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Practice Pregnancy Plus

Migraine in pregnancy

BMJ 2008; 336 doi: (Published 26 June 2008) Cite this as: BMJ 2008;336:1502
  1. Peter J Goadsby, professor 1,
  2. Jay Goldberg, associate professor2,
  3. Stephen D Silberstein, professor3
  1. 1Headache Group, Department of Neurology, University of California, San Francisco, CA 94143-0114, USA
  2. 2Department of Obstetrics and Gynecology, Jefferson Medical College, Philadelphia, PA
  3. 3Jefferson Headache Center, Philadelphia, PA
  1. Correspondence to: P J Goadsby, Headache Group, Department of Neurology, University of California, San Francisco, 505 Parnassus Ave, San Francisco CA 94143-0114 USA peter.goadsby{at}
  • Accepted 5 March 2008

The authors explore whether migraine affects pregnancy, how pregnancy alters migraine, and how to treat and prevent migraine in pregnancy

Migraine is common, with a one year prevalence of 12-15% in the Western world.1 The case described here (see the Scenario box) illustrates many of the problems that arise when a patient who has migraines becomes pregnant.


A 32 year old woman with a history of episodic headache has recently become aware she is pregnant. She has had troublesome headaches from childhood. She has no other medical problems. Her sister and mother have migraines. She is a non-smoker. In the previous five years, her headaches have become more frequent, with five to seven attacks a month of disabling left or right sided, throbbing pain around the parietal and temporal region. The pain is aggravated by physical activity and any movement and associated with nausea and marked vomiting, prominent photophobia, and phonophobia. The attacks last two to three days. She had no aura symptoms. Neurological and general physical examinations were normal, and thus her diagnosis is migraine without aura.2

She has had minimal benefit from over the counter analgesics, including paracetamol (acetaminophen) with and without codeine; aspirin; metoclopramide; prochlorperazine; domperidone; and non-steroidal anti-inflammatory drugs (notably ibuprofen and naproxen). She was started on sumatriptan 20 mg nasal spray. This provided headache relief in about two hours, with some mild chest discomfort. She was also started on topiramate as a migraine preventive, which, at a dose of 50 mg twice daily, reduced her attack frequency to two a month. Breakthrough attacks were treated with sumatriptan. She had some mild paraesthesia with topiramate but no other side effects. This pregnancy, her first, was unplanned. She is currently …

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