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Drug Info Maternal Matters

Is it safe to take Nurtec during pregnancy?

It’s unknown, but there are alternatives to treat migraine when you’re expecting
By | Oct. 3, 2024 Medically reviewed by Kimberly Bowman, MD
A woman holding a bottle of pills | Nurtec and pregnancy

Key takeaways

  • Nurtec ODT is one of the newest drugs used to prevent and treat migraines. It is unknown whether it is safe to take during pregnancy or by individuals with breastfed infants.

  • Acetaminophen is a safe treatment for migraines during pregnancy, as are triptans and some anti-nausea medications.

  • Migraines can be treated with supplements like magnesium and vitamin B2 or with behavioral strategies, such as resting in a dark room.

  • It’s important to find a migraine treatment that works for you during pregnancy, as untreated migraines during pregnancy may increase your risk of prenatal complications.

In this article:

While not quite as common as tension headaches, millions of people in the United States experience migraines. According to the journal JAMA, 17.1% of women report having migraine symptoms, with the majority of those women being between ages 20 and 50. As such, countless women experience migraines during pregnancy, and those often come with unpleasant symptoms that require treatment with medication, like Nurtec (rimegepant).

“Nurtec ODT is a medication that is utilized to treat migraines,” says OB-GYN Kecia Gaither, MD, Director of Perinatal Services/Maternal Fetal Medicine at NYC Health + Hospitals/Lincoln in the Bronx. Manufactured by Pfizer Inc., it is also used for preventive treatment of episodic migraine. Nurted ODT is an orally disintegrating tablet that comes in a blister pack, belonging to a class of drugs called calcitonin gene-related peptide (CGRP) inhibitors. These medications interfere with the release of CGRP, a protein that causes migraine symptoms.

According to Dr. Gaither, it is unknown if it is safe to take Nurtec ODT in pregnancy. Here, we’re diving into why exactly that’s the case, plus what you need to know about treating migraines during pregnancy.

Can you take Nurtec while pregnant?

“Like most newer migraine medications, Nurtec was not studied in pregnant women. As a result, there is not adequate evidence on the safety of its use in pregnant women,” says Aaron Emmel, Pharm.D., founder and program director at Pharmacy Tech Scholar, an online education service for pharmacists. Indeed, Nurtec was just approved by the U.S. Food and Drug Administration (FDA) for the treatment of acute migraine in February 2020 after one clinical trial of patients with at least a one-year history of migraine headaches or chronic migraine. Since this was so recent, there have yet to be studies of Nurtec on pregnant humans.

However, studies have been done on rats. “Animal studies did show some fetal harm at extremely high doses, and no effects on fetal development at lower doses that were still much higher than equivalent doses in humans,” notes Dr. Emmel. “Animal studies aren’t always a reliable predictor of what will happen in humans, so these results must be interpreted cautiously.”

What about the drug’s safety during lactation? According to the prescribing information, only small amounts of the medication are passed from a dose of Nurtec ODT into breast milk, so the use of Nurtec ODT is thought to be safe for breastfeeding infants.

Nurtec has not been found to be definitively safe to take during pregnancy, but it has not been found to be dangerous either. Pregnant or breastfeeding women should seek medical advice from a healthcare provider before taking the medication.

What are the risks of taking Nurtec while pregnant?

Since no studies have been completed on the effects of Nurtec in pregnant women, the explicit risks for mother and baby are not known. The most common side effects of Nurtec ODT include stomach pain, indigestion, and nausea, which could make pregnancy even more uncomfortable and difficult. There are also some other potentially serious adverse effects, including allergic reactions that could cause symptoms like swelling of the face, eyes, mouth, throat, tongue, or lips, rash, hives, itching, and trouble breathing. It is contraindicated in individuals with liver problems.

“Some prescribers and patients will decide to use Nurtec or the other CGRP receptor antagonists during pregnancy after careful consideration of the benefits and potential risks,” notes Dr. Emmel. Since the only way to determine the risks of taking Nurtec while pregnant is through data collection, Emmel urges pregnant women who do decide to try it to register with The Migraine Observational Nurtec Pregnancy Registry, which is actively collecting information from pregnant women and healthcare providers on the safety of Nurtec during pregnancy.

What can I take instead of Nurtec during pregnancy?

“Generally, first-line therapy for migraines in pregnancy is acetaminophen,” says Dr. Gaither. This over-the-counter pain medication is safe to take throughout pregnancy. But for those who need something stronger, that’s when it starts to get tricky. The American College of Obstetricians and Gynecologists (ACOG) suggests the combination of acetaminophen and caffeine, up to 200 mg per day from all sources, as additional first-line therapy for migraine headaches in pregnancy.

“Many of the medications used to prevent migraines are contraindicated during pregnancy, which complicates management even more,” says Dr. Emmel. In addition to Nurtec, the other CGRP antagonists, which include Vyepti (eptinezumab-jjmr), Ubrelvy (ubrogepant), Emgality (galcanezumab-gnlm), Ajovy (fremanezumab-vfrm), and Aimovig (erenumab-aooe), have not been studied in pregnant women and are not recommended.

That’s why many healthcare providers turn to triptans for pregnant women with migraines. “There is some population evidence that triptan medications are not associated with fetal harm, so many providers prefer these drugs if a migraine-specific treatment is required during pregnancy,” Emmel says. There are many triptan medications (also known as selective serotonin agonists). The following have been analyzed for use during pregnancy and determined to have no increased risk for congenital disorders, making them a preferred acute treatment of migraine attacks:

In addition, there are prescription medicines for nausea and vomiting that can ease migraine symptoms during pregnancy, according to the American Headache Society:

The ACOG recommends metoclopramide alone or in combination with diphenhydramine as the next step in the treatment of persistent headaches in pregnancy when acetaminophen with caffeine is not effective. Metoclopramide is especially effective for nausea associated with migraines.

Natural remedies for migraine during pregnancy

Pregnant women can also use natural remedies, like vitamins and minerals, to help combat migraines during pregnancy. Dr. Gaither recommends taking the following in supplement form:

You can also try behavioral or lifestyle changes, such as:

  • Resting in a dark room when you have a migraine
  • Staying hydrated
  • Using a cold pack on your head
  • Completing relaxation exercises
  • Avoiding triggers, such as stress

In the end, it’s important to work with a healthcare professional to find the combination of treatments that works for you. “There are potential consequences of untreated migraines during pregnancy, including an increased risk for preeclampsia and gestational hypertension in addition to the devastating impact of migraine pain on function and quality of life,” says Dr. Emmel. “The severity of migraine, the patient’s history of response to different treatments, and other existing health conditions and medications must all be considered when determining how to manage migraine during pregnancy.”

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