A large-scale Norwegian population study has provided reassuring evidence that prenatal exposure to triptans does not increase the risk of neurodevelopmental disorders in children, according to research published in Neurology. The findings offer important safety data for healthcare providers treating migraine in women of childbearing age, a population where treatment decisions often involve weighing potential risks to the developing fetus.
Study Design and Population
Researchers analyzed health registry data from the entire Norwegian population, identifying 26,210 pregnancies in women with migraine. Of these, 21,281 participants (over 80%) had used triptans in the year before pregnancy, while 4,929 had not received any triptan therapy during that period.
The study team, led by Hedvig Nordeng, PhD, of the University of Oslo, stratified triptan users into four exposure groups based on timing and intensity of use: low-use discontinuers before pregnancy (42%), early discontinuers who increased use six months before pregnancy (31%), moderate users who continued into early pregnancy (21%), and high-use patients who maintained therapy throughout pregnancy (6%).
Long-term Neurodevelopmental Outcomes
Children were followed for an average of eight years, with some tracked until age 14, to assess diagnoses of neurodevelopmental disorders including autism spectrum disorder, ADHD, behavioral disorders, learning disabilities, and speech and language disorders.
The results showed minimal differences between exposure groups. Among children in the highest triptan exposure category, 2.2% were diagnosed with ADHD compared to 2.1% of children whose mothers did not use the medications. Similarly, 1.1% of the high-exposure group developed speech and language disorders versus 1.0% in the non-medicated group.
Overall, 1,140 children (4.3%) received a neurodevelopmental disorder diagnosis during the study period, with ADHD and speech and language disorders being the most common conditions identified.
Statistical Analysis and Confounding Factors
When researchers adjusted for potential confounding variables—including parental neurodevelopmental disorders, folic acid intake, and concurrent use of other medications such as opioids or antidepressants—no statistically significant increased risk emerged for children with prenatal triptan exposure.
"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," Nordeng stated.
Clinical Implications for Migraine Management
The findings address a significant clinical challenge, as migraine affects nearly one in five people of childbearing age. While migraine symptoms often improve during pregnancy, approximately 8% of patients experience worsening attacks that can increase risks of both maternal and fetal complications.
Triptans represent a cornerstone of acute migraine treatment, functioning by modulating blood circulation in the brain and altering pain signal processing. Sumatriptan, the first triptan approved in the 1990s, established this drug class as a first-line therapy for migraine attacks, including menstrual migraine and cluster headaches.
Study Limitations and Future Directions
The researchers acknowledged that prescription filling data was used as a proxy for actual medication consumption, potentially leading to exposure misclassification. The study design also could not establish causality, only associations between prenatal triptan exposure and neurodevelopmental outcomes.
Despite these limitations, the large population size, extended follow-up period, and comprehensive registry data provide robust evidence supporting the safety profile of triptans during pregnancy. The findings may help inform clinical guidelines and shared decision-making between healthcare providers and patients managing migraine during pregnancy.
