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What to Know About Migraine During Pregnancy

What to Know About Migraine During Pregnancy
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Updated on March 28, 2025
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Being pregnant means lots of changes in your body — the way you feel, your energy level, and your mood can all be less predictable than usual. For women with migraine during pregnancy, some of these changes may be worrisome. Will migraine attacks become more frequent, and if so, is it possible to safely manage migraine pain when you’re expecting?

Here’s how being pregnant impacts migraine and what you can do to manage and even minimize migraine attacks when you’re expecting.

Why Pregnancy Can Trigger Migraine Attacks

When it comes to pregnancy, hormone changes can seem like a wild roller coaster ride throughout the trimesters, and for migraine sufferers, these fluctuations can be the perfect environment for a migraine attack.

“A common trigger for migraine in women is hormonal fluctuations, specifically changes in estrogen levels,” says Jasmin Dao, MD, pediatric and adult neurologist at Miller Children’s & Women’s Hospital and MemorialCare Medical Center in Long Beach, California. “Pregnant women can have more frequent migraine attacks during the first trimester of pregnancy because hormone levels such as estrogen and progesterone are drastically changing.”

Women are also especially susceptible to other migraine triggers during pregnancy, she adds, such as poor sleep, stress, and dehydration from early pregnancy nausea and vomiting.

These triggers may also prompt a migraine attack in those who have never experienced one before. Several studies show that 1 percent to 16.7 percent of women can experience their first migraine attack during pregnancy.

While data varies on the amount of women who experience migraine during pregnancy, it’s estimated that roughly 15 to 20 percent of pregnant women have migraine attacks.

Will Migraine Get Worse as Pregnancy Progresses?

Recent research has shown that 66 percent of women found that their migraine attacks decreased as the pregnancy progressed, especially for those who experienced migraine without aura.

 This is thought to be due to an increase in endorphins during the second and third trimesters – a welcome relief for those who fear that their migraine attacks will remain constant throughout the pregnancy.

Symptoms of a Migraine Attack During Pregnancy

A migraine attack while pregnant can feel debilitating. While symptoms can vary and affect pregnant women differently, the majority of symptoms include:

  • Throbbing headache, usually on one side of the head
  • Nausea
  • Vomiting
  • Sensitivity to light

It’s important that you keep in close contact with your providers when it comes to any headaches, working with both your OB-GYN and primary care physician and/or neurologist to manage migraine attacks. Dr. Dao recommends that patients contact their providers if they experience any headache that occurs suddenly and with intense pain, such as a thunderclap headache. She also recommends that patients talk to their doctor about any new or worsening headache or changes in vision with headaches.

Migraine With Aura During Pregnancy

For pregnant women who experience a migraine attack for the first time, it can be alarming, especially if vision changes accompany it. Research has shown that migraine with aura is most common for pregnant women who have never experienced a migraine before, often due to fluctuating hormone levels.

 Aura refers to changes in vision, including zigzag lines, flashing lights, bright spots that move across the line of vision, or dark blurred spots in the center of vision.

While these changes are often harmless symptoms of migraine, it’s important that you alert your medical provider of any new vision changes so the migraine can be diagnosed as the cause and proper treatment can be provided, if needed.

Which Migraine Medications Are Safe to Take During Pregnancy?

When it comes to treating migraine, it’s important that you discuss with your medical provider what medications are safe during pregnancy.

“Acetaminophen is considered first-line medication therapy for headache in pregnancy,” says Dao. “Second-line agents include a class of migraine medications called triptans, which have shown to be effective, with growing evidence that they are relatively safe during pregnancy. There is growing evidence of other migraine medications that have been deemed safe during pregnancy, so it is always important to talk to your doctor regarding your options.”

Triptans

Triptans cannot prevent your migraine attacks, but they can stop the pain by altering blood circulation in the brain and changing how your brain processes the pain.

Your doctor may recommend sumatriptan, as it has been used most commonly in the past, without adverse effects.

A few other triptans, such as rizatriptan, zolmitriptan, and eletriptan, have been logged by major pregnancy studies, and were found to have no increased risk of birth defects.

Occipital Nerve Blocks

Occipital nerve blocks are a pain relief treatment that injects local anesthetic, such as lidocaine, near the occipital nerve on the back of the head.

 Sometimes, this is combined with a steroid injection.

Anti-Nausea Medications

Your doctor might also choose to prescribe anti-nausea medication if you experience additional nausea with migraine attacks. This might include cyclizine, ondansetron, or prochlorperazine. Discuss all potential side effects and any plans for breastfeeding with your doctor, as some anti-nausea medications, like promethazine, can affect milk production.

 Others, such as ondansetron, which is connected to heart-rhythm problems, may not have enough history of proven use during pregnancy to be categorized as safe.

Migraine Medications to Avoid During Pregnancy

Migraine medications that are linked to congenital defects or other complications include beta blockers, tricyclic antidepressants (such as amitriptyline), and anti-epileptic medications.

Several of the medications that are generally avoided during pregnancy may be used under your doctor’s supervision, based on your individual health and needs. NSAIDs like aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve) might increase risk of miscarriage or birth defects if used during the first trimester,

 and increase risk of kidney problems, low amniotic fluid levels, and pulmonary hypertension in the baby if used after week 20 of pregnancy.

 Studies show that the second trimester is the safest time to use NSAIDs, and they may remain a part of your treatment plan during pregnancy, under your doctor’s supervision.

While pregnant, your doctor may choose to keep you on small doses of baby aspirin if alternative migraine medications are not working effectively, or to treat preeclampsia (a potentially life-threatening disorder of pregnancy characterized by high blood pressure), but it is not a first choice of medication without your doctor’s supervision.

 Aspirin use by breastfeeding women is also linked to Reye’s syndrome, which can be fatal.

Other medications to avoid, if possible, include opioids. Opioid use can lead to addiction problems for your baby, or possible neonatal death.

A variety of other migraine treatments are available, but their safety during pregnancy remains unclear.

Pregnancy-Safe Migraine Medications
Migraine Medications to Avoid
Acetaminophen (Tylenol)
Aspirin
Triptans
Ibuprofen (Advil, Motrin)
Occipital Nerve Blocks
Naproxen (Aleve)
Anti-Nausea Medications
Opioids

Questions to Ask Your Doctor Before Taking or Changing Medications

Before adding or changing migraine medications, there are some key questions you may want to ask your doctor, including:

  • How does this medication affect my pregnancy?
  • Will the medication dosage need to be adjusted during pregnancy?
  • Are there side effects from the medication that could impact my quality of life while pregnant?
  • Are there certain medications I should avoid while pregnant?
  • Can this medication be taken while breastfeeding?

How to Change Migraine Medications if You’re Pregnant

You should always reach out to your medical provider about any symptoms you’re having, says Christine Greves, MD, obstetrician and gynecologist at Orlando Health Women’s Institute Center for Obstetrics & Gynecology in Florida. If your symptoms are worsening or migraine attacks are affecting your stress levels, discuss with your provider other treatment options that might be available to you.

You should always discuss medication changes with your doctor — especially when you’re pregnant. Your doctor may adjust your medication based on your overall health, the health of your unborn child, or the stage of your pregnancy.

 Some medications are metabolized differently during pregnancy and may require different, or even higher, dosages.

 If medications that are known to be problematic during pregnancy must be used, they would likely be prescribed at a lower dosage, such as a baby aspirin.

It’s also important to keep in mind that some medications can impact the growing fetus, depending on gestational age, says Dr. Greves, and some can be used earlier in the pregnancy or even sparingly throughout the pregnancy, or during specific trimesters, depending on the medication.

 For these reasons, it’s important to discuss all medications with your doctor, taking into account the impact on both you and the baby.

Non-Medication Treatments for Migraine Attacks During Pregnancy

While migraine medications can be helpful, lifestyle changes, home remedies, or complementary and integrative treatments may also help relieve migraine symptoms.

Lifestyle Changes

Ensure that you’re getting quality sleep for the recommended hours as this can help relieve stress and keep your body functioning at optimal levels.

 It is generally recommended to get seven to nine hours of sleep, but getting eight to ten hours is recommended during pregnancy.

 It’s also important to make sure that you’re drinking enough water — especially while pregnant — to avoid dehydration, and to take steps to avoid any personal migraine triggers.

 Including gentle physical activity, such as a walk, can also help lower stress levels and eliminate migraine triggers.

Integrative Treatments

Integrative treatments such as massage and acupuncture are other options for relieving migraine attacks. These complementary treatments can help relieve muscle tension and stress, and help alleviate painful symptoms.

Other integrative treatment options that might be beneficial include relaxation techniques (such as yoga or deep breathing), using pain-reducing devices such as head massagers, and biofeedback. Biofeedback is a conditioning exercise that teaches you how to become more aware of your body’s involuntary functions.

 This additional awareness helps some patients better control their breathing, heart rate, or other functions when under stress or experiencing pain.

Complications of Pregnancy Due to Migraine

If you develop migraine for the first time during pregnancy, or if there’s an increase in migraine symptoms during pregnancy, they should be taken seriously.

“Research studies suggest that pregnant women with prior history of migraine pregnancy may have a greater risk of complications in pregnancy,” says Dao. Women who experienced migraine during pregnancy are 26 percent more likely to have adverse pregnancy outcomes, including preterm delivery, preeclampsia, and low birth weight.

Migraine After Pregnancy: Does It Come Back?

It’s difficult to predict whether migraine attacks will continue after giving birth, says Greves — even for medical professionals. Fluctuations in hormones following birth can create an environment where migraine attacks may occur.

 However, breastfeeding appears to prevent migraine after the initial postpartum period in many women, as it keeps estrogen levels stable and low.

“Headaches and migraine after giving birth are common,” says Dao. “They can occur more frequently in the six weeks postpartum due to hormonal fluctuations after giving birth. In addition, with the new lifestyle of caring for a newborn, there is decreased sleep, dehydration, and stress, which can trigger migraine attacks. Usually, women who have had pre-pregnancy migraine attacks are more likely to experience migraine after giving birth.”

You’ll want to discuss all medications, including migraine medications, with your doctor before taking them if you are breastfeeding, as some can be transmitted through breast milk and are not safe for your baby.

 The migraine medication ergotamine, for example, may make your baby nauseated, tired, or vomit. It may also decrease milk production, as can some anti-nausea medications.

The Takeaway

  • Fluctuating hormones, poor sleep, and dehydration during pregnancy can impact the severity and frequency of migraine attacks.
  • Be sure to share your symptoms or ongoing concerns with your medical provider so that proper and safe treatment can be received.
  • Treatment for migraine attacks may be adjusted during the pregnancy based on the trimester.
  • Women who experience pre-pregnancy migraine attacks are more likely to have them following birth. Breastfeeding, however, appears to decrease migraine frequency after the postpartum period.

Common Questions & Answers

Are migraine attacks common during pregnancy?
The frequency and severity of migraine attacks during pregnancy vary by person, but it isn’t uncommon for fluctuating hormones, poor sleep, and dehydration to increase the risk of migraine, especially during the first 16 weeks of pregnancy.
Migraine attacks can be treated with pregnancy-safe medications, such as Tylenol. Patients can also find relief from home remedies, lifestyle changes, and integrative treatments.
A migraine attack isn’t indicative of a miscarriage. However, if a severe headache is associated with abdominal pain or bleeding, women are encouraged to consult with their medical provider, as that may be a symptom of other complications.
Any symptoms that are affecting your quality of life or are new and worsening should be discussed with your doctor. It’s a good idea to discuss any vision changes associated with migraine attacks with your doctor as well.
For less severe headaches, or to prevent them from occurring, prioritize sleep and ensure that you’re drinking ample water, as dehydration can cause headaches. Tylenol can also be used to help lessen headache symptoms.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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Kara Smythe, MD

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Kara Smythe, MD, has been working in sexual and reproductive health for over 10 years. Dr. Smythe is a board-certified fellow of the American College of Obstetricians and Gynecologists, and her interests include improving maternal health, ensuring access to contraception, and promoting sexual health.

She graduated magna cum laude from Florida International University with a bachelor's degree in biology and earned her medical degree from St. George’s University in Grenada. She completed her residency in obstetrics and gynecology at the SUNY Downstate Medical Center in Brooklyn, New York. She worked in Maine for six years, where she had the privilege of caring for an underserved population.

Smythe is also passionate about the ways that public health policies shape individual health outcomes. She has a master’s degree in population health from University College London and recently completed a social science research methods master's degree at Cardiff University. She is currently working on her PhD in medical sociology. Her research examines people's experiences of accessing, using, and discontinuing long-acting reversible contraception.

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