Expert Answer: Cleft Lip/Palate & Migraine

Question: Is there any relationship between cleft lip /palate and migraine?

There is no published evidence that being born with a cleft lip and palate lead to migraine.

What we now know is that cleft lips or palates are now a risk for infants born to women treat with Topamax (topiramate) during pregnancy. This new human data was released in March 2011 and as a result, topiramate is now in the Pregnancy Category D instead of its previous Category C. Category D means there is positive evidence of human fetal risk based on human data but the potential benefits in pregnant women may be acceptable in certain situations despite its risk. That situation could be epilepsy or seizures. In the case of treatment for migraine prevention during pregnancy, there are safer alternatives such as some of the beta-blockers.

The data released in March 2011 showed 1.4% of babies exposed to Topamax or the generic topiramate had cleft lips or palates. Other epilepsy drugs used during pregnancy showed a .38-.55% incidence. In mothers not on these medications there was only a .07% of cleft lip and palate.

The take-home point is for women who take Topamax or the generic topiramate to consider tapering off this medication prior to pregnancy unless it is considered medically necessary to stay on this medication for reasons such as epilepsy. There are other safer migraine preventive medications.

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