Headaches during pregnancy are a common problem among women. Headache can be caused by various reasons, including hormonal changes, dehydration, stress, and lack of sleep. However, pregnant women need to be careful about the medications they take to treat headaches, because some drugs can harm the fetus. In this article, we will discuss headache treating medications that are safe and not safe for pregnant women, including their uses, indications, contraindications, dosage, and side effects.
What headache treating medications are safe for pregnant women?
There’s generally little information about safe headache treating medications to take during pregnancy. Still, up to 70% of pregnant women with a migraine condition take medications to relieve headache.
Acetaminophen (Tylenol)
Acetaminophen (Tylenol) is one of the most commonly used medications during pregnancy. Up to 65% of pregnant women use this pain reliever.
Acetaminophen is used to treat mild to moderate pain and fever. Acetaminophen works by reducing the production of prostaglandins, which cause pain and fever.
Dosage: The recommended dose of acetaminophen for pregnant women is 650-1000mg every 4-6 hours, not to exceed 4000mg per day.
Side effects: Acetaminophen is generally well-tolerated, but it can cause liver damage if taken in large doses.
Some studies, however, suggest that taking acetaminophen during pregnancy may affect the growth and development of the unborn baby. These studies mostly suggest links between acetaminophen use during pregnancy and the likelihood that children have autism or show signs of attention deficit-hyperactivity disorder (ADHD).
However, many of these studies have conflicting findings or are of low quality. Some studies were only conducted on animals (not humans). So we need more research to say for sure whether acetaminophen is safe in pregnancy or not.
A larger study comparing acetaminophen to nonsteroidal anti-inflammatory drugs is more more believable. This study showed that acetaminophen is linked to fewer birth defects than nonsteroidal anti-inflammatory drugs. We’ll discuss nonsteroidal anti-inflammatory drugs more below.
This conflicting information can be confusing. Still, the American College of Obstetricians and Gynecologists recommends acetaminophen. They consider acetaminophen a low-risk medication for treating pain during pregnancy. But they emphasize that medications should only be used when needed. It’s best to take medicine as little as possible and only after speaking with a healthcare professional.
What headache treating medications are not safe for pregnant women?
There are several headache treating medications that aren’t safe for pregnant women. Some medications have risks of birth defects, miscarriage, and preterm birth. Preterm birth means giving birth earlier than 37 weeks of pregnancy.
Nonsteroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs are often used to relieve headache. These drugs include over-the-counter medications, such as ibuprofen (Advil), naproxen (Aleve), and aspirin. There are also prescription nonsteroidal anti-inflammatory drugs, like celecoxib (Celebrex).
The US Food and Drug Administration recommends avoiding nonsteroidal anti-inflammatory drugs at 20 weeks of pregnancy or later. Nonsteroidal anti-inflammatory drugs raise the risk of serious kidney problems in unborn babies. These medications can also cause low levels of amniotic fluid. Taking nonsteroidal anti-inflammatory drugs after 30 weeks of pregnancy raises the risk of heart issues in unborn babies.
It’s not clear whether it’s safe to take these medications before the 20th week of pregnancy or not. There’s some evidence that use of nonsteroidal anti-inflammatory drugs in early pregnancy might lead to miscarriage. So some healthcare professionals recommend avoiding nonsteroidal anti-inflammatory drugs during all stages of pregnancy.
Aspirin
Pregnant women should avoid taking aspirin, because it can increase the risk of bleeding and miscarriage, especially during the first and third trimesters. Aspirin can also cause premature closure of the ductus arteriosus, a blood vessel in the fetal heart.
Codeine
Codeine is an opioid medication used to treat pain and cough. Codeine can cause respiratory depression and neonatal withdrawal syndrome in the fetus.
Pregnant women should avoid taking codeine.
Triptan drugs
According to the American Academy of Family Physicians, sumatriptan (Imitrex) drug can be used to treat severe headaches during pregnancy. But you should only try sumatriptan drug after careful discussion with a healthcare professional.
Sumatriptan belongs to the triptan class of medications. It’s the most well-studied triptan drug for pregnant women. But there’s mixed information about how safe it is during pregnancy.
Studies of use of sumatriptan drug or rizatriptan (Maxalt) drug during pregnancy showed reports of miscarriage. These studies also reported preterm births and infants with low birth weights. Other reports found that sumatriptan use in the third trimester caused umbilical cord problems. On the other hand, further studies didn’t show that triptan drugs raised the risk of major birth defects.
These mixed results make it hard to say whether triptan drugs are safe during pregnancy or not. You should discuss these risks with a healthcare professional first.
Ergot derivative drugs
Ergot derivative drugs, like dihydroergotamine (Migranal), are old migraine treating medications. These medications are less commonly used today. These medications aren’t safe; you should avoid them at all stages of pregnancy.
Ergot derivative drugs relieve headaches by tightening blood vessels of the brain. But these drugs also tighten blood vessels in the uterus. This effect could lower blood flow to an unborn baby, and subsequently lead to birth defects and low birth weight infants.
Ergot derivative drugs can also cause contractions. This problem can lead to preterm birth.
Ergotamine (Ergomar)
Ergotamine is a medication used to treat migraines. Ergotamine can cause uterine contractions and fetal distress, making it unsafe for pregnant women.
Other headache treating medications
Over the years, newer headache treating medications have become available. Examples include Ubrelvy (ubrogepant) and Nurtec ODT (rimegepant). These medications are relatively new. So there’s not enough information yet about their safety during pregnancy. Currently, you should avoid taking these medications if you’re pregnant.
Caffeine-containing medications
You should avoid medications that contain caffeine. An example of this kind of medication is Excedrin Tension Headache (acetaminophen/caffeine). Avoiding these products helps limit the amount of caffeine you consume each day.
American College of Obstetricians and Gynecologists has found that consuming less than 200 mg of caffeine a day is likely safe. This amount of caffeine doesn’t seem to raise the risk of miscarriage or preterm birth. Drinking one cup of coffee or less per day will keep you within this limit.
But other studies suggest opposite information. These studies found that even smaller amounts of caffeine during pregnancy may raise the risk of complications. These complications included miscarriages, stillbirths, and low birth weights.
Butalbital-containing medications
During pregnancy, don’t take any headache medications that contain butalbital. Examples include Bupap (butalbital/acetaminophen) and Fioricet (butalbital/acetaminophen/caffeine).
Butalbital is a barbiturate that helps you relax and lowers anxiety. Butalbital can pass through the placenta and affect your unborn baby. Studies suggest that butalbital use during pregnancy is linked to certain heart defects.
Butalbital can also be habit-forming if used long term. This problem can cause your unborn baby to become dependent on this medication. Once born, your baby may show signs of neonatal abstinence syndrome.
Signs of neonatal abstinence syndrome include seizures, high-pitched crying, and poor feeding. If not treated, neonatal abstinence syndrome can lead to long-term health problems.
What are other things I can do to treat a headache while I’m pregnant?
You should take as little medication as possible during pregnancy. You should try other methods to relieve headache pain first.
Certain lifestyle changes and alternative therapies can help ease headache symptoms. Below are some tips and non-medication options to relieve headache pain:
- Take a quick nap and remember to get enough good-quality sleep.
- Find a dark, quiet room with few distractions.
- Place hot or cold packs on your neck, head, or stomach to soothe pain.
- Massage your head or temples for temporary relief.
- Exercise for 30 to 60 minutes, 3 to 5 days a week.
- Eat regular, healthy meals and drink plenty of fluids
- Find stress-relieving activities to do, like breathing exercises and yoga.
- Try acupressure or acupuncture.
- Consider trying cognitive behavioral therapy
Conclusion
Currently, acetaminophen is the safest choice for treating headache during pregnancy. Other medications might cause harm to your baby. But it’s recommended to try non-medication remedies to reduce headache pain first.
If you’re pregnant and have a headache, talk to a healthcare professional or pharmacist. They can help you decide which medications are safe to take. If you do need medication, it’s best to take the lowest dose for the shortest time possible.
Sources of information:
- American College of Obstetricians and Gynecologists. (2018). Headaches During Pregnancy. Retrieved from https://www.acog.org/womens-health/faqs/headaches-during-pregnancy
- Briggs, G. G., Freeman, R. K., & Yaffe, S. J. (2017). Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk. Lippincott Williams & Wilkins.
- National Institutes of Health. (2021). Acetaminophen. Retrieved from https://medlineplus.gov/druginfo/meds/a681004.html
- National Institutes of Health. (2021). Ibuprofen. Retrieved from https://medlineplus.gov/druginfo/meds/a682159.html
- National Institutes of Health. (2021). Sumatriptan. Retrieved from https://medlineplus.gov/druginfo/meds/a601116.html
- US Food and Drug Administration. (2018). Use of Aspirin for Primary Prevention of Heart Attack and Stroke. Retrieved from https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-about-serious-bleeding-risk-over-counter-antacid-products
- US National Library of Medicine. (2021). Codeine. Retrieved from https://medlineplus.gov/druginfo/meds/a682065.html
- US National Library of Medicine. (2021). Ergotamine. Retrieved from https://medlineplus.gov/druginfo/meds/a601100.html
- American Pregnancy Association
