Migraines and Pregnancy

Migraine headaches are different from stress or tension headaches. Migraine headaches are a type of vascular headache that is a result from blood vessels dilating in the brain.

There is no standard experience of migraine headaches when it comes to pregnancy. Women prone to getting migraines, may experience stronger headaches, or may find that they diminish. It is also normal for women to experience their first migraine during pregnancy. Some studies have found a slight correlation between migraines and hormones. Women tend to get migraines more often than men.

Doctors generally advise pregnant women, or women planning to become pregnant, to stay off medications unless they’re absolutely needed. Doctor and patient have to weigh the potential risks to your unborn baby of a drug against the potential benefits of relief. In some cases, a decision will need to be made based on scant or inconclusive research on a particular drug.

Many of the anti-migraine medications to treat or prevent migraine headache and its symptoms should be avoided during pregnancy. That’s because they’ve been linked to birth defects in babies. Other medications are associated with pregnancy complications. For instance, some have been associated with bleeding, miscarriage, or intrauterine growth restriction (IUGR). With IUGR the uterus and fetus don’t grow normally.

Topamax, which also goes by the name Topiramate, is a medication used to treat different forms of epilepsy and the control of seizures, and was also shown to help those who suffer from migraine headaches by decreasing their frequency. The Food and Drug Administration (FDA) has released new data showing that pregnant women taking Topamax for migraines run higher risks of having babies who develop cleft lip and palate deformities than pregnant women who do not.

During the first trimester of pregnancy, oral defects such as cleft lip and cleft palate occur when parts of the lip or palate fail to fuse completely. Unfortunately, most women do not know they are pregnant until the end of their first trimester, therefore if they were already taking Topamax or its generic form, any risks to the fetus have already occurred.

The FDA uses a drug system of categories that include A, B, C, D, and X. This system classifies possible risks to the fetus when taken during pregnancy. Topamax was previously classified as a Category C medication meaning the drug had not proven to be harmful to unborn children.

Because of new data showing increased risks, Topamax has been moved to category D. According to the FDA the category D definition means “there is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective.) They should be used during pregnancy only when the alternatives are worse”.

According to the FDA, the following drug information should now be given to patients before beginning Topamax in any form:

• If taking this medication, the risk for cleft lip or cleft palate in fetuses is increased. Women who are considering becoming pregnant should consult their doctors for alternative medications.
• If you are still able to conceive but are not planning on becoming pregnant, you should find an effective form of birth control while taking this medication. Consult your physician regarding the best form of birth control to use.
• If you decide to take this medication, you should let your physician know if you are currently pregnant, or are planning on becoming pregnant in the near future. He or she may offer different alternatives to this medication.
• Notify your physician immediately if you become pregnant and have been taking this medication.
• Do not stop this medication abruptly without first speaking to your physician. If being treated for epilepsy, serious problems harmful to mother and fetus can occur.
• This medication does pass to breast milk. However, there is no current information on the possible effects to babies.