In every pregnancy, a woman starts out with a 3-5% chance of having a baby with a birth defect. This is called her background risk. This sheet talks about whether exposure to sumatriptan may increase the risk for birth defects over that background risk. This information should not take the place of medical care and advice from your health care provider.

What is sumatriptan?
Sumatriptan (Imitrex®, Imigran®) is a medication used to treat migraine headaches. It can be used orally (pill), by nasal spray or by injection (shot). Sumatriptan is also available in a combination product (Treximet®) that also contains naproxen. Naproxen containing products are best to avoid during late pregnancy.

Are there any effects of having a migraine headache during pregnancy?
During pregnancy, the frequency and severity of migraines often decreases, although in 25% of women these symptoms remain the same or get worse. Some studies have shown that women with a history of migraine headaches have a slightly higher chance for pregnancy complications including high blood pressure, preeclampsia (dangerously high blood pressure) and pregnancy-related stroke. One study suggested an increased chance of fetal limb defects in mothers who had untreated migraines in the first trimester of pregnancy but this finding has not been confirmed.

Can sumatriptan use during the first trimester cause a miscarriage?
It is unlikely. Several studies have found no increase in the rate of miscarriages or stillbirths when sumatriptan was used at any time during pregnancy.

Can taking sumatriptan in the first trimester cause a birth defect?
It is unlikely. Several types of studies have not found an increase in the rate of birth defects when sumatriptan is used in the first trimester.

Can taking sumatriptan in the second or third trimester cause other pregnancy complications?
Concerns have been raised about whether the use of sumatriptan late in pregnancy may be associated with preeclampsia (dangerously high blood pressure), preterm birth, low birth weight and heavy bleeding following delivery. Several studies have noticed a small increased chance for these outcomes. However, it is not yet clear if these outcomes were due to the migraines or the medications or a combination of both.

Can sumatriptan be used by a breastfeeding mother?
Only small amounts of sumatriptan enter breastmilk. Since sumatriptan is not well absorbed by the gut, any of the medication that gets into breast milk would be unlikely to enter the baby’s system making it unlikely to cause problems for the baby. It is possible that premature babies (born before 37 weeks) with digestive systems that are not fully developed may be able to absorb more of the medication through breast milk. Be sure to talk to your health care provider about all your choices for breastfeeding.

What if the father of the baby takes sumatriptan?
There are no studies looking at possible risks to a pregnancy when a father has migraine headaches or uses sumatriptan. In general, exposures that fathers have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures and Pregnancy at http://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/pdf/.

Selected References:

  • Duong S, et al. 2010. Safety of triptans for migraine headaches during pregnancy and breastfeeding. Can Fam Physician; 56(6):537-9.
  • Bánhidy F, et al. 2006. Maternal severe migraine and risk of congenital limb deficiencies. Birth Defects Res a Clin Mol Teratol; 76(8):592-601.
  • Cunnington M, et al. 2009. The safety of sumatriptan and naratriptan in pregnancy: what have we learned? Headache; 49(10):1414-22
  • Fox AW, et al. 2002. Evidence-based assessment of pregnancy outcome after sumatriptan exposure. Headache; 42(1):8-15.
  • Källén B, et al. 2011. Delivery outcome after maternal use of drugs for migraine: a register study in Sweden. Drug Saf; 34(8):691-703.
  • Nezvalová-Henriksen K, et al. 2010. Triptan exposure during pregnancy and the risk of major congenital malformations and adverse pregnancy outcomes: results from the Norwegian Mother and Child Cohort Study. Headache; 50(4):563-75.
  • Nezvalová-Henriksen K, et al. 2013. Triptan safety during pregnancy: a Norwegian population registry study. Eur J Epidemiol; 28(9):759-69.
  • Olesen C, et al. 2000. Pregnancy outcome following prescription for sumatriptan. Headache; 40(1):20-4.
  • Schenker S, et al. 1995. Sumatriptan (Imitrex) transport by the human placenta. Proc Soc Exp Biol Med; 210(3):213-20.
  • Shuhaiber S, et al. 1998. Pregnancy outcome following first trimester exposure to sumatriptan. Neurology; 51(2):581-3.
  • Soldin OP, et al. 2008. Triptans in pregnancy. Ther Drug Monit; 30(1):5-9.
  • Wabnitz A, Bushnell C. 2015. Migraine, cardiovascular disease, and stroke during pregnancy: systematic review of the literature. Cephalalgia; 35(2):132-9.
  • Wojnar-Horton RE, et al. 1996. Distribution and excretion of sumatriptan in human milk. Br J Clin Pharmacol; 41(3):217-21.