Migraines

Last Update: 06 Aug 2025

Condition

Table of content

1. What is it? 2. Why managing? 3. Non-Medical Options 4. Medications 5. Breastfeeding/ chestfeeding 6. Key Takeaways 7. Limits of Research

Welcome to our Fact Sheet on migraines during pregnancy and breastfeeding or chestfeeding. The information is based on current research and may be updated as new scientific knowledge emerges. It’s important to remember that the content shared here does not replace personalized advice from healthcare professionals.

1. What are migraines?

A migraine is a very strong headache that can last for hours or even days. It can make daily activities difficult and often comes with other symptoms like nausea or sensitivity to light and sound.

Migraines are different from regular headaches, which are usually milder and shorter. The table 1 shows the main differences between migraines and other types of headaches.

Table 1. Differences between migraines and other kinds of headaches

Symptoms	Headaches	Migraines
Pain Intensity	Mild to moderate	Moderate to severe
Pain Type	Dull or pressure-like	Throbbing or pulsating
Pain Location	Both sides or forehead	Usually one side
Duration	30 minutes to a few hours	Several hours to a few days
Nausea or Vomiting	Rare	Common
Light or Sound Sensitivity	Sometimes	Often
Impact on Daily Activities	Usually doesn’t stop activities	Often disrupt or prevent activities

Migraines can be triggered by hormone changes, stress, certain foods (like red wine or sulfites in deli meat) or family history (migraines can run in families). The exact cause of migraines is still not fully understood.

During pregnancy, your body goes through big hormonal and physical changes. These can affect migraines and other kinds of headaches.

First trimester: Migraines or other types of headaches may happen more often because of rising hormone levels and increased blood volume.
Second and third trimesters: Many people with migraines start to feel better. About 3 out of 4 notice their migraines become less frequent or less intense, and some pregnant people stop having migraines completely.

Knowing how migraines can change during pregnancy can help you and your healthcare provider find safe and effective ways to manage them.

IMPORTANT: Most headaches are not dangerous, but some can be a warning sign of a serious health problem. For example, severe or persistent headaches can be linked to high blood pressure or preeclampsia. Always talk to your healthcare professional about any unusual or severe headaches to rule out serious conditions.

2. Why is it important to manage migraines during pregnancy?

Migraines can disrupt daily life more than regular headaches. The pain and discomfort can interfere with sleep, eating, physical activity, and overall well-being—habits that are important for a healthy pregnancy. Thus, not addressing migraines can have a significant impact on both your physical and mental health.

Some headaches, such as those caused by stress, dehydration, or lack of sleep, can also affect your quality of life. Others, though less common, like those linked to high blood pressure or preeclampsia, can pose risks to both you and your baby.

That’s why it’s important to talk to your healthcare team about migraines and other types of headaches. This way, you can prevent complications and have a more comfortable pregnancy.

Understanding Risks in Pregnancy

Every pregnancy has some risk of complications like miscarriages (loss of the baby), premature birth (baby comes before 37 weeks), congenital malformations (birth defects), and other complications. These risks can happen in any pregnancy for many reasons, unrelated to migraines or its treatment. This is called the background risk.

Research helps us estimate these risks and compared them with the risks when migraines are not managed. According to current research, migraines may increase certain risks like premature birth and hypertension, but:

Some risks are well documented, while others still need more research
Your own risk depends on factors like age, genetics, lifestyle, ethnicity, and other health conditions.

Table 2 show a summary of the possible risks of unmanaged migraines compared to the background risks.

Table 2: Possible risks linked to unmanaged migraines during pregnancy.

Who?	What?	What does research say?
Pregnant person	Fertility (Ability to get pregnant)	No research found.
	Miscarriage	Migraines does not seem to increase this risk.
	Pre-eclampsia/ high-blood pressure	Large studies including thousands of pregnancies found a higher risk of pregnancy-related high blood pressure and preeclampsia.
	Cesarean delivery	Slightly higher chance compared to people without migraine. More research needed.
	Mental health	Higher risk of mental health problems around the time of delivery.
Unborn baby	Premature birth	9 studies on thousands of pregnancies found a slightly higher risk of preterm birth (before 37 weeks) if left unmanaged.
	Neonatal health	Slightly higher risk of hospitalisation, breathing problems, and febrile seizures were found in pregnancy with migraines compared to pregnancies without migraines.
	Congenital malformations	No increased risk compared to the background risk.
	Low birth weight (less than 5 pounds and 8 ounces [2,500g])	No increased risk compared to the background risk.
Future child	Brain development	More research needed to understand if there’s a risk.

3. What can I do to manage my migraines besides medications?

Before considering medications, there are simple steps that can help manage headaches and migraines during pregnancy. These strategies are often first-line treatment and can sometimes be enough on their own:

Healthy habits: Drink plenty of water, eat regular meals, sleep well, and try light exercise to support your overall well-being.
Cognitive-Behavioral Therapy (CBT): This type of therapy can help reduce stress and teach you ways to cope with migraine triggers.
Relaxation techniques: Try yoga, deep breathing, or gentle stretching to ease tension.
Massage: Light massages can relax tight muscles and reduce pain.
Ice packs: Place an ice pack on your head or neck to reduce pain and inflammation.
Avoid triggers: Identify and try to stay away from things that can cause headaches, like stress, lack of sleep, bright lights, or certain foods.
Rest: Lying down in a quiet, dark room can help you feel better.
Keep a headache diary: Write down when headaches happen and what might have triggered them, like stress, dehydration, poor sleep, certain foods, hormone changes, or frequent pain medication use.
Aerobic exercise: Light exercise can sometimes reduce the frequency of headaches.

These steps may reduce how often you get headaches or migraines happen and make them less intense.

4. Medications prescribed for managing pain

If physical activity or other non-medication options are not enough, medication may be needed to manage your migraines. The choice of medication depends on how often symptoms happen, how strong the headaches are, the stage of your pregnancy, and what is safest for you and your baby.

What does research say?

As first-line treatment, your pharmacist might recommend over-the-counter (available without prescription) options like:

Acetaminophen or paracetamol (Tylenol®) is usually the first choice. It’s generally considered safe to use in all trimesters of pregnancy and while breastfeeding, when used according to directions. It’s important to not exceed the maximum daily dose (3 g/day) and talk to a healthcare provider if you need it often. For more information, see our fact sheet here.
Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (e.g., Advil, Motrin) are common pain relievers but should be avoided after 20 weeks, unless approved by your doctor. They may raise the risk of pregnancy complications. Your doctor can explain when and how NSAIDs can be used safely during pregnancy.

If acetaminophen or NSAIDs are not enough, or if your migraines are frequent, your healthcare provider may suggest:

Acute treatments like triptans or gepants. They are taken as soon as a migraine starts. These medications are not meant for daily use, and their safety during pregnancy varies.
- Sumatriptan (Imitrex®) is the most studied triptan in pregnancy and has not been linked to increased risk for the baby. Other triptans like almotriptan have limited research.
- Gepants are newer migraine medications (available in Canada since 2023) and have very limited information about their safety in pregnancy
Preventive treatments are taken every day to reduce how often migraines happen or make them less severe. These include medications like propranolol (blood pressure medication), amitriptyline (previously used as antidepressant), and topiramate (anti-seizure medication). Preventive medications may take a few weeks to work. These are usually avoided during pregnancy unless clearly needed, and only with close supervision from a healthcare provider.

If any medication is needed during pregnancy, your healthcare team will often recommend:

Using the lowest effective dose for the shortest time
Starting with acetaminophen (Tylenol®)
Considering triptans like sumatriptan (Imitrex®) if needed
Avoiding NSAIDs after 20 weeks
Avoiding opioids as they can be dangerous and cause addiction
Adding anti-nausea medication if migraines come with vomiting

The table 3 below lists some of the most common medications available in Canada to treat migraines. Keep in mind that not all of these are recommended as first line medications during pregnancy. For details on a specific medication, consult the related fact sheet and always discuss with your healthcare provider before making changes.

Table 3. Some medications available in Canada to treat migraines

Medication Types	Medication Names	Brand names
Pain relief (first-line treatment)	Acetaminophen, paracetamol	e.g. Tylenol^®
Non-steroidal anti-inflammatory drugs (NSAIDS) (avoid on 1st trimester and after 20 weeks)	Acetylsalicylic acid	e.g. Aspirine^®
	Ibuprofen	e.g. Advil^®, Motrin^®
	Naproxen	e.g. Aleve^®, Naprosyn^®
Triptans (Not first-line)	Sumatriptan	e.g. Imitrex®
Triptans (Not first-line)	Eletriptan, Rizatriptan, Zolmitriptan, and others	e.g. Amerge®, Relpax®, Zomig®, and others
Gepants (Few studies)	Atogepant	e.g. Qulipta®
	Ubrogepant	e.g. Ubrelvy®
	Rimegepant	e.g. Nurtec®

Other medications can be prescribed for migraines. Not all of them are recommended during pregnancy. For example, ergotamine (including dihydroergotamine) should not be used in pregnancy because it can harm the baby. Certain antiepileptic medicines sometimes used to prevent migraines, such as valproic acid (Depakene®, Epival®) and topiramate (Topamax®), carry a higher risk of birth defects and are usually avoided during pregnancy. Always talk to your doctor before making changes.

How do I know which one to take?

There’s no completely risk-free choice when it comes to medications during pregnancy. Every treatment has potential benefits and risks, but there are also risks with unmanaged migraines during pregnancy. Your healthcare team (doctor, nurse, pharmacist, or midwife) can help you make the safest decision for you and your baby.

Always talk to your pharmacist, nurse, doctor, or midwife if your current treatment isn’t working, the pain persists, or the side effects are interfering with your daily activity.

It’s important to avoid self-medication. Using substances like cannabis for pain relief during pregnancy or breastfeeding/ chestfeeding can increase risk for you and your baby.

If you’re unsure about your treatment or have questions, it’s best to discuss them your healthcare team. They can help you look at the benefits of your medications and any possible risks. Whether you talk to a pharmacist, nurse, physician, or midwife, they are there to support you and help you make an informed decision for your health and your baby’s health.

5. What about pain while breastfeeding or chestfeeding?

If you are taking medications for migraines, it’s important to discuss with your healthcare professional. Some medications can pass into human milk and may affect your baby.

Despite this, most migraine medications that are not recommended during pregnancy are considered compatible with breastfeeding or chestfeeding. For example, ibuprofen (Advil®) is avoided after 20 weeks of pregnancy unless prescribed by a doctor, but it is safe and often first-line treatment during breastfeeding/ chestfeeding, like acetaminophen (Tylenol®).

If you have any concerns or questions about breastfeeding or chestfeeding, speak with your healthcare professional (doctor, nurse, pharmacist) or a lactation consultant from your region (e.g. Canadian Lactation Consultant Association).

Key Takeaways

Migraines are intense headaches that often come with nausea, vomiting, and sensitivity to light and sound.
Untreated migraines may increase certain risks of complications like preterm birth, low birth weight, or high blood pressure.
Non-medication strategies are important, including hydration, regular meals, rest, relaxation, and avoiding known triggers like stress or certain foods.
For migraines, acetaminophen (Tylenol®) is the first-line option recommended in pregnancy. Sumatriptan (Imitrex®) and other medication may be used if needed, under medical advice.
Working with your healthcare team helps you make the best choices, monitor your health, and adjust your treatment as needed to have a healthy pregnancy while managing your pain.

Research Is Great, But It Is Not Perfect

Making informed decisions during pregnancy also means understanding the limits of research. Here’s what our experts found about headaches and migraines studies during pregnancy:

Small studies: Some studies are too small to detect rare side effects.
Prescription-based studies: It is often unclear if people took medications exactly as prescribed or used other medications, which can affect results.
Other medications or conditions: Sometimes, it is unclear if people were using other medications or had health issues that could influence results.
New treatments: Very limited research exists on newer migraine medications during pregnancy.
Few controlled studies: Pregnant people are rarely included in trials for ethical reasons. Most safety data come from animal studies or people who were already taking the medication.

Bottom line: Research helps guide decisions, but your personal care plan should always be made with your healthcare team.

Other online resources

Clinical guidance published by the Canadian Headache Society: https://www.headachesociety.ca/clinicalguidance

References

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