Not All Migraine Meds Safe for Pregnant Women, Review Finds

Drugs that were once considered safe for pregnant women with migraines may not be, according to researcher at Wake Forest Baptist Medical Center. Findings from the study are published in Current Neurology and Neuroscience Reports.

Rebecca Erwin Wells, MD, and lead author of the review, highlighted 4 concerning treatment options that doctors have commonly used for pregnant women with migraines: magnesium, ondansetron, acetaminophen, and butalbital.

Magnesium, which has been considered one of the safest supplements for use during pregnancy, is now rated at level D by the Food and Drug Administration (FDA). This rating indicates that it may not be safe. Ondansetron is often prescribed for off-label use to treat nausea and vomiting of pregnancy and migraines. Its use during pregnancy has become a debated issue due to maternal-fetal safety concerns; however, data is not conclusive.

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Over 65% of pregnant women in the United States report use of acetaminophen but some evidence indicates possible correlations between maternal acetaminophen use and pediatric development of attention deficit hyperactivity disorder. Butalbital is a barbiturate indicated for headache in combination with caffeine, acetaminpohen, aspirin, and/or codeine. Though frequently prescribed for migraines in pregnancy, some data suggests a potential increase in the risk of congenital heart defects.

Dr. Wells said that headaches experienced during pregnancy and lactation should be taken seriously, that not all are migraines, and may in fact be due to a serious underlying condition. She concluded, “patients and doctors need to be aware that concerns exist and they should carefully weigh the risks and benefits of these treatments.”

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