Are monthly migraine injections safe before pregnancy?

Question

Hello Doctor,

I am a 33-year-old woman experiencing chronic migraines, occurring approximately fifteen days each month. I have tried Triptans (Serotonin receptor agonists), Beta blockers (antihypertensives), and made several dietary changes, but unfortunately, none of these have provided long-term relief.

A friend recently mentioned monthly migraine injections, specifically calcitonin gene-related peptide (CGRP) inhibitors. I would like to know if these injections are considered safe for women who are planning to conceive within the next one to two years. Additionally, do these medications have any impact on hormones or the menstrual cycle?

I am currently using birth control, and I have heard that it could potentially interact with certain migraine treatments. I often feel exhausted and overwhelmed, living in constant fear of the next migraine attack.

Could you kindly explain, in simple terms, how CGRP injections work, who they are most effective for, and whether I might be a suitable candidate for this treatment?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

CGRP injections, or monoclonal antibodies targeting calcitonin gene-related peptide (CGRP Inhibitors), are a newer class of preventive medications used to manage migraines. They work by blocking calcitonin gene-related peptide (CGRP), a molecule involved in the pain signaling pathway of migraines. By doing so, they help reduce both the frequency and severity of migraine attacks.

These injections are especially beneficial for individuals who experience frequent or debilitating migraines and have not achieved relief with standard treatment options.

Who may benefit from CGRP inhibitors:

Frequent migraines: Individuals who experience migraines regularly.
Failed prior treatments: Those who have not responded to other preventive medications such as beta blockers (antihypertensives), antidepressants, or anti-seizure medications (anticonvulsants).
Migraine with aura: CGRP Inhibitors have shown effectiveness in treating both migraine with aura and migraine without aura.
Medication overuse headache: These medications can be helpful for individuals who have developed rebound headaches from frequent use of acute migraine treatments.

Good candidates for CGRP injections include:

Individuals diagnosed with chronic migraines.
Those seeking a preventive approach to managing migraine.
Patients who are comfortable with injection-based treatments.

CGRP, hormones, and birth control:

Although CGRP Inhibitors do not directly interfere with the effectiveness of oral contraceptives, there is a complex relationship between CGRP and hormonal fluctuations. CGRP levels can be influenced by sex hormones, particularly estrogen.

For example, a drop in estrogen levels, which naturally occurs during menstruation, has been associated with increased CGRP activity. This change may trigger or worsen migraine attacks in women. Hormonal birth control may also influence this dynamic, depending on the type and dosage.

Planning for pregnancy:

If you are planning to conceive within the next year or two, it is important to consider timing. Although CGRP Inhibitors are not known to directly cause harm, most medical experts recommend discontinuing them several months before attempting pregnancy. This allows the medication to fully clear from your system and reduces any theoretical risk to fetal development.

In summary:

CGRP Inhibitors are a safe and effective option for many women with chronic migraines, including those who use hormonal birth control. However, if pregnancy is planned shortly, it is advised to stop the medication several months before conception. Always consult with your neurologist or headache specialist for a tailored treatment plan.

I hope this helps.

Thank you.