Migraine Meds and Safety in Pregnancy/Trying to Conceive

I live with migraines.

I also struggle with infertility.

How do migraine and infertility relate?

First, it takes me a long time to conceive, which means that there are several months or even years before pregnancy that my body is treated as "pregnant," although it's not actually growing a baby. It means that even when I am not pregnant and just trying to become pregnant, I cannot take medication that is unsafe for pregnancy.

Second, it also seems that my getting pregnant requires a high level of hormone induction, medications, and technological interventions - which all seem to trigger my migraines.

The first time trying to conceive

I first started trying to conceive in 2017. It took 18 months of trying and then undergoing treatments before I got pregnant with my daughter. That meant that through 18 months of ups and downs, of hormone surges and depletions, I had to manage my migraines and other health conditions only with medications that would be safe if I became pregnant. Each month, the disappointments and frustrations were amplified by the ways that this was impacting my health.

The second time trying to conceive

About three months after my daughter's birth in 2019, I began trying to conceive again. I really wanted to give her a sibling and knew that it could likely take a long time to succeed. Today, I'm nearly two years into this chapter and reflecting on the challenges I'm experiencing living in this space of continually trying to get pregnant.

A miscarriage and earth-shattering attack

Most significantly, I found frustration last fall, after my first miscarriage. The dramatic drop in hormone levels left me bedridden for days and then in the emergency room with an earth-shattering migraine. After I recovered, I found a new migraine specialist and asked a million questions about my treatment options.

Preventive medications and pregnancy

It turns out that virtually none of the preventive medications for migraines are approved for pregnancy or for trying to conceive. It doesn't mean they are NOT safe. It just means that clinical trials on pregnant women haven't taken place, which makes sense since pregnant women are considered a vulnerable population and are typically excluded from clinical trials. However, this means that preventing migraines while trying to get pregnant or while actually living through pregnancy is pretty impossible.

Abortive medications safe for pregnancy

Currently, there are several abortive migraine medications that are safe for pregnancy. I always recommend consulting with your doctor, but in my experience the following are available options:

• NSAIDs
• Acetaminophen
• Triptans (Imitrex and Maxalt being most common)

What have I used?

I really had hoped to find peace of mind in utilizing a preventive migraine medication during my seasons of fertility treatment, but unfortunately, this just didn't seem like a good option. While not actually pregnant, I have been able to use stronger abortive medications (as they don't stay in the body for long periods of time), and I have coupled those with the use of the Nerivio device, something I know I'll be able to continue utilizing once I am hopefully pregnant again.

I also have found some solace knowing that my migraine attacks actually decreased significantly during my first pregnancy, and I hope that if I'm lucky enough to experience a second pregnancy, I'll fare similarly.

If you've managed both migraines and infertility, what have you found to be the biggest challenge? What did you learn about the experience that you wish you'd known earlier?