Pregnancy and migraine headaches

  I am 34 yrs old and have had migraine headaches since I was 19 yrs old.  Until right before my pregnancy in 1995, the only medication I took was Fiorinal (plain and with codeine).During my first pregnancy, my headaches worsened, especially in my first trimester.  The only thing that I took for them was two Aspirin-Free Excedrin...and that did not help.  I was told that a max of 300 mg of caffeine daily is safe during pregnancy (Excedrin has 65 mg per caplet).  Is that true?  I have also tried Tylenol, Advil, and Alleve to no avail.  I had preeclampsia and delivered my first child at 32 weeks. Now, I have begun taking Prometrium because I recently had a miscarriage at 7 weeks.  Since we are planning on a pregnancy my question is: Could you give any recommendations on migraine headache medications and/or prophylactic medications that are safe to take during pregnancy?  Thank you for any suggestions that you may have for me.

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Dear Esther:
Migraine headaches are associated with contractions of blood vessels. They are highly variable in their frequency and quite unpredictable in pregnancy: some women get better and some worsen.
Migraine headaches may respond to non-medical therapies: lying down in a dark room; ice or warmth applied to the temple or neck areas.
Most medications, including pain medications, have not been scientifically evaluated during pregnancy. Hence, they do not carry a label of safety: rather, there are simply no reports of harm and the decision to use the medications is based on need.
Tylenol with codeine is a very common prescription because we have a lot of experience with the agent; it seems to work against a lot of pain types; other than constipation and drowsiness, the agent is well tolerated.
A few agents used in the treatment of migraine headaches (ergot compounds) are known to be harmful to pregnancy.
Progesterone has a quieting effect on blood vessels and may be helpful to migraine headaches.
300 mg of caffeine represents 3 cups of coffee and there are studies that suggest up to 3 cups of coffee had no influence on the outcome of pregnancy.
Keywords: migraine headache, pregnancy
This information isprovided for medical education and is not a consultation. If you have specific questions, please speak with your healthcare provider.