No Reason Not to Treat Migraine

Women with migraine who are planning a pregnancy or become pregnant do not need to be medication-free, according to a presentation at the Canadian Neurological Sciences Federation Congress 2025.

“Migraine is so common, and pregnancy is so common, so, just by numbers alone, you are going to end up having a lot of people who become pregnant when they have migraines,” said William Kingston, MD, a headache specialist at Sunnybrook Health Sciences Centre and assistant professor at the University of Toronto, Canada. 

While many women may be advised to refrain from taking medication for migraine while they are trying to get pregnant, this approach may not work for all women, he added.

“Migraine is a disabling brain condition, and it doesn’t go away because someone becomes pregnant,” he said. Pregnant women or women trying to become pregnant often are told by a healthcare provider that they can’t take their medication for their headache. “They don’t know what it’s like when they don’t treat it,” said Kingston. 

Safe Options During Pregnancy

The accumulated evidence for sumatriptan suggests that exposure to this drug does not increase the risk for birth defects, making it a good option to treat migraine during pregnancy, said Kingston. 

“W e have the most registry data for sumatriptan, just by virtue of the fact that it was the first triptan,” he continued. “We have not found any teratogenic effect, which, in my experience, is the first question that people will often have, and there is not a clear signal for adverse pregnancy outcomes.”

Another option is injected onabotulinumtoxinA, for which “very reassuring” data indicate safety during pregnancy, according to Kingston. A retrospective review concluded that the prevalence of major fetal defects among live births among pregnant women who use onabotulinumtoxinA is consistent with the rates reported in the general population. 

Newer agents to treat migraine, such as calcitonin gene-related peptide inhibitors, should be discontinued if a woman becomes pregnant, said Kingston. He cited data from the World Health Organization pharmacovigilance database. 

Lactation Offers Benefit

A piece of good news for women with migraine who have given birth is that they are likely to have improved migraine control if they are breastfeeding. “We think lactation is protective for migraines,” said Kingston, but pointed out that sumatriptan, if needed, is safe to use when a woman is breastfeeding. “We think that people who are successful at breastfeeding tend to do better from a migraine standpoint than people who are not breastfeeding.”

Suzanne Christie, MD, a neurologist at the Ottawa Hospital and Ottawa Headache Centre, Ontario, remarked that she has observed lactation conferring protection from migraine in real-world practice. Patients who breastfeed report fewer migraines, she said. Most of her patients with migraine breastfeed after giving birth. Christie is president of the Canadian Headache Society. 

Individualized Approach Appropriate

Christie supported Kingston’s view that some pharmacologic agents are relatively safe to take. “Sometimes patients, if they are really having trouble getting pregnant, may abandon that focus for a while and go back on treatment,” said Christie. “It is really done on a case-by-case basis.”

Sumatriptan is a wise therapeutic choice for a woman with migraine who is planning pregnancy or for a woman who is already pregnant, said Christie.

Most neurologists would feel comfortable using sumatriptan, she added. “Most evidence is probably for sumatriptan, but all the triptans are probably safe. They have been available forever.”

Kingston reported receiving consulting and speaking fees from Novartis, Eli Lilly, Teva, Lundbeck, Pfizer, Allergan/AbbVie, and Miravo/Aralez. Christie reported having no relevant financial relationships.