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Migraine in pregnancy planning — RACGP Fellowship MCQ

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ModerateChronic disease managementMigraine in pregnancy planningRACGP Fellowship

A 38‑year‑old woman has recurrent migraine without aura, two to three attacks each month. She plans pregnancy within six months and uses ibuprofen frequently. Neurological examination is normal. What would you advise?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Discuss trigger management, limit acute medicines and choose pregnancy‑compatible options if prevention is needed

Preconception migraine care should focus on non‑pharmacological strategies (e.g. trigger avoidance), limiting use of acute agents due to safety concerns (NSAIDs like ibuprofen carry risk in early pregnancy), and reserving pharmacological prevention to agents with favourable safety for pregnancy. Valproate is teratogenic and contraindicated. Opioids are not recommended due to dependency and neonatal risks. Avoiding all acute treatment may leave migraines disabling; normal exam makes MRI unnecessary.

Reference: Ornello R et al. Migraine management during pregnancy, breastfeeding and in women planning pregnancy. Review. 2025. PubMed PMID 41263702. https://pubmed.ncbi.nlm.nih.gov/41263702/