How to Plan for Pregnancy When You Have Migraine

Thinking about having a baby when you also have migraine can feel a bit like trying to plan a wedding during a thunderstorm: exciting, emotional, and occasionally hijacked by the weather in your head. The good news? With smart planning, a supportive care team, and a solid migraine strategy, many people with migraine go on to have healthy pregnancies and healthy babies.

This guide walks you through how to plan for pregnancy when you have migrainefrom preconception prep to medication reviews, lifestyle tweaks, and what to expect once you see those two pink lines.
It’s based on current guidance from headache and obstetrics experts, but it’s not a substitute for personalized medical advice. Always confirm your plan with your neurologist and OB-GYN.

How Migraine and Pregnancy Interact

Migraine is more than “just a headache”it’s a neurological condition often influenced by hormones, stress, and changes in routine. Pregnancy is essentially a nine-month festival of hormonal changes, blood-volume shifts, and sleep disruption, so it’s natural to wonder what’s going to happen to your brain during all of this.

For many people, migraine actually improves during pregnancy, especially in the second and third trimesters. Rising estrogen and natural pain-relieving endorphins are thought to play a role, and some women report fewer and less intense attacks once they’re past the first trimester.

But this isn’t universal. Some people see no change; others actually worsen, especially if nausea, vomiting, dehydration, or poor sleep become major triggers. That’s why planning aheadbefore you’re pregnantis so important.

Migraine With Aura vs. Without Aura

If you have migraine with aura (visual changes like zigzags or flashing lights, numbness, or strange sensations before the pain hits), planning is even more crucial. Migraine with aura is associated with a slightly higher risk of stroke, and certain hormones (like estrogen in some birth control methods) can add to that risk.

That doesn’t mean pregnancy is unsafebut it does mean your providers will want to be thoughtful about your medications, birth control transition, and any other stroke risk factors like smoking, high blood pressure, or clotting disorders.

Step 1: Schedule a Pre-Pregnancy Migraine Checkup

The best time to get serious about migraine and pregnancy is before you’re actively trying to conceive. A preconception visit lets you and your care team review:

• How often you get migraine attacks
• What medications and supplements you’re using (prescription, OTC, and “natural” remedies)
• Other health issueslike high blood pressure, anxiety, depression, or autoimmune disease
• Your current birth control method and when to switch

Some headache specialists suggest giving yourself several monthsand in cases of very frequent attacks, even up to a yearto try safer preventive strategies and gradually simplify your medication list before pregnancy.

Ideally, this visit includes:

• An OB-GYN or maternal-fetal medicine specialist (for pregnancy risk assessment)
• A neurologist or headache specialist (for migraine strategy)
• Possibly a primary care clinician, if you have other medical conditions

Medications to Flag Right Away

Some migraine preventives can pose significant risks in pregnancy and are usually stopped well before conception. Guidelines and headache organizations consistently warn against medications such as:

• Sodium valproate (valproic acid) – associated with serious birth defects and developmental problems
• Topiramate – linked to increased risk of oral clefts and other complications
• Angiotensin-receptor blockers (like candesartan) or ACE inhibitors – not recommended in pregnancy due to effects on the fetal kidneys and other systems

These drugs are commonly listed among medications to avoid when pregnant or trying to conceive, and they should be changed under close medical supervision before you start trying.

Step 2: Review Acute Migraine Medications Before Conception

Next up: the medications you reach for when an attack hits. The goal is to have a short, well-understood list of acute treatments your doctors are comfortable using during early pregnancy (including weeks when you might not yet know you’re pregnant).

Common Acute Options and What We Know

• Acetaminophen (Tylenol) – Frequently recommended as a first-line pain reliever in pregnancy when used appropriately; considered relatively safe by headache and obstetric guidelines.
• NSAIDs (like ibuprofen or naproxen) – Some guidelines allow cautious use for short periods in the second trimester, but recommend limiting or avoiding in the first trimester and avoiding entirely after about 20 weeks due to risks like low amniotic fluid or effects on the fetal heart.
• Triptans (such as sumatriptan) – Large pregnancy registries haven’t shown a major increase in birth defects, and sumatriptan in particular is often considered an option with shared decision-making when attacks are severe.
• Opioids – Generally discouraged due to the risks of dependence, neonatal withdrawal, and less effective migraine control compared with other options.

Newer migraine drugslike CGRP monoclonal antibodies (e.g., fremanezumab) and oral gepants (e.g., atogepant)don’t yet have robust pregnancy safety data. For that reason, many specialists recommend stopping them well before conception unless there’s a compelling reason to continue.

The bottom line: don’t guess. Make a written list of everything you use for migraineincluding supplements, herbal products, and “as-needed” medsand go through each item with your clinicians.

Step 3: Strengthen Your Non-Drug Migraine Game Plan

The best migraine tool in pregnancy is often the least glamorous: lifestyle. Non-medication strategies matter even before you conceive, because the more stable and predictable your migraine pattern is now, the easier it may be to manage when pregnancy adds extra variables.

Core Lifestyle Habits

• Sleep consistency – Go to bed and wake up at roughly the same time every day (yes, even on weekendssorry). Irregular sleep is a classic trigger.
• Hydration and regular meals – Dehydration and low blood sugar love to crash your party. Keep water nearby and favor small, frequent meals, especially once pregnancy nausea kicks in.
• Trigger tracking – Use an app or journal to track patterns: specific foods, weather changes, skipped meals, stress spikes, or hormonal shifts. This becomes a roadmap for prevention once you’re pregnant.
• Stress management – Relaxation techniques like mindfulness, deep breathing, yoga, and biofeedback are all endorsed by headache organizations as helpful for some people with migraine.
• Physical activity – Gentle, regular exercise can support mood, sleep, and migraine control, as long as it’s cleared by your provider and not a trigger for you personally.

Building these habits before pregnancy makes them easier to maintain when you’re dealing with first-trimester fatigue or a third-trimester belly that has its own gravitational field.

Step 4: Revisit Birth Control and Timing

Many people planning a pregnancy need to transition off hormonal birth control. If you have migraineespecially with aurathis transition can be a chance to reduce stroke risk and simplify your migraine profile before you conceive.

People with migraine with aura are often advised to avoid estrogen-containing contraceptives (like some combined oral pills, patches, and rings) because the combination of aura and supplemental estrogen can increase stroke risk, especially if other risk factors (like smoking) are present.

Your doctor may recommend:

• Switching to a progestin-only pill, injection, or implant
• Using a hormonal or copper IUD
• Using non-hormonal methods in the months just before trying to conceive

The timing matters too. Some women notice temporary headaches during the transition off hormonal birth control, so it can be helpful to make the switch a few months before trying, giving your migraine pattern time to stabilize.

Step 5: Plan for Each Stage of Pregnancy

While this article focuses on planning, it helps to know what you might encounter in each trimester so you and your clinicians can prepare in advance.

First Trimester: The Wild Card

The first trimester is a time of intense hormonal changeand often morning sickness, fatigue, and strong food aversions. For some people, migraine worsens or appears for the first time in early pregnancy.

Since this is also the most sensitive period for fetal development, providers usually lean heavily on non-drug strategies and the safest medications (like acetaminophen) while being cautious about other drugs. Short courses of certain treatments may still be considered if attacks are severe, but this is a highly individualized decision.

Second Trimester: Often the “Easier” Phase

Many people experience improved migraine frequency and intensity in the second trimester. Estrogen levels are more stable, and morning sickness often eases up, reducing dehydration and irregular eating.

Some guidelines allow limited use of NSAIDs for stubborn migraine attacks during this window, typically for short durations and with an upper limit on total days.

Third Trimester: Finish Line With Caveats

Toward the end of pregnancy, migraine often stays stable or continues to improvebut some people experience recurrence, especially as sleep becomes more disrupted and physical discomfort increases.

By late pregnancy, NSAIDs are generally avoided because they may affect amniotic fluid levels and fetal circulation.

This is also when your team will help you distinguish ordinary migraine from warning-sign headaches linked with high blood pressure or preeclampsia.

Step 6: Know the Red-Flag Headache Symptoms

Not every headache in pregnancy is “just migraine.” Obstetric and headache guidelines highlight several red-flag symptoms that should prompt immediate medical evaluation:

• A sudden, severe “worst headache of my life”
• New headache very different from your usual migraine
• Headache with weakness, difficulty speaking, confusion, or vision loss
• Headache with fever, stiff neck, or seizure
• Headache with very high blood pressure or severe swelling

If something feels off or “not like my normal migraine,” err on the side of getting evaluated quicklywhether that’s calling your OB-GYN, your neurologist, or going to the ER.

Step 7: Explore Safer Preventive Options Before Pregnancy

If your migraine attacks are frequent or disabling, you may need preventive treatment even while trying to conceive or during pregnancy. The key is choosing options with a better safety profile and using the lowest effective dose.

Guidelines often highlight several categories as relatively safer options when prevention is necessary:

• Calcium channel blockers (like nifedipine) and certain antihistamines – frequently cited as among the safer preventive choices in pregnancy.
• Beta blockers (such as propranolol or metoprolol) – widely used for both blood pressure control and migraine prevention; considered acceptable in many pregnancy guidelines when needed.
• Tricyclic antidepressants (like amitriptyline) – sometimes used as a backup preventive when first-line options aren’t enough.

Even with these medications, timing and dose-adjustments are individualized. Your providers will weigh how disabling your migraine is against possible risks, and may adjust your plan by trimester.

Step 8: Create a Written Migraine–Pregnancy Plan

Think of this as your “migraine birth plan,” but starting before conception. A written plan can include:

• Which medications you’ll stop before trying to conceiveand when
• Which acute treatments are okay to use while trying and once pregnant
• What your non-drug plan looks like (sleep, food, hydration, stress tools)
• Who to call for flares (OB-GYN, neurologist, triage nurse)
• What to do if you can’t keep medications down (severe nausea/vomiting)
• When to seek urgent care (red-flag symptoms and high blood pressure)

Make copies for yourself, your partner or support person, and your care team. When pregnancy brain kicks in and you can’t remember where you put your phone, your plan will still be there.

Real-Life Experiences: Planning Pregnancy With Migraine

Evidence and guidelines are essentialbut so is the lived experience of people who’ve done this. Everyone’s migraine story is different, but these composite examples illustrate how planning can play out in real life.

1. The “Heavy Hitter” Who Needed a Long Runway

Imagine someone who has 10–12 migraine days a month and has tried multiple medications over the yearstopiramate, a CGRP monoclonal antibody, and a couple of different triptans. When she decides she wants to try for a baby, her neurologist suggests a long runwayabout a yearto gradually simplify her regimen.

Together, they:

• Slowly discontinue topiramate and her CGRP injection under supervision
• Introduce a beta blocker that has more pregnancy data behind it
• Strengthen non-drug strategies: sleep, yoga, hydration, and trigger tracking
• Switch her from estrogen-containing birth control to a non-estrogen method

Her migraine days don’t vanish, but they become more predictable and slightly fewer. By the time she starts trying, her team has a clear list of one or two acute medications and one preventive that everyone is comfortable using as she moves into pregnancy.

2. The “Surprised by Pregnancy” Migraine Planner

Another person isn’t actively tryingbut isn’t preventing, either. She finds out she’s pregnant while taking occasional NSAIDs for migraine and a CGRP oral preventive. At first she panics, but her clinicians reassure her and focus on moving forward safely.

They:

• Review exactly what she’s taken and when
• Switch her preventive to a beta blocker at the lowest effective dose
• Emphasize acetaminophen and non-drug strategies for acute attacks
• Schedule more frequent check-ins during the first trimester

Her experience is a reminder that unexpected pregnancies happen, even to planners. The key is early communication with your care team rather than hiding medications out of fear or guilt.

3. The Aura-Heavy, High-Anxiety Planner

Someone with frequent visual aura and a family history of stroke may feel particularly nervous about pregnancy. Her neurologist and OB-GYN:

• Stop estrogen-containing birth control and move to a progestin-only option
• Screen for other stroke risk factors (blood pressure, clotting issues, smoking)
• Encourage walking, mindfulness, and therapy for anxiety
• Create clear instructions for when to go to the ER vs. call the office

Having a very specific planplus emergency red-flag criteria printed on her fridgehelps her feel more in control and less afraid. She ultimately has fewer aura episodes in pregnancy than she expected, partly because her triggers are better understood and managed.

4. The “I Thought Pregnancy Would Cure My Migraine” Realist

Many people hear that pregnancy makes migraine disappear. For some, that’s truebut not for everyone. One person goes into pregnancy expecting her migraine to magically vanish, so she doesn’t do much planning. When her migraine continues into the second trimester, she feels blindsided and discouraged.

After finally seeing a headache specialist, she learns that:

• It’s normal for some people not to improve during pregnancy
• There are still safe acute and preventive options available
• Her sleep, hydration, and eating schedule are all sabotaging her efforts

With a more deliberate planand realistic expectationsshe regains a sense of control. Her story highlights why planning is useful even if you’re secretly hoping you’ll be one of the “migraine went away!” success stories.

Bringing It All Together

Planning a pregnancy when you have migraine doesn’t mean eliminating all risk or guaranteeing zero attacks. Instead, it’s about stacking the odds in your favor: choosing safer medications, strengthening your non-drug toolkit, coordinating care between your neurologist and OB-GYN, and knowing when to seek help.

You don’t have to do everything perfectly. You don’t have to become a sleep-hydration-yoga robot. But the more intentional you are before conception, the more options you and your care team will have once pregnancy begins.

Most importantly, remember this: migraine doesn’t disqualify you from a healthy pregnancy or from being a great parent. With preparation, support, and a plan that actually fits your life, it can be one important part of your storybut not the whole story.