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Headaches During Pregnancy
Dr. Robbins
Posted June 2000
Excerpt from Dr. Robbins' 2nd edition of Headache Help

If you suffer from migraines, chances are that pregnancy, especially the second and third trimesters, will bring a welcome relief. If you do get headaches at this time, however, they are particularly hard to treat because you must avoid drugs that may potentially be harmful to the fetus. First try ice packs, relaxation therapy, and rest in a dark room. Ask your doctor about using small amounts of medication, such as acetaminophen (Tylenol). While caffeine decreases headaches, its use during pregnancy remains controversial. Limited amounts are probably fine. If you need something stronger, the doctor may try small doses of meperidine (Demerol), hydrocodone (Vicodin), or acetaminophen with codeine. Limited amounts of cortisone are also used on occasion. Take antinausea medications only if absolutely necessary, and only in small amounts. Over-the-counter preparations that may help nausea include Vitamin B6 and Emetrol. For more severe nausea, Reglan or Compazine are occasionally used.

If your migraines are frequent and severe, or you get daily headaches that are intolerable, your doctor may recommend preventive medications with minimal doses after the first trimester. A beta-blocker (such as propranolol, metoprolol, nadolol, or timolol) is often prescribed and discontinued three weeks before delivery to avoid harming the baby. Be sure you understand all the risks before trying any of these medications.

When beta-blockers don’t work or can’t be used, the doctor may recommend a very low dose (such as 10 or 25 mg.) of amitriptyline if daily preventive medication is necessary. However, there have been isolated reports that amitriptyline may trigger abnormalities in babies’ arms or legs. Again, be sure you understand whatever risks that this or other medications pose during pregnancy. Prozac and Zoloft have been used during pregnancy, and preliminary studies indicate that they are probably safe. However, this has not been proven. You need to be completely informed about all the possible risks of any medications used during pregnancy.