Headache During Pregnancy
Headache During Pregnancy
We analyze recommendations from the world’s leading obstetrics and gynecology organization — what is safe, what is prohibited, and when to see a doctor urgently
Good News!
If you suffered from migraines or frequent headaches before pregnancy, there is real reason for hope. The body changes during pregnancy, and often chronic headaches, including migraines, become less frequent or disappear.
But “getting better” does not mean “can be ignored.” Because headache during pregnancy is sometimes just fatigue, and sometimes a signal requiring immediate attention.
What Can Be Taken?
Here is the main thing to know about treatment: the choice of medications during pregnancy is greatly limited, but it exists. ACOG recommendations.
Paracetamol 1000 mg — up to 3 times a day
Can be combined with caffeine up to 200 mg/day. This is the first and main choice in all trimesters.
Metoclopramide (Cerucal) — if nausea is present
Helps both headache and nausea simultaneously. Safe during pregnancy and breastfeeding.
Sumatriptan — if pain does not subside
Triptans — only if the first steps did not help. Among all triptans, sumatriptan is the most studied during pregnancy.
NSAIDs: Depends on the Trimester
Ibuprofen, diclofenac, and other anti-inflammatory drugs are a separate story. In the 1st and 3rd trimesters they should be avoided, but in the 2nd trimester they are permissible. Be sure to check with your doctor.
What Is Safe and What Is Not
🩺 If you suffer from headaches during pregnancy, discuss the prescription of these medications with your doctor. The data below is based on international guidelines, but every situation is individual.
Allowed During Pregnancy
- Paracetamol
- Caffeine (up to 200 mg/day)
- Metoclopramide
- Sumatriptan (2nd line)
- Calcium channel blockers (prophylaxis)
- Antihistamines (prophylaxis)
- IV magnesium (for migraine with aura)
- Acupuncture and biofeedback
Not Allowed During Pregnancy
- Ergotamine (ergot)
- Valproate, topiramate
- Gabapentin
- Beta-blockers (Deralin)
- Medications with butalbital
- Opioids
- Antidepressants (TCA, venlafaxine)
- Botox (onabotulinumtoxin)
💊 During Breastfeeding — paracetamol, NSAIDs, and metoclopramide are safe. Caffeine — use with caution: it is slowly eliminated in preterm and newborn infants. Bonus: metoclopramide additionally stimulates milk production.
When to See a Doctor Immediately 🚨
This is the most important part. Some headaches during pregnancy may be signs of preeclampsia, thrombosis, or other serious conditions.
Red Flags — See a Doctor Urgently
If you have any of these signs, do not wait, seek medical help immediately:
Important: preeclampsia must be ruled out not only during pregnancy but also up to 6 weeks postpartum. If headache is severe and blood pressure is elevated, this is a reason for examination even after discharge from the maternity hospital.
🤱 For Breastfeeding Moms
Headaches also occur after childbirth. Hormonal changes, lack of sleep, dehydration do their part.
Paracetamol and ibuprofen are compatible with breastfeeding. Metoclopramide is too, and it also helps to establish lactation. Just remember to drink water and take care of yourself.
Where Does This Data Come From?
This material is based on the clinical guideline of the American College of Obstetricians and Gynecologists (ACOG) — the world’s leading professional organization in obstetrics and gynecology. Their recommendations are recognized as the international standard of evidence-based medicine and are used by doctors worldwide, including in Israel.
Original source: ACOG Clinical Practice Guideline No. 3. Obstet Gynecol. 2022;139(5):944–972.
