Migraine without Aura in Pregnancy
Treating acute migraine attacks during pregnancy requires balancing effective pain relief against foetal safety. The appropriate approach is shaped by trimester, and several agents routinely used outside of pregnancy are either unapproved or contraindicated in this population.
Clinical scenario
Migraine without aura in a pregnant patient. Trimester is a critical determinant: options that are acceptable in early pregnancy may be restricted or prohibited later, and certain standard migraine-specific drug classes cannot be used at any stage.
Treatment approach
Analgesic therapy forms the basis of acute attack management, with trimester-dependent restrictions governing which agents are appropriate. Key migraine-specific drug classes are either unapproved or explicitly contraindicated throughout pregnancy, narrowing the available options.
The complete structured protocol — including agent selection by trimester, order of preference, and specific contraindication criteria — is in the full regimen.
References
DOI: 10.1177/2514183X1882337
Migraine attacks can be treated between the first and second trimenon of pregnancy with ASA or ibuprofen.
These substances should be avoided in the third trimenon.
Paracetamol should only be given if there are contraindications for ASA.
Triptans are not approved for use in pregnancy.
Ergots are contra-indicated during pregnancy.
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