Anti-CGRP Migraine Drugs in Pregnancy And Risk of Spontaneous Abortion

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13 Oct Anti-CGRP Migraine Drugs in Pregnancy And Risk of Spontaneous Abortion

Posted at 19:26h in Author Interviews, JAMA, Neurology, OBGYNE by

MedicalResearch.com Interview with:

Professor Anick Bérard PhD FCAHS FISPE

Canada Research Chair Tier 1 on Medications and Pregnancy

Faculty of Medicine, Université Paris Cité, France

Faculty of Pharmacy, University of Montreal

Adjunct Professor, Faculty of Pharmacy, Université Claude Bernard Lyon 1, France

Principal Investigator: Canadian Mother-Child Initiative on Drug Safety in Pregnancy (CAMCCO – Research, Training, Knowledge-Dissemination); CONCEPTION study – COVID-19 and Pregnancy; AMerican PREGNANcy-Mother-Child CohorT (AM-PREGNANT)

Director, Research Unit on Medications and Pregnancy, Research Center – CHU Sainte-Justine

Editor in Chief, Frontiers in Pharmacology – Pharmacoepidemiology

Medication and Pregnancy Notice: Migraine preventive medications, including anti-CGRP therapies and propranolol, should only be prescribed and monitored by your healthcare provider. If you are pregnant, planning a pregnancy, or think you may be pregnant, do not stop, start, or change any medication on your own. Talk with your healthcare provider about the risks and benefits for your individual situation.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:

  • Migraine is very prevalent in pregnancy – 20%.
  • It usually improves in the 2nd/3rd trimester – especially for migraine without aura.
  • Anti-CGRPs are effective therapies for the prevention of migraine but their safety in pregnancy is unknown. Guidelines do not recommend use during pregnancy except in very few cases. Women with chronic migraine are usually switched to safer alternatives 5-6 months before pregnancy (because of the 30-day half-life – 5 times the half-life). But inadvertent exposures occur.
  • Our study is the first large scale study looking at the safety of anti-CGRP during pregnancy for the prevention of chronic migraine. Using data from US pregnant women with chronic migraine, anti-CGRP use increased the risk of spontaneous abortion by 42% (baseline risk of clinically detected spontaneous abortions is 6-8%; the absolute risk on anti-CGRP becomes 8-11%); but propranolol use did not. Our findings are in line with the current guidelines on migraine preventive therapies which recommend discontinuation of anti-CGRP at least 5 months before conception and switch to established migraine preventive therapies such as propranolol.

MedicalResearch.com: What should the recommendations be for practitioners and patients based on these results?

Response: Our study supports the current guidelines on the preventive treatment of migraine during pregnancy. Given that anti-CGRP are given to those with more severe migraine, a personalized risk-benefit plan needs to be discussed ideally before pregnancy or as soon as a pregnancy is recognized. One needs to keep in mind that the increase in the risk of spontaneous abortions associated with anti-CGRP use remains small.

MedicalResearch.com: Is there anything else you would like to add?

Response: Inadvertent exposure to anti-CGRP occurs given that approximately 50% of pregnancies are unplanned. Please consult your health care provider before making any decision, in the event that this happens.

Citation:

Flatman LK, Leal LF, Leroux E, Lipton RB, Bérard A. Early Pregnancy Use of Anti-CGRP Monoclonal Antibodies and Propranolol and Spontaneous Abortion Risk. JAMA Neurol. Published online October 12, 2026. doi:10.1001/jamaneurol.2026.357

Patient information on miscarriage is available from ACOG (American College of Obstetricians and Gynecologists). For more of Prof. Bérard’s research on this topic, see this MedicalResearch.com interview on antibiotics and the risk of miscarriage.

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Last Updated on October 13, 2026 by Marie Benz MD FAAD

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