Given that migraine without aura often improves during pregnancy women should aim to stop migraine prophylactic treatments before pregnancy.

Migraine with aura often continues unchanged.

Before commencing treatment, potential harmful effects of therapies need to be discussed with women who are, or may become, pregnant.

Acute therapies

Good practice point tickDue to its safety profile, paracetamol is first choice for the short-term relief of mild-to-moderate headache during any trimester of pregnancy.

RecommendationConsider sumatriptan in all stages of pregnancy. The risk associated with use should be discussed before commencing treatment.

Good practice point tickAspirin, in doses for migraine, is not an analgesic of choice during pregnancy and should not be used in the third trimester of pregnancy.

Preventive therapies

Therapies to avoid during pregnancy or breastfeeding:

  • candesartan
  • topiramate
  • sodium valproate
  • flunarazine
  • CGRP monoclonal antibodies.

RecommendationBefore commencing treatment with topiramate women should be informed of:

  • the risks associated with taking topiramate during pregnancy
  • the risk that potentially harmful exposure to topiramate may occur before a women is aware she is pregnant
  • the need to use highly-effective contraception
  • the need to seek further advice on migraine prophylaxis if pregnant or planning a pregnancy.

Good practice point tickAlthough initiation of valproate is not recommended for those under the age of 55, for those who are on it and who fulfil MHRA requirements, inform the patient of the risks to children exposed to valproate in utero and the need to use effective contraception - see

Check the Medicines and Healthcare products Regulatory Agency (MHRA) website for current advice.