Prenatal exposure to triptans, alone or with other migraine medications, was not linked to a significantly increased risk for neurodevelopmental disorders (NDDs) in children born to Norwegian mothers with a history of migraine, found researchers.
The team, led by Margherita Camanni, University of Milano-Bicocca, Milan, Italy, and with collaboration from the University of Oslo, had carried out a registry-based cohort study in Norway using data from multiple national health registries between 2008 and 2023, and which included more than 26 000 children born to mothers with migraine. The offspring were followed up to 14 years of age.
Among the mothers, 81% used triptans and 19% did not.
In their study, published online in Neurology, the researchers said prenatal exposure to triptans and other anti-migraine medications was determined by prescription fills from 12 months before pregnancy until delivery. Exposure was grouped as low use (42%), short-term low use (31%), moderate use (21%), and high use (6%).
The primary outcome was diagnosis in the children of a composite of any NDD, including autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and language or speech disorders.
Medscape reports that among the 4% of children who developed an NDD during the study, ADHD was the most common condition.
Children with any prenatal exposure to triptans had a slight but not substantial increased risk for NDD compared with those with no exposure (low use weighted hazard ratio [wHR], 1.08; short-term low use wHR, 1.05; moderate use wHR, 1.09; high use wHR, 1.16). These risks decreased to null when the comparator was in low use (wHR range, 0.94-1.01).
A slightly increased risk for ASD was observed in children with moderate and high exposure to triptans (wHRs, 1.24 and 1.30, respectively), but the weighted risk differences were less than 1%.
The probability of exposure to other antimigraine medications was less than 10%. Prenatal exposure to co-medications was not significantly associated with the composite NDD outcome, they observed.
Encouraging
“These results are encouraging for migraine sufferers who may be taking these drugs before they even know they are pregnant, and this is helpful information for their physicians, who can make more informed decisions about treating women with debilitating migraine attacks,” said study investigator Hedvig Nordeng, PhD, University of Oslo.
Study details
Association of Prenatal Exposure to Triptans, Alone or Combined With Other Migraine Medications, and Neurodevelopmental Outcomes in Offspring
Margherita Camanni, Marleen van Gelder, Anna Cantarutti, Hedvig Nordeng, and Angela Lupattelli.
Published in Neurology on 24 June 2025
Abstract
Background and Objectives
The long-term reproductive safety of migraine medications remains uncertain. This study sought to examine the effect of different intensities and durations of prenatal exposure to triptans, alone and combined with other preventive migraine medications, on neurodevelopmental disorders (NDDs) in children.
Methods
This nationwide health registry study in Norway included pregnancies of women with migraine before pregnancy and followed up their children up to 14 years of age. Single and multiple group-based trajectory models and group-based multitrajectory models were applied to cluster triptan exposure alone and combined with preventive anti-migraine medications. Child outcomes, based on specialist outpatient and inpatient diagnoses, included autism spectrum and behavioural disorders, learning and intellectual disabilities, speech/language and developmental co-ordination disorders, and attention-deficit hyperactivity disorders (ADHDs). We fit adjusted and weighted pooled logistic regression models and standardised risk curves using propensity score–based overlap weighting.
Results
We included 26,210 pregnancies of women with migraine; 4,929 and 21,281 were, respectively, nonmedicated and medicated with triptans in the year of prepregnancy. In the latter group, we identified 4 group-based trajectories of triptans alone and combined with preventive medications: discontinuers before (low use) (41.5%, 47.0%), early discontinuers (short-term low use) (31.3%, 28.8%), late discontinuers (moderate use) (21.3%, 9.1%), and late discontinuers (high use) (5.9%, 15.2%). Overall, 1,140 children (4.3%) had a NDD (mean follow-up time: 8 years). Children born to women with any triptan trajectory had a slightly higher risk of NDD compared with children of non-medicated women (magnitude range of the weighted hazard ratio [wHR]: 1.05–1.16). These risks decreased to the null when discontinuers before (low use) acted as a comparator (magnitude of wHR: 0.94–1.01) or when analyzing speech/language disorders or ADHD (magnitude of wHR: 0.82–1.14). There was a slightly elevated risk of autism disorders with both triptan late discontinuation trajectories (wHR 1.24, 95% CI [0.78–1.97]; wHR 1.30, 95% CI [0.66–2.56]), but the 95% CI crossed the null and the weighted risk difference remained low.
Discussion
Our findings indicate that prenatal exposure to triptans, alone or combined with other migraine medications, does not substantially increase the risk of a broad range of neurodevelopmental outcomes in children up to adolescence.
Medscape article – Tracking Triptan Safety During Pregnancy (Open access)
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