Women experiencing migraines who are either planning a pregnancy or are already pregnant don’t necessarily need to discontinue their medication, according to a presentation at teh Canadian Neurological Sciences Federation Congress 2025.

William Kingston, MD, a headache specialist at Sunnybrook Health Sciences Center adn assistant professor at the University of Toronto, Canada, stated, “Migraine is so common, and pregnancy is so common, so, just by numbers alone, you are going to end up having a lot of people who become pregnant when they have migraines.”

Dr. Kingston noted that while many women might be advised to avoid migraine medication while trying to conceive, this strategy isn’t suitable for everyone.

“Migraine is a disabling brain condition, and it doesn’t go away because someone becomes pregnant,” he said. He added that pregnant women or those trying to conceive are often told by healthcare providers to stop their headache medication, and “they don’t know what it’s like when they don’t treat it.”

Safe Options During Pregnancy

According to Dr. Kingston, sumatriptan has accumulated evidence suggesting that exposure to the drug does not elevate the risk of birth defects, making it a viable option for treating migraines during pregnancy.

“W e have the most registry data for sumatriptan, just by virtue of the fact that it was the first triptan,” he continued. “We have not found any teratogenic effect, which, in my experience, is the first question that people will frequently enough have, and there is not a clear signal for adverse pregnancy outcomes.”

Injected Onabotulinumtoxina is another option, with “very reassuring” data indicating its safety during pregnancy, according to Dr. Kingston. A retrospective review found that the prevalence of major fetal defects among live births in pregnant women who used onabotulinumtoxinA was consistent with rates in the general population.

“Migraine is a disabling brain condition,and it doesn’t go away because someone becomes pregnant.”

Dr. Kingston advised that newer migraine treatments,such as calcitonin gene-related peptide inhibitors, should be discontinued upon pregnancy. He cited data from the World Health Institution pharmacovigilance database.

Lactation Offers Benefit

Women with migraines who have given birth may experience improved migraine control while breastfeeding. “We think lactation is protective for migraines,” said Kingston, who also noted that sumatriptan is safe to use during breastfeeding, if needed. “We think that people who are successful at breastfeeding tend to do better from a migraine standpoint than people who are not breastfeeding.”

Suzanne Christie, MD, a neurologist at the Ottawa Hospital and Ottawa Headache centre, Ontario, has also observed lactation providing protection from migraines in her practice. She noted that patients who breastfeed report fewer migraines, and most of her migraine patients breastfeed after giving birth. Dr. Christie is president of the Canadian Headache Society.

Individualized Approach Appropriate

Dr.Christie echoed Dr. Kingston’s sentiment that certain medications are relatively safe.”Sometimes patients, if they are really having trouble getting pregnant, may abandon that focus for a while and go back on treatment,” said Christie. “It is really done on a case-by-case basis.”

Dr. Christie considers sumatriptan a sound therapeutic option for women with migraines who are planning a pregnancy or are already pregnant.

She added that most neurologists would be agreeable prescribing sumatriptan. “Most evidence is probably for sumatriptan, but all the triptans are probably safe. they have been available forever.”