Migraine treatment can usually continue in some form while you try to conceive — but the regimen often needs to change first. ACOG guidance treats acetaminophen and metoclopramide as first-line for attacks in pregnancy, with sumatriptan as a second-line option. Among preventives, topiramate, valproate, and CGRP monoclonal antibodies are on the avoid list, and some need to stop months before conception. Review your list with your prescriber before you stop contraception.
Prevention drugs are the ones with lead time
Why migraine medicines need a review before you try
Migraine is common in people of reproductive age, and many people use both an “acute” medicine for attacks and a “preventive” medicine taken daily or monthly. The preventive side is where most of the planning lies. A 2023 review in Practical Neurology notes that some migraine medicines need to be stopped about six months before conception, and that unplanned pregnancies are common — which is why the review encourages starting these conversations early.
This article stays at the level of medication classes and published guidance. It is a map for the conversation with your prescriber, not a substitute for it. Please do not stop a preventive medicine abruptly on your own: some cause rebound headaches or withdrawal effects, and some (like valproate) are also used for other conditions where stopping suddenly can be dangerous.
Acute medicines: what ACOG guidance prefers
ACOG’s clinical consensus on headaches in pregnancy and postpartum (summarized in American Family Physician, 2023) groups acute treatments roughly as follows:
| Group | Medicine classes |
|---|---|
| First-line | Acetaminophen (optionally with limited caffeine); metoclopramide for nausea and headache |
| Second-line | Sumatriptan, for headaches that persist. ACOG notes other triptans have less pregnancy data. |
| Timing-dependent | NSAIDs such as ibuprofen and naproxen: ACOG advises avoiding them in the first and third trimesters. Separately, the FDA advises against NSAIDs from 20 weeks of pregnancy unless a clinician specifically recommends them. |
| Avoid | Butalbital-containing products, opioids, and ergot alkaloids (which can stimulate uterine contractions) |
| Not recommended (lack of data) | Gepants such as ubrogepant and rimegepant, per the Practical Neurology review of ACOG guidance |
On triptans specifically, the Practical Neurology review says sumatriptan and other triptans have been studied extensively in pregnancy registries without a signal for major birth defects, and that debated links with other outcomes have not been consistent.
NSAIDs deserve a note for the trying phase. You may not know you are pregnant in the earliest weeks, so ask your prescriber how they want you to use NSAIDs during the two-week wait. Some people simply switch to the first-line options while actively trying.
Preventive medicines: the ones that need lead time
The same ACOG summary sorts migraine preventives into three groups for pregnancy:
| Group | Medicine classes and examples |
|---|---|
| Preferred | Calcium channel blockers; antihistamines; non-drug approaches (sleep, trigger management, hydration, cognitive behavioral therapy, acupuncture, biofeedback) |
| Some evidence of risk — use with caution | Beta blockers; tricyclic antidepressants; venlafaxine; clonidine; lamotrigine; carbamazepine; coenzyme Q10 and riboflavin; oral magnesium; nerve blocks and nerve stimulators |
| Avoid in pregnancy | Topiramate; valproate; gabapentin; CGRP monoclonal antibodies; ACE inhibitors and ARBs (sometimes used for migraine); onabotulinumtoxinA; feverfew; melatonin |
“Use with caution” does not mean “never.” Beta blockers such as propranolol sit in this group — and in the 2026 study described below, propranolol showed no association with miscarriage. “Caution” means the decision weighs the benefit of fewer attacks against what is known about the medicine — which is exactly the conversation to have before conceiving.
Valproate and topiramate: the clearest warnings
The FDA has issued specific pregnancy warnings for both:
- Valproate (valproic acid, divalproex): in 2013 the FDA announced that valproate products are contraindicated for migraine prevention in pregnancy, citing evidence that exposure in the womb is linked to lower IQ scores in children, in addition to known birth-defect risks. The FDA advised people of childbearing age to use effective birth control and avoid valproate unless it is essential.
- Topiramate: in 2011 the FDA warned of an increased risk of cleft lip and/or cleft palate in babies exposed during pregnancy, based on pregnancy registry data, and advised people who could become pregnant to discuss other options.
Both warnings also say the same thing this article does: do not stop on your own. Contact your prescriber if you are planning pregnancy or become pregnant while taking either one.
The CGRP antibody question
Monthly or quarterly CGRP monoclonal antibodies (such as erenumab, fremanezumab, galcanezumab, and eptinezumab) have transformed prevention for many people. They also stay in the body for a long time, and pregnancy data are limited. The Practical Neurology review advises stopping them about six months before pregnancy.
New data published in October 2026 add weight to planning ahead. A study in JAMA Neurology analyzed 7,579 pregnancies in people with migraine using U.S. commercial insurance claims and found that exposure to anti-CGRP antibodies around conception and in early pregnancy was associated with a higher risk of miscarriage (adjusted hazard ratio 1.42), while propranolol showed no association. The authors noted real limitations — claims data cannot capture migraine severity, outcome timing was partly estimated, and the number of exposed pregnancies was modest — so this is a signal to take seriously, not a final answer.
In practice, that makes the CGRP antibody the medication most worth discussing early, because the switch involves a long gap and a replacement preventive. The same caution applies to gepants used for prevention, which have essentially no pregnancy data.
Non-drug options and devices
ACOG’s guidance places lifestyle measures, cognitive behavioral therapy, biofeedback, and acupuncture among preferred preventive approaches, while noting the evidence for some is limited. The Practical Neurology review adds that FDA-cleared neuromodulation devices can be considered in pregnancy, though safety data are limited, and that nerve blocks with local anesthetic may help attacks that do not respond to other treatment. These options are worth exploring before conception, when you have time to see what works for you.
Headaches that need prompt attention in pregnancy
Once you are pregnant, not every headache is a migraine. ACOG lists warning signs that call for prompt evaluation:
- A sudden, severe “thunderclap” headache, or a change from your usual pattern.
- Headache with high blood pressure, fever, confusion, or new neurological symptoms (such as weakness, numbness, or vision changes).
- A new headache in the third trimester.
High blood pressure with headache can be a sign of preeclampsia. If chronic high blood pressure is part of your history, see chronic high blood pressure before pregnancy.
What to bring to your prescriber
- Every migraine medicine you use: acute, preventive, injections, supplements, and over-the-counter combinations.
- How many headache days you have per month, and how often you use acute medicine.
- Which preventives you have tried before, and what happened.
- Your timeline for trying, and your contraception plan until the switch is done.
- Other conditions and medications — for example, if you take an ACE inhibitor or ARB for blood pressure or migraine.
If you keep a list of supplements, our network’s guide to a TTC supplement list for doctor review may help you organize it.
The human side: fear of losing what works
For people whose migraines are finally controlled, the idea of giving up a preventive can be genuinely frightening. That fear is legitimate. Migraine is disabling, and pregnancy does not guarantee relief — the Practical Neurology review notes that severity may fall during pregnancy, “but not in everyone.” A good plan names this out loud: what the replacement preventive is, what the acute plan is for bad days, and who to call when it is not working. You deserve treatment that lets you function while you try.
Frequently asked questions
What migraine medicine is considered safest while trying to conceive?
ACOG guidance lists acetaminophen and metoclopramide as first-line options for migraine attacks in pregnancy, with sumatriptan as a second-line option. Your prescriber can tailor this to you.
Do I need to stop my CGRP injection before trying to get pregnant?
CGRP monoclonal antibodies are on ACOG’s avoid list for pregnancy, and a 2023 Practical Neurology review advises stopping them about six months before pregnancy. A 2026 JAMA Neurology study also found an association with miscarriage. Plan the switch with your prescriber.
Is topiramate safe while trying to conceive?
The FDA has warned that topiramate exposure in pregnancy increases the risk of cleft lip and palate, and ACOG lists it among preventives to avoid. Do not stop it on your own; ask your prescriber about alternatives before trying.
Can I take ibuprofen for migraines while trying to conceive?
ACOG advises avoiding NSAIDs in the first and third trimesters, and the FDA advises avoiding them from 20 weeks unless a clinician recommends them. Ask your prescriber how to handle NSAIDs while actively trying, when you may not know you are pregnant yet.
Is acetaminophen still okay in pregnancy after the 2025 FDA announcement?
In 2025 the FDA announced a label change citing a possible link to neurodevelopmental conditions, while acknowledging studies that found no link. ACOG said the announcement is not backed by the full body of evidence and that acetaminophen remains one of the few safe options for pain and fever in pregnancy. Discuss how to use it with your clinician.
Sources & guidance
- American Family Physician: Headache During Pregnancy and Breastfeeding — ACOG Recommendations (2023)
- Practical Neurology: Management of Headache in Pregnant Women (May–June 2023)
- AJMC: Anti-CGRP antibody exposure near conception linked to miscarriage risk (JAMA Neurology study, October 2026)
- Drug Topics: FDA warns against valproate use for migraine prevention during pregnancy (2013)
- Drugs.com: FDA alert — Topamax (topiramate) and risk of oral clefts (2011)
- FDA: Avoid use of NSAIDs in pregnancy at 20 weeks or later
- HCPLive: ACOG and AAP respond to White House autism announcements on acetaminophen (September 2025)