (17.5%) reported frequent use (daily or 1-2 times/week) of antimigraine medication before pregnancy, but only 79 of 1586 (5.0%) in the first trimester. Having a short length of education of 1-2 years, other chronic somatic diseases, or mental illness were, after adjustment for maternal age and parity, associated with frequent use of antimigraine medication in the first trimester compared to women with higher education, without other chronic somatic diseases, or without mental illness, respectively (adjusted odds ratio [aOR] = 3.09, 95% confidence interval [CI] = 1.93-4.95; aOR = 1.92, 95% CI = 1.14-3.23; and aOR = 2.14, 95% CI = 1.05-4.38).

Most women with migraine used antimigraine medication before pregnancy, whereas usage decreased markedly in the first trimester. Only a few women had frequent use in the first trimester. Women with a short length of education of 1-2 years, additional chronic somatic diseases, or mental illness were more likely to report use of antimigraine medication. By offering an overview of patient-reported use of antimigraine medication before and during early pregnancy in a hospital-based setting, this study contributes to existing knowledge in the field and provides valuable insights for clinicians working with pregnant women affected by migraine.