Recommendations for Migraine Treatment During Pregnancy Presented by Dr. Carrie Dougherty, MedStar Georgetown University Hospital

Dr. Carrie Dougherty delivered a presentation titled “Managing Migraine in Pregnancy” at the 2023 Scottsdale Headache Symposium. In this presentation, Dr. Dougherty discussed the importance of treating migraine during pregnancy and surveyed the literature documenting the safety and efficacy of migraine treatment options.

Dr. Dougherty highlighted the association of untreated migraine during pregnancy with a higher risk of cardiovascular complications, preterm delivery, preeclampsia, and low birth weight infants. Results from the Nurses’ Health Study II prospective cohort found that migraine was associated with higher risk of:

• Preterm delivery (relative risk [RR]=1.17 [95% CI, 1.05-1.30]).

• Gestational hypertension (RR=1.28 [95% CI, 1.11-1.48]).

• Preeclampsia (RR=1.40; 95% CI, 1.19-1.65]).

Dr. Dougherty compared headache interventions in pregnancy that may be associated with fetal/child adverse effects (eg, acetaminophen, prednisolone, indomethacin, ondansetron, antipsychotics, and intravenous magnesium) with interventions that may not be associated with adverse effects (eg, triptans, calcium channel blockers [CCBs] and antihistamines). She also examined limited case report data on the use of onabotulinumotoxinA during pregnancy and provided an update on safety data from the WHO VigiBase study which demonstrated that calcitonin gene-related peptide monoclonal antibody (CGRP mAB) treatment during pregnancy showed no specific maternal toxicities, patterns of major birth defects, or increased reporting of spontaneous abortion.

In conclusion, Dr. Dougherty provided practical advice for treating patients with migraine during pregnancy, including

• The need for shared decision-making with patients
• The importance of coordinating care with colleagues in obstetrics/gynecology and maternal fetal medicine
• A reminder to report exposures to registries

For a more extensive treatment on the topic of migraine treatment during pregnancy, please see a recent article on this subject from the May/June 2023 issue of Practical Neurology and Dr. Dougherty’s 2019 article, “Migraine During Pregnancy.”

Dr. Dougherty is Associate Professor of Neurology at MedStar Georgetown University Hospital. She has received consulting fees from AbbVie, Axsome, Eli Lilly, Lundbeck, Pfizer, and Satsuma, and is a principal investigator for clinical trials sponsored by AbbVie, Axsome, and Eli Lilly.