Topamax recently made headlines for causing birth defects, but this isn’t the only migraine medication that can be dangerous during pregnancy. If you’re pregnant and suffer from migraines, these are some of the medications you absolutely must avoid:

Dangerous medications: Non-steroidal anti-inflammatory drugs (NSAIDs)

Although NSAIDs help safely reduce migraine pain during an attack, they have been shown to cause heart defects in fetuses during their development. Drugs like Advil or Motrin are off-limits during pregnancy — they just aren’t worth the risk.

Dangerous medications: Triptans

A triptan is a migraine medication used to relieve swelling in the brain during a migraine attack, which doctors believe helps relieve headache pain, nausea, vomiting and sensitivity to light and sound. It works by narrowing the vessels in the brain.

Physicians worry that it can also cause the vessels in the fetus to narrow, which can damage the vessels leading to the spine. This can paralyze the fetus as it develops. These worries have not been scientifically proven, however, so it is unclear if triptans are dangerous during pregnancy.

Advice: Better safe than sorry. If you can avoid taking triptans, do so.

Dangerous medications: Acetaminophen combinations

This type of migraine medication contains acetaminophen, a pain-relieving drug, aspirin and caffeine. Caffeine helps speed up the pain-relieving action of acetaminophen.

Unfortunately, doctors worry that pregnant women may accidentally consume too much caffeine if they use acetaminophen combinations, which can be dangerous for the fetus. Aspirin has also been shown to increase the risk for bleeding during the third trimester of pregnancy, making it unsafe for pregnant women. However, acetaminophen itself is a safe medication for relieving migraine pain during pregnancy.

Dangerous medications: Migraine medications containing codeine

A handful of migraine medications contain codeine, which in normal circumstances is safe to take. During pregnancy, however, codeine can be very dangerous.

According to one study, codeine has been associated with respiratory and heart defects in infants, with noted increases in cleft lip and hernias.

Other studies dispute these claims, however, putting the blame on other medications. Still, there may be the risk that these medications can cause these birth complications.

Dangerous medications: Beta-blockers

Like acetaminophen combinations, beta-blockers are effective for treating migraines, but they can be dangerous during pregnancy due to their effects on the fetus. The most common complication noted is a condition called neonatal hypoglycemia. Left untreated, it can cause seizures, heart failure and developmental problems. Neonatal hypoglycemia does not always produce symptoms.

So what medications are truly safe during pregnancy? Unfortunately, there appears to be few — resting, avoiding migraine triggers and using biofeedback are the most effective options here.