Some migraine sufferers quit painkillers when pregnant
Even if they have severe headaches and it is safe to use their prescribed drugs.
Migraines are painful. Over one in ten Norwegian women experience migraine attacks, with headaches often compounded by nausea, vomiting and hypersensitivity to light and noises.
Many, however, find they get some relief when pregnant. A third of women with chronic migraines lose them during pregnancies.
Norwegian women, with or without migraines, cut down on their normal use of medications while pregnant. This was made evident through a questionnaire among women who gave birth at Akershus University Hospital from 2008 to 2010.
A third who use painkillers stop taking them completely.
Those who continue often switch to less effective analgesics.
Six in ten who normally use triptans, most commonly the antimigraine drug sumatriptan, switch over to paracetamol. Seven in ten who use another drug type for their migraines, NSAIDs, which include Ibuprofen, also make the switch.
This is not simply because they are getting a respite and suffering less. Even the women who continue to be plagued by migraines and severe headaches cut out the effective triptans during their pregnancies.
Two out of ten of these opt to use nothing, whereas nearly seven in ten opt for paracetamol.
Not good for the child if mum is sick
This means that some are living with severe pains.
“Many of them make do with paracetamol or nothing at all. That’s just bad,” says Research Fellow Gerd-Marie Eskerud Harris at the University of Oslo.
The study is part of her doctoral thesis in pharmaceutics. Her work was conducted in collaboration with researchers at Akershus University Hospital and the Norwegian Institute of Public Health.
“It is generally bad for the child in the womb when mum is ill. The migraines can cause vomiting and dehydration or nausea that prevents her from getting enough nutrition. Some studies have also indicated that bad migraine attacks during pregnancy can also raise the risk of hypertension and preeclampsia,” says Harris, while adding that such risks depend on how plagued the woman is.
“One should be cautious with the use of medications during pregnancies. The pros and cons need to be considered. A balance has to be based on the severity of attacks and their frequency.”
A total of 1,981 women participated in the study and only 100 had migraines during their pregnancies. But 262 had migraines the year prior to their pregnancies. The number with severe migraines during their pregnancies was 48.
The women reported how strong their headaches were on a scale of one to ten. The researchers could not ascertain through the questionnaire what they were using the medications against for sure – perhaps their headaches were not medically designated as migraines.
However, another Norwegian study involving 3,480 women has shown that a fourth of pregnant women with migraines used triptans.
Harris thinks many pregnant women can consider using the migraine medication sumatriptan. An examination made by other Norwegian researchers has shown that sumatriptan is safe to use during pregnancies.
“Current information indicates that this is not so risky to use,” says Harris, who is also working on a study of the long-term effects on the child. One study has indicated that triptans can contribute to behavioural problems.
But even paracetamol can contribute to these.
The pharmacist says pregnant women with migraines need to be closely attended to by their doctors. Still another Norwegian study of 400 women showed that less than a third felt they were getting sufficient treatment while pregnant or afterwards when still nursing their infants.
“Doctors should talk with the woman at an early stage about the safe use of medications during her pregnancy,” says Harris.
“Women should not be plagued in their pregnancies by migraines, because there are alternatives.”
The education level of the women in the study was a little above the average among women giving birth. They were less likely to be smokers and more often married or living with partners. This means the study does not necessarily apply to pregnant women in general.
The charting of medications used by the pregnant women was just a minor part of the so-called ABC study, in which women responded to questions about a host of things from back pains to mental problems. Because of its general and broad scope there are issues or details that the researchers lack answers to.
They have not asked why some of the women reduce their use of medications during pregnancies, even while suffering strong pains.
Harris thinks many are simply anxious and wishing the best for their child. Another Norwegian study shows that pregnant women generally exaggerate the risk of taking drugs and medications.
“My impression is that pregnant women are sceptical regarding medications because they fear harm to their child. They can be swayed by things they have read on the internet or impressions they get from their doctors about triptans.
Some doctors might advise against triptans because they are unsure how safe they are. Research shows that it is best to use paracetamol for migraine attacks if they it has a sufficient effect and the woman isn’t stricken too frequently. But doctors can certainly consider sumatriptan for severe attacks or if paracetamol doesn’t work. NSAID medications such as Ibuprofen are not recommended in the first and third trimesters.
Translated by: Glenn Ostling
- Harris, G-M. et al.: Patterns and predictors of analgesic use in pregnancy: a longitudinal drug utilization study with special focus on women with migraine. BMC Pregnancy and Childbirth (2017) 17: 224, 14 July 2017. DOI 10.1186/s12884-017-1399-0