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Risks associated with medications prescribed to manage migraine during pregnancy and lactation

Risks associated with medications prescribed to manage migraine during pregnancy and lactation Risks associated with medications prescribed to manage migraine during pregnancy and lactation
Risks associated with medications prescribed to manage migraine during pregnancy and lactation Risks associated with medications prescribed to manage migraine during pregnancy and lactation

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The incidence and patterns of migraine differs in correlation with various reproductive stages of women including puberty, pregnancy and lactation 

As women found to have more incidence of migraine as compared to men, after the puberty and up to 70% of the women patients showed progression in headache severity during menstruation, pregnancy, menopause, and also during lactation. The management of migraine in pregnancy and lactation is a major challenge, and therefore investigations were made and found noteworthy evidence regarding some abortive and preventive treatments.

Evidence regarding abortive treatment for migraine during pregnancy and lactation:


During pregnancy -

  • Ibuprofen shows significant efficacy during the first trimester.
  • Metoclopramide is safe to use in pregnancy.
  •  Triptans also did not exhibit any significant adverse events, and Sumatriptan provides the most supporting evidence.


During Lactation -

  • Ibuprofen is known to reflect very low levels of medicine in breast milk, even after administrating in high doses and therefore is a preferred NSAID.
  •  Eletriptan and Sumatriptan also exhibited low levels in breast milk.
  • Naproxen is associated with adverse events such as vomiting and drowsiness in infants.
  • Aspirin is associated with the risk of Reye’s syndrome.

 

Evidence regarding preventive treatment for migraine during pregnancy and lactation:

During pregnancy -

  • Out of nutraceutical, 100 mg 3×/day Coenzyme Q10 and 400 mg/day Riboflavin provides significant outcomes if started three months ere pregnancy.
  • Anticonvulsants, Topiramate and Valproic acid, should be avoided due to the associated risk of congenital birth defects,  and cognitive and motor impairment, respectively.
  • Atenolol, a beta-blocker administration during the first trimester showed the risk of low birth weight. Other beta-blockers also need close fetal monitoring.
  • Tricyclic antidepressants are known to lead craniofacial and cardiac malformations; however, serotonin-norepinephrine reuptake inhibitors not associated with such results.
  • The use of Angiotensin receptor blockers and Angiotensin-converting enzyme inhibitors should also be avoided as it may lead to the skull, pulmonary, and renal malformations.


During Lactation -

  •  Propranolol is safe because of their low maternal plasma levels.
  • Topiramate is also safe during this period; however, valproic acid should be avoided. 
  • Angiotensin receptor blockers and Angiotensin-converting enzyme inhibitors are related to the risk of having renal toxicity in premature infants.
  • While using tricyclic antidepressants, infants should be monitored for poor feeding, anticholinergic side effects and sedation.
  • Clinicians should think thoroughly before prescribing the medication for migraine in pregnancy, as prescriptions of true teratogens might cause undesirable manifestations, whereas, prescriptions misattributed as teratogens or as a lactation risk could not manage migraine properly.

Source:

Neurology Advisor

Article:

Managing Migraine During Pregnancy and Lactation

Authors:

Simy K. Parikh et al.

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