Which migraine injection is safe during pregnancy?

Question

Hello doctor,

I suffer from chronic migraines, with over 15 headache days a month. My neurologist has recommended starting preventive injections. I previously tried Topiramate, but it caused significant side effects like cognitive issues and hair loss, which were very upsetting.

Propranolol helped reduce the frequency somewhat but left me with fatigue and poor exercise tolerance. My migraines seem to be strongly hormone-related, as they get worse around menstruation and ovulation. The pain is often so intense that I miss work three to four days each month.

A recent MRI came back normal, though it did show some small white matter lesions, which I find concerning. My doctor has suggested either Botox injections or CGRP monoclonal antibody injections for prevention. I am 31 and currently trying to conceive, so safety during pregnancy and fertility is a key concern for me.

Which of these migraine injections is likely to be more effective for hormonally-driven migraines and also safer for someone planning a pregnancy? Please help.

Thank you in advance.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

It is a good step that you are considering preventive treatments.

1. Botox injections: Botox (OnabotulinumtoxinA) is FDA (Food and Drug Administration) -approved for chronic migraine (a condition where a person experiences headaches on 15 or more days per month, with migraine features on at least eight of those days) prevention and is typically given every 12 weeks around the head and neck. It has been effective for many, but there is limited research on its safety during pregnancy. If you are trying to conceive, this should be discussed carefully with your neurologist.

2. CGRP antagonists: These newer medications, like Erenumab, Fremanezumab, and Galcanezumab, block the CGRP (calcitonin gene-related peptide) pathway involved in migraine development. They have been effective for many patients with chronic migraines, but safety data during pregnancy is limited. Always consult your doctor before starting them if you are planning a pregnancy.

3. Hormonal migraine management: Since your migraines seem linked to your menstrual cycle, tracking symptoms and identifying patterns can help in planning treatment. Some women find relief through cycle-based strategies. In addition, lifestyle changes, such as stress reduction, consistent sleep, hydration, and avoiding known triggers, can also support migraine control.

If you would like to explore these options further or have more questions, I would happily guide you through a more personalized approach.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.