Spontaneous abortion may be associated with patterns of migraine medication use but not with preexisting migraine, according to results of a study published in The Journal of Headache and Pain.
Data for this analysis were sourced from Pregnancy Study Online (PRESTO), which is an ongoing prospective study of lifestyle and medical factors affecting fertility conducted at the Slone Epidemiology Center of Boston University. The subset of women (N=7890) who became pregnant between 2013 and 2021 within 12 months of PRESTO recruitment were evaluated for risk for spontaneous abortion on the basis of whether they had self-reported migraine before the pregnancy. A spontaneous abortion was defined as loss of pregnancy before 20 weeks’ gestation.
Participants were categorized as having no migraine (n=6207), having migraine but without medication use (n=1021), or having migraine with medication use (n=662). The study cohorts were well balanced at baseline. A history of spontaneous abortion was reported among 25% of women with no migraine, among 26% of women with migraine but without medication use, and among 32% of women with migraine and medication use.
The rate of spontaneous abortion during the observation period was 19%, and the median weeks’ gestation at the time of spontaneous abortion was 6 (range, 3-19) weeks.
In the crude and adjusted analyses, migraine status, frequency of migraine, medication use, frequency of other medication use, timing of medication use after conception, or other pain medication use were not significantly associated with risk for spontaneous abortion.
There were trends toward higher risk observed for migraine medication use more than 8 weeks before conception (adjusted hazard ratio [aHR], 1.43; 95% CI, 0.87-2.37), prescription migraine prophylaxis medication use (aHR, 1.43; 95% CI, 0.72-2.84), triptan use (aHR, 1.30; 95% CI, 0.83-2.07), aspirin use for migraine (aHR, 1.21; 95% CI, 0.82-1.79), and over-the-counter medication use (aHR, 1.16; 95% CI, 0.93-1.44).
These findings may be biased by reliance on self-reported migraine and patterns of medication use.
Study authors conclude that although a migraine history was not associated with risk for spontaneous abortion, patterns of medication use may increase risk to some extent. They further explain that “[t]his increased risk is likely due to more severe underlying vascular pathophysiology as opposed to risk from medications.”
Crowe HM, Wesselink AK, Wise LA, et al. Pre‑pregnancy migraine diagnosis, medication use, and spontaneous abortion: a prospective cohort study. J Headache Pain. Published online December 20, 2022. doi:10.1186/s10194-022-01533-6