Migraine during pregnancy

• Most women (up to 80%) with migraine will notice an improvement in frequency and severity of attacks in the second and third trimesters.
  • Those with premenstrual migraine and migraine without aura are most likely to have an improvement.
• paracetamol 1g is first-line
• NSAIDs can be used second-line in the first and second trimester
• avoid aspirin and opioids such as codeine during pregnancy

Migraine and the combined oral contraceptive (COC) pill

• if patients have migraine with aura then the COC is absolutely contraindicated due to an increased risk of stroke (relative risk 8.72)

Migraine and menstruation

• many women find that the frequency and severity of migraines increase around the time of menstruation
• SIGN recommends that women are treated with mefanamic acid or a combination of aspirin, paracetamol and caffeine. Triptans are also recommended in the acute situation

Migraine and hormone replacement therapy (HRT)

• safe to prescribe HRT for patients with a history of migraine but it may make migraines worse