𝗠𝗶𝗴𝗿𝗮𝗶𝗻𝗲 𝗠𝗲𝗱𝗶𝗰𝗮𝘁𝗶𝗼𝗻𝘀, 𝗣𝗿𝗲𝗴𝗻𝗮𝗻𝗰𝘆, 𝗮𝗻𝗱 𝗕𝗿𝗲𝗮𝘀𝘁𝗳𝗲𝗲𝗱𝗶𝗻𝗴: 𝗪𝗵𝗮𝘁 𝗬𝗼𝘂 𝗡𝗲𝗲𝗱 𝘁𝗼 𝗞𝗻𝗼𝘄

If you have migraine and are thinking about becoming pregnant, one of the most important conversations to have with your healthcare provider is about your medications. Many women worry that they will have to stop all migraine treatments, but the answer is often more nuanced. Some medications should be discontinued well before conception, while others can sometimes be used during breastfeeding.

Triptans

Triptans, such as sumatriptan (Imitrex®), rizatriptan (Maxalt®), and eletriptan (Relpax®), are among the most effective medications for treating an acute migraine attack.

Fortunately, triptans do not need to be stopped months before pregnancy. Because they leave the body quickly, they can generally be discontinued once pregnancy is recognized or when actively trying to conceive. Sumatriptan has been studied the most and has not been associated with an increased risk of major birth defects when used occasionally during pregnancy.

During breastfeeding, sumatriptan is considered one of the preferred migraine medications. Only a very small amount passes into breast milk. While some manufacturers recommend waiting 12 hours after taking a dose before nursing, many headache specialists believe this is unnecessary for most mothers because infant exposure is extremely low. There is also reassuring, though more limited, data for eletriptan and rizatriptan.

Gepants

The newer gepants—including ubrogepant (Ubrelvy®), rimegepant (Nurtec ODT®), and zavegepant (Zavzpret®)—have become increasingly popular because they effectively treat migraine without causing blood vessel constriction.

Unfortunately, there is very little human pregnancy data available. Because of this uncertainty, experts generally recommend stopping gepants before attempting pregnancy. Since these medications have relatively short half-lives, stopping them several days before conception is generally sufficient, although many clinicians recommend discontinuing them once pregnancy is being actively planned.

There is also very limited information regarding breastfeeding. Until more safety data become available, gepants are generally not recommended during lactation, particularly while nursing newborn or premature infants.

Injectable CGRP Monoclonal Antibodies

The injectable CGRP monoclonal antibodies—including erenumab (Aimovig®), fremanezumab (Ajovy®), galcanezumab (Emgality®), and eptinezumab (Vyepti®)—have transformed migraine prevention for many patients.

These medications remain in the body for a long time. Because they have half-lives of approximately one month, most headache specialists recommend stopping them five to six months before trying to conceive. This allows enough time for nearly all of the medication to be eliminated before pregnancy begins.

There are currently insufficient data to recommend their use during pregnancy or breastfeeding. Although very little of these large antibody molecules is expected to enter breast milk—and even less is likely to be absorbed by the infant—the absence of robust human safety studies means they are generally avoided while breastfeeding, especially during the first few months after delivery.

Ditans

Lasmiditan (Reyvow®) is the only approved ditan and is used to treat acute migraine attacks.

Because human pregnancy data are extremely limited, lasmiditan should generally be discontinued before attempting pregnancy. Fortunately, it is cleared from the body within about one day, so it does not require a prolonged washout period.

Breastfeeding is also not recommended immediately after taking lasmiditan. Current prescribing information advises avoiding breastfeeding for 24 hours after each dose because it is unknown how much medication passes into breast milk.

Planning Ahead Makes All the Difference

If you are planning a pregnancy, don’t stop your migraine medications without first speaking with your neurologist or obstetric provider. An individualized treatment plan can help minimize migraine attacks while keeping both mother and baby as safe as possible.

For many women, migraine actually improves during the second and third trimesters of pregnancy, although this is not true for everyone. Safe treatment options—including lifestyle strategies, acetaminophen, selected anti-nausea medications, magnesium, and in some cases sumatriptan—can often provide relief when needed.

BeCare Migraine  can help with a headache calendar,  tracker of triggers and symptoms, neurologic exam, community of headache sufferers and an AI assistant . Understanding the frequency and triggers for your headaches is key for optimal headache management.  Be Aware with BeCare.  Become a driver in your own headache journey.