Skip to Accessibility Tools Skip to Content Skip to Footer

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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • Timothy W. Schroyer
    8 years ago

    Hello I am a producer for the film Gwapa which is a documentary about a Filipino family who has 3 children with Cleft lips and pallets. They are treated by a non profit organization that treats cleft lips and pallets disorders. It is a wonderful story. Please help us spread the word about our documentary. Our facebook page is.

    Thank you so much.
    Tim Schroyer

  • Ellen Schnakenberg
    8 years ago

    Dr. Hutchinson, I’m curious if there is any data re: risks respective of dosage? For those women for whom topiramate is the only thing that is helpful, might a lower dosage decrease the risk?

  • Poll