Prenatal triptan exposure unlikely to harm neurodevelopmental outcomes in children

Maternal use of the migraine drug triptans before or during pregnancy does not appear to put infants at risk of developing neurodevelopmental disorders, according to a study.

Children born to mothers who were taking triptans before and/or during pregnancy initially appeared to have a slightly higher risk of neurodevelopmental disorders compared with those born to nonmedicated mothers (magnitude range of the weighted hazard ratio [wHR], 1.05–1.16). However, this association disappeared when considering low triptan use as a comparator (wHR, 0.94–1.01). [Neurology 2025;doi:10.1212/WNL.0000000000213678]

Moderate and high maternal triptan use were associated with a slightly increased risk of autism spectrum disorder in children (wHR, 1.24, 95 percent confidence interval [CI], 0.78–1.97 and wHR, 1.30, 95 percent CI, 0.66–2.56, respectively), but the 95 percent CI crossed the null, and the weighted risk difference remained low.

The probability of prenatal exposure to other antimigraine medications was low at below 10 percent, and prenatal exposure to co-medications demonstrated no significant association with the composite neurodevelopmental disorder outcome.

“These results are encouraging for people with migraine, who may be taking these drugs before they even know that they are pregnant, and this is helpful information for their physicians, who can make more informed decisions about treating people with debilitating migraine attacks,” said one of the study authors Dr Hedvig Nordeng from the University of Oslo in Norway.

“Migraine affects almost one in five of people of childbearing age. [And] while symptoms often improve during pregnancy, about 8 percent of people experience worsening attacks during pregnancy, which can lead to increased risks of both maternal and foetal complications, so it’s vital to have treatment options available,” Nordeng added.

The study included 26,210 children born to women with migraine in Norway who were followed up to 14 years of age. A total of 1,140 children (4.3 percent) received a diagnosis of any neurodevelopmental disorder, including autism spectrum and behavioural disorders, learning and intellectual disabilities, speech/language and developmental coordination disorders, and attention-deficit hyperactivity disorder. The mean follow-up duration was 8 years.

Prenatal exposure to triptans and other antimigraine medications was ascertained by analysing prescription fills from 12 months before pregnancy until delivery. Most of the mothers used triptans (81 percent). Among them, 41.5 percent stopped using the drugs before pregnancy (low use), 31 percent stopped using the drugs in early pregnancy (short-term low use), 21.3 percent continued using the drugs into early pregnancy (moderate use), and 5.9 percent continued using the drugs throughout pregnancy (high use).

The study was limited by the use of prescription fill data as a proxy for actual medication intake, potentially resulting in exposure misclassification. The risk of specific neurodevelopmental disorders in children after prenatal exposure to combined migraine treatments and individual triptans could not be evaluated due to small sample sizes. Additionally, whether medication discontinuation at the last menstrual period was due to a decrease in migraine severity was not established.