Women taking some of the newest migraine treatments may face a higher risk of miscarriage, a major study has found.
Researchers observed more than 7,500 pregnancies in women who suffer from migraines and found those on newer medications could be most at risk.
They found a 40% higher risk of losing a baby in the first 20 weeks among women taking CGRP antibody preventives, which are offered on the NHS when people have not responded to at least three other medications.
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The older drug propranolol – which helps to prevent the debilitating condition before it starts – showed no such link.
The figures suggest around 29 in every 100 pregnancies among women exposed to the drugs ended in miscarriage, compared with around 25 in every 100 pregnancies for those who had not taken them, the study in the JAMA Neurology medical journal revealed earlier this month.
The paper stressed that the observational findings cannot prove the drugs caused the pregnancy losses.
Rosie Scott, an osteopath who trained as a specialist in headache disorders at the Danish Headache Centre in Copenhagen, runs a clinic for the condition in Wandsworth, South West London.
She has spent 17 years in clinical practice and says women – who are three times more likely to suffer from migraines – are routinely being let down by the healthcare system, so they should turn up to their doctor’s appointment fully prepared, with a list of questions to ask.
The authors of the study have also advised doctors to be ready to discuss the limited pregnancy data with anyone who may become pregnant.
But Rosie says many women are not given enough time with a doctor to discuss their treatment options, particularly when planning a pregnancy.
SIX questions to ask your doctor
Rosie told What’s The Jam that women taking the drugs should discuss their options with a doctor well before trying to conceive, as the newer injectable medications can remain in the body for months.
She said: “The key is how long these medications stay in our system after they have been administered.
“The newer injectables (Ajovy, Vyepti, Aimovig and Emgality) are built to last for months and have a half-life of about a month, so you need to have enough time after stopping before seeing that positive pregnancy test.”
However, she warns that no one should stop taking their prescribed medication, as stopping can see the symptoms return aggressively, which is particularly difficult for pregnant women who may be suffering with other symptoms.
Rosie advises women to discuss their treatment plans with their doctor before attempting to conceive, including what to do if they become pregnant unexpectedly.
She recommends asking:
What needs to change before you try to conceive, and how far in advance?
What should you do if you conceive unexpectedly? Who should you contact, and should you continue taking your medication until you speak to them?
What medication can you use to treat an attack during pregnancy?
Could you come off a preventive altogether if your migraine attacks reduce enough?
What is the plan for after the birth?
Should you be referred to specialist services rather than remain under your GP if your migraine is not sufficiently controlled?
Rosie says patients can make the most of short GP appointments by arriving with a clear idea of what they need to discuss.
She recommends writing down current medications, including over-the-counter treatments, alongside pregnancy plans and the main question they want answered.
She said: “Say from the outset what the appointment is for and what you want from it.
“Write it down and hand it over: what you take already, including over the counter; what you are planning and roughly when; the one thing you want answered in that appointment.
“Lead with the decision you want from the appointment, not the history. Not ‘I have had migraine since I was fourteen’. Start with ‘I am on a preventive for migraine, and I want to try for a baby next year’.
“If the doctor does not raise it, use this sentence: ‘Before we finish, is anything I am taking a problem if I become pregnant?’ It is short, and it ensures you get an answer and a considered review.
“Ask for the answer in writing so you can check it if you have forgotten by the time you get home.”
Rosie believes better preparation can help patients get the information they need from appointments, particularly when decisions about medication and pregnancy are involved.
Rosie says much of her work involves helping patients understand their condition and prepare for conversations with healthcare professionals.
She is also the founder of Erin, a headache management platform launching in December.
It tracks symptoms and good days to map patterns, and guides users towards evidence-backed pathways. It does not diagnose or provide medical treatment.
Her message to women is simple.
She added: “There are far more ways to manage migraine than you have been offered.
“You do not have to tolerate treatment that is not working.
“Your symptoms are real, and you deserve to be believed.”
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