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Abstract

Migraine is a common neurological disorder that predominantly affects women during their reproductive years, presenting unique challenges in the context of pregnancy, breastfeeding, and pregnancy planning. In the present review, we intend to summarize those challenges and propose possible solutions. Women with migraine, particularly those with aura, face an increased risk of pregnancy-related complications, including preeclampsia, stroke, and preterm birth, highlighting the need for careful monitoring throughout gestation. When migraine persists during pregnancy, management should prioritize non-pharmacological approaches, with a strong emphasis on lifestyle modifications and behavioral therapies. In some settings, non-invasive neuromodulation may also be a reasonable option. However, disabling migraine should not be left untreated and may require pharmacological management. Pharmacological treatments should be chosen primarily based on safety considerations, as many migraine medications are not suitable for use during pregnancy. Given the limited safety data available for several treatments, shared decision-making between patients and healthcare providers is essential. During breastfeeding, medication selection should focus on minimizing infant exposure while ensuring effective migraine control for the mother. In women of childbearing potential, caution is needed when prescribing certain migraine treatments, as unplanned pregnancies can occur. Special considerations should also be given to those requiring preventive treatment while planning pregnancy. Given the complexities of migraine management in this population, an individualized approach is crucial to balancing maternal well-being with fetal and infant safety.

Keywords

migraine pregnancy pregnancy planning breastfeeding migraine treatment review

Introduction

Migraine is a neurological disorder that disproportionately affects women in their reproductive years (1). In most women with migraine, the occurrence and severity of attacks are intricately connected with sex hormone fluctuations associated with menarche, menses, pregnancy, breastfeeding, or menopause (2).

As migraine often peaks during the reproductive years, its management during pregnancy and breastfeeding is a significant clinical challenge. While migraine frequency and intensity commonly improve during the second and third trimesters due to reduced fluctuations in sex hormone levels (3), up to 8% of pregnant women experience worsening symptoms or develop new-onset migraine, most often with aura (4). For those who experience improvement, this effect is typically limited to pregnancy, as migraine symptoms frequently recur in the early postpartum period (3), likely due to an abrupt drop in estrogen levels. Given the association between migraine and pregnancy-related complications, careful monitoring of pregnant women with migraine is essential (5). Special consideration should also be given to the management of migraine prevention in women of childbearing age, as both planned and unplanned pregnancies can occur. This review explores the challenges associated with migraine treatment during pregnancy, breastfeeding, and the reproductive years, providing guidance on safe and effective management strategies.

Search strategy

In our search we included original papers, narrative reviews, and systematic reviews published in high-impact journals in the last ten years and indexed in PubMed and/or Scopus. Relevant older references were selected only if deemed particularly relevant and unreplaceable by more recent literature. Key terms for the search included “migraine” coupled with “pregnancy”, “puerperium”, or “lactation” and with “treatment”, “CGRP”, “monoclonal antibody”, “gepant”, “oral treatment”, “neuromodulation”, “tDCS”, “TMS”, “non-pharmacological”, “onabotulinumtoxinA”, “erenumab”, “fremanezumab”, “galcanezumab”, or “eptinezumab”. Articles were extracted by two screeners independently (RO, SS) and discussed among all Authors in case of doubt for inclusion.

Migraine and the risk of pregnancy-related adverse events

Migraine management in pregnancy or in women planning pregnancy includes a discussion not only about potential treatment but also on the health risks associated with pregnancy in women with migraine.

Migraine increases the risk of pregnancy-related adverse events, including pregnancy-induced hypertension, (pre)eclampsia, preterm delivery, and low birth weight (6). Meta-analyses reported that the pooled odds ratio (OR) for preeclampsia in women with migraine, compared with those without migraine, was 2.05 (95% confidence interval [CI] 1.47–2.84), while the OR for preterm birth was 1.26 (95% CI 1.21–1.32) (5,7,8). A pooled analysis showed that triptan use during pregnancy may further elevate miscarriage risk from 8.2% to 10.2%, with a corresponding pooled OR of 3.54 (95% CI 2.24–5.59]) (9). Although absolute risks are low (0.1–0.3%), women with migraine have an 8.46-fold increased risk of ischemic and hemorrhagic stroke (subarachnoid and intracerebral) during pregnancy and the puerperium (10 –12). As in migraine in general, the association with stroke is most pronounced for migraine with aura, particularly for ischemic stroke, and a similar pattern is seen for the risk of preeclampsia (6).

In addition to direct risk of stroke, individuals with migraine, including pregnant women, have higher rates of vascular risk factors such as obesity, hypertension, and unfavorable lipid profiles (10,13 –15). Conversely, there is no clear evidence for an increased risk of gestational diabetes in women with migraine compared with those without migraine (6). However, the increased stroke risk during pregnancy persists even after adjusting for these factors. Obesity and higher maternal age, influenced by migraine-related delays in pregnancy planning, are potential confounders for obstetric complications (10,16,17). Nevertheless, the increased risk of pregnancy-induced hypertension and preeclampsia associated with migraine is independent of age and body mass index (6).

A possible pathophysiological mechanism linking migraine and pregnancy-related adverse events is endothelial activation, mediated by hypercoagulable and proinflammatory states (18); additional mechanisms include the hypercoagulable states that might be associated with migraine (19) and worsen pregnancy outcomes (Figure 1). Cortical spreading depression, the transient neuronal and glial depression of activity underlying migraine aura and triggering headaches, may also explain the increased stroke risk in migraine with aura through episodes of cerebral hypoperfusion. During pregnancy, rising estrogen levels further increase the risk of cortical spreading depression and migraine with aura (20).

Figure 1.

Possible mechanisms leading to the risk of adverse events during pregnancy in women with migraine.

During pregnancy, careful monitoring of women with migraine, particularly those with the aura subtype, is advisable. Specific primary prevention with antithrombotic agents cannot be recommended as there is no evidence of potential benefits associated with this strategy. Notably, the assessment of women with migraine should be aware not only of vascular, but also of non-vascular adverse events of pregnancy whose risk is increased by a history of migraine, such as post-partum depression (21,22).

Migraine management in pregnant women

Migraine management during pregnancy requires a careful balance between alleviating maternal symptoms, ensuring fetal safety, and promoting the smooth progression of pregnancy. Both pharmacological treatments - acute and preventive - and non-pharmacological strategies are integral to care (23,24).

The use of drugs during pregnancy poses potential risks to the fetus by crossing the placenta and/or impairing the course of pregnancy and maternal health. While not all substances in the maternal circulation cross the placenta, those that do can exert toxic or teratogenic effects. Substances that do not cross the placenta can still indirectly harm the fetus by constricting placental blood vessels, impairing oxygen and nutrient exchange, or altering maternal physiology, such as inducing hypotension or severe uterine hypertonia, as shown by evidence on recreational drugs (25). The impact of drugs on the fetus is largely determined by the stage of fetal development, placental permeability, maternal health, drug potency, and dosage. During the pre-implantation stage, which occurs within 20 days of fertilization, drug exposure typically has an “all-or-nothing” effect, either resulting in embryo death or leaving it unaffected, with teratogenesis being unlikely. During organogenesis, which occurs between 20 and 56 days after fertilization, the fetus is most vulnerable to teratogenic effects. Drug exposure at this stage may lead to structural abnormalities, spontaneous abortion, subtle functional or metabolic defects that manifest later in life, or increased risks of conditions such as childhood cancers (26). After organogenesis, during the second and third trimesters, teratogenesis becomes less likely; however, drug exposure can still impact the growth and functional development of fetal organs (26). As placental metabolism becomes more active, higher drug doses may be required to produce adverse fetal effects.

Whenever possible, non-pharmacological approaches should be prioritized for both acute symptom relief and preventive therapy, given their safety profile and the commitment to minimizing maternal and fetal exposure to medications. Non-pharmacological approaches include general measures such as lifestyle modifications and education, complementary and integrative treatments, and non-invasive neuromodulation which unfortunately is not widely available. Despite their benefits, non-pharmacological strategies alone may not provide sufficient pain relief during pregnancy. Migraine is a serious neurological disease, and its attacks can be profoundly disabling, significantly impacting a woman's quality of life and overall well-being. Therefore, women with persistent or severe migraine should not be left untreated and require appropriate pharmacological management, ideally under the care of a physician with an expertise in migraine. For pharmacological treatment, medications with well-established safety profiles during pregnancy should be prioritized. It is important to emphasize that undertreatment of migraine not only results in persistent pain and reduced quality of life, but also increases maternal psychological distress, which has been associated with adverse neurodevelopmental outcomes in offspring (27).

The following sections will address the specific considerations for both non-pharmacological and pharmacological management strategies during pregnancy, particularly focusing on new treatments and highlighting the unique characteristics and applications of each approach.

Table 1 shows current recommendations for migraine management during pregnancy according to international consensus and guidelines, while Figure 2 graphically summarizes the possible approaches to migraine in pregnant women.

Figure 2.

Therapeutic approaches to migraine during pregnancy.

Table 1.

Current recommendations on migraine treatments during pregnancy.

Study	Acute / preventive management	Type of document
Puledda et al, 2024 (24)	Preventive: In cases where non-pharmacological approaches or peripheral nerve blocks are ineffective, propranolol or amitriptyline can be considered, taking potential risks into account. Propranolol should be discontinued during the last part of the third trimester. OnabotulinumtoxinA can be considered for chronic migraine, taking into account the risks and benefits. Valproate, topiramate, candesartan, and lisinopril must be avoided.	International Headache Society Global Practice Recommendations
Puledda et al, 2024 (23)	Acute: In cases where non-pharmacological approaches are ineffective, acetaminophen (paracetamol) and triptans can be considered, taking potential risks into account. Metoclopramide can be added.	International Headache Society global practice recommendations
Eigenbrodt et al, 2021 (28)	Acute: Acetaminophen (paracetamol) can be used as the first line, and if needed NSAIDs but only during the second trimester. Triptans can be used under specialist supervision. Metoclopramide can be used for nausea.	Consensus Statement endorsed by the European Headache Federation and the European Academy of Neurology
Eigenbrodt et al, 2021 (28)	Preventive: Should be avoided. If necessary, propranolol or amitriptyline can be used under specialist supervision. Topiramate, candesartan and sodium valproate must be avoided.
Ashina et al, 2021 (29)	Acute: Acetaminophen (paracetamol) can be used as the first line. Ibuprofen, diclofenac, and naproxen can be used with caution (only second trimester). Sumatriptan can be used under supervision.	Lancet migraine series
Ashina et al, 2021 (29)	Preventive: Should be avoided. If necessary, beta-blockers can be used. Amitriptyline can be used as the second line.	Lancet migraine series
González-García et al, 2022 (30)	Acute: Oral acetaminophen (paracetamol) as the first line. Alternatively, oral NSAIDs (ibuprofen, naproxen, diclofenac) in the second trimester. If needed, sumatriptan (other triptans) and/or metoclopramide (ondansetron as the second line) can be used.	Spanish Society of Neurology's Headache Study Group
González-García et al, 2022 (30)	Preventive: Propranolol or metoprolol should be used as the first line and amitriptyline as the second choice. Nerve blocks can be considered if needed.	Spanish Society of Neurology's Headache Study Group
Medrea et al, 2024 (31)	Preventive: Should be avoided. If necessary, beta-blockers can be used. Amitriptyline can be used as the second line. OnabtulinumtoxinA can be considered on a case-by-case basis.	Canadian Headache Society Migraine Prevention Guideline
Moisset et al, 2024 (32)	Preventive: amitriptyline, beta blockers, and onabotulinumtoxinA can be used during pregnancy; topiramate, valproate, and other anti-seizure medications are contraindicated	French headache society position paper
Ornello et al, 2025 (33,34)	Acute: The use of triptans during pregnancy could be considered as a second line approach in the case of acetaminophen failure. Among triptans, sumatriptan, naratriptan, and rizatriptan should be preferred. NSAIDs, combination analgesics, and lasmiditan should be avoided.	Evidence-based guidelines of the Italian Society for the Study of Headache and the International Headache Society for the pharmacological treatment of migraine
	Preventive: Amitriptyline can be used during pregnancy only after a careful evaluation of the risk/benefit ratio. Topiramate, valproate, calcium channel blockers, and angiotensin pathway inhibitors should be avoided.
	OnabotulinumtoxinA is safe in pregnant women.

Lifestyle modification and education

Education alone, including awareness of triggers, is beneficial for migraine in general (35). Lifestyle recommendations in pregnancy are largely extrapolated from studies outside pregnancy, and include stress management, healthy diet and hydration, limited caffeine intake, good sleep hygiene, and physical exercise. Physical exercise is generally recommended during pregnancy (36). However, there are no studies directly proving that physical exercise may benefit migraine in pregnancy. Outside pregnancy, physical exercise has low-quality evidence for reducing migraine intensity and duration (37). Therefore, despite the uncertainty regarding its direct benefits for migraine, physical exercise should still be recommended to pregnant women with migraine for its overall health benefits. Given the restrictions on medication use during pregnancy and the limited evidence supporting alternative treatments, physical activity should be encouraged, while also assessing whether it provides migraine relief on an individual basis.

Complementary and integrative therapies

Table 2 lists complementary and integrative approaches to migraine. In a 2024 review by the Agency for Healthcare Research and Quality (https://www.ahrq.gov), relaxation therapy, cognitive behavioral therapy, and mindfulness-based interventions (some in combination with other interventions) were suggested to reduce migraine attack frequency, albeit with a low quality of evidence (38). This finding was confirmed by a systematic review and meta-analysis pointing out that most of the available trials have a high risk of bias due to measurement bias and incomplete data (39). Mindfulness has several potential impacts on migraine, including increasing self-efficacy and altering pain perception (40), and is widely accessible via digital methods such as apps. Acceptance and commitment therapy integrates cognitive behavioral therapy and mindfulness concepts to increase psychological flexibility and values-based living and has been shown to reduce migraine disability (41). Among other integrative approaches, yoga has low-quality evidence for reducing migraine attack frequency and intensity (42), and a meta-analysis found low-grade evidence that yoga increases the odds of normal vaginal birth, in addition to improving maternal anxiety, depression, and stress (43). Acupuncture is safe and effective for migraine prevention in the overall population (44) and is likely safe in pregnancy, although its effectiveness in pregnant women with migraine is still questioned (45,46); there is very low-quality evidence from an observational retrospective study suggesting that acupuncture in pregnancy may improve migraine attack frequency and severity as well as nausea and vomiting (47).

Table 2.

Non-pharmacological treatments for women with migraine during pregnancy.

Lifestyle

o Healthy habits (e.g., avoidance of tobacco, alcohol, excessive caffeine intake) (48)

o Regular nutrition (avoid skipped meals) (49)

o Routine exercise including strength training and aerobic activity as tolerated (50)

o Sleep hygiene, including regular sleep time, and management of insomnia if present

o Maintenance of healthy weight for pregnancy (51)

o Personalized stress management interventions (21,52)

o Trigger and prodromal awareness (e.g., work accommodations, avoid excessive noise, odors) (53)

Behavioral, Complementary, and Integrative (39,54)

o Acupuncture (45)

o Biofeedback (may be combined with relaxation and physical therapy) (55,56)

o Cognitive behavioral therapy

§ Acceptance and commitment therapy (57)

o Mindfulness/meditation

o Relaxation training

o Yoga (37,42)

Notably, none of the abovementioned integrative treatments has been specifically tested in pregnant women with clinical trials; therefore, there is insufficient direct evidence to recommend these treatments in pregnancy (58). Nevertheless, given the scarcity of alternative treatment options and the safety of these interventions, their use in pregnant women appears justified.

Oral conventional migraine treatments

Table 3 provides detailed information on conventional migraine medications during pregnancy.

- For acute migraine management during pregnancy, acetaminophen (paracetamol) is widely regarded as the first-choice medication due to its favorable safety profile (23,59), even if it crosses the placenta and some evidence suggests potential adverse effects on fetal neurodevelopment (60,61).

- Caffeine, which is combined with acetaminophen in some formulations to increase pain relief, is associated with possible risks for fetal neurodevelopment if taken during pregnancy (62); however, international recommendations state that caffeine single intakes up to 200 mg (63,64) or daily caffeine doses of 3 mg/kg of body weight (65) are safe during pregnancy.

- When additional options are required, non-steroidal anti-inflammatory drugs (NSAIDs) can be used during the second trimester only, as their use during the first trimester might be associated with miscarriage and congenital malformations while their use can be associated with fetal renal insufficiency after 24 weeks and premature closure of ductus arteriosus after 35 weeks of pregnancy (23).

- Metoclopramide may be considered for nausea and vomiting (23,59).

- Ondansetron may also be considered for nausea (30).

- Ergot derivatives should not be used because of teratogenicity (66).

- Opioids, although not proven effective for migraine, might still be used in emergency settings in women with pregnancy (67).

- The use of steroids can be considered only occasionally in women that do not respond to other treatments, avoiding long-term use that can be associated with congenital anomalies, fetal adrenal suppression, or stillbirth (68).

- Sumatriptan is the only migraine-specific medication that has some pregnancy-related safety data (23,69). The available human data, although underpowered, do not suggest an increased risk of birth defects with sumatriptan use; however, given the evidence of developmental toxicity in animal studies and the potential risk for miscarriage associated with the use of triptans as a whole (9), it can be considered as a third-line treatment after acetaminophen – throughout pregnancy – and NSAIDs – during the second trimester (23).

- When migraine prevention is needed, beta blockers, including propranolol and metoprolol, are safe during pregnancy (24,28,29), although tapering or discontinuation two to three days before delivery is advisable to prevent fetal bradycardia and hypoglycemia (24,70).

- A potential alternative is amitriptyline as the teratogenicity of tricyclic antidepressants has no clear proof (24).

- Referring to anti-seizure medications, valproate exposure can be associated with fetal malformations, cognitive deficits, and autism (71), while topiramate exposure can be associated with neurodevelopmental issues (72).

- ACE inhibitors and angiotensin receptor blocker can also be teratogenic (73), especially during the second and third trimester (24).

Calcitonin gene-related peptide pathway inhibitors

Calcitonin gene-related peptide (CGRP) is the main therapeutic target for the most recently marketed acute and preventive treatments specific for migraine. Those treatments, including monoclonal antibodies (CGRP-mAbs) for prevention (eptinezumab, erenumab, fremanezumab, and galcanezumab) and gepants for either acute attacks (rimegepant, ubrogepant, and zavegepant) or prevention (atogepant and rimegepant), showed good efficacy and excellent safety in the general migraine population and represent one of the leading therapeutic options for individuals with migraine.

Table 3.

Use of conventional oral treatments for the treatment of the acute migraine attack or for migraine prevention during pregnancy. 23, 30, 59, 69

Medication	Dose	Evidence	Considerations	Recommendations for prescription in women of childbearing age or planning pregnancy	Recommendations for prescription during pregnancy
Acute treatment
Acetaminophen (paracetamol) (23,30,59,69)	500–1000 mg for each dose	In normal doses (<4000 mg daily), no increased risk for adverse maternal or fetal outcomes.	Limited effectiveness.	No special concerns.	Represents first line treatment.
		In high doses, increased risk for fetal death or spontaneous abortion.			Can be used across all pregnancy.
		No teratogenic effect reported.			Can be used across all pregnancy.
NSAIDs (ibuprofen, naproxen) (23,30,59,69)^cv	Ibuprofen: 200–600 mg for each dose.	Use after 30 weeks gestation associated with increased risk of premature closure of ductus arteriosus.	Ibuprofen preferred to naproxen due to shorter half-life.	Stop when pregnancy is detected.	Unsafe during the first and third trimester of pregnancy.
	Naproxen: 550 mg for each dose	Use after 20 weeks of gestation can be associated with fetal renal dysfunction.
	Naproxen: 550 mg for each dose	Use during the first trimester associated with risk of miscarriage.
Metoclopramide (23,30,69)	10 mg per each syringe	Animal studies have revealed no evidence of harm to the fetus. Human observational studies suggest no association with congenital defects.	Can be added for nausea and vomiting.	No special concerns.	Can be used if needed.
Metoclopramide (23,30,69)	10 mg per each syringe		Can be added for nausea and vomiting.	No special concerns.	Check neonates for extrapyramidal signs.
Triptans (sumatriptan) (23,30,59,69)	50–100 mg (oral; 6 mg (subcutaneous)	All available data refer to sumatriptan.		Stop when pregnancy is detected.	Can be used in highly selected cases.
		Animal studies have shown increased risk of fetal damage.			Sumatriptan is the only triptan with enough data.
		Human studies have not shown increased risk for congenital defects.			Sumatriptan is the only triptan with enough data.
Ondansetron (30)	8 mg per dose	Animal studies have not shown increased risk of fetal damage.	Can be added for nausea and vomiting.	No special concerns.	Can be used if needed.
Ondansetron (30)	8 mg per dose	Limited human studies have not shown increased risk of congenital defects.	Can be added for nausea and vomiting.	No special concerns.	Can be used if needed.
Preventive treatment
Beta blockers (propranolol, metoprolol) (24,30,59)	Propranolol: 80–160 mg daily Metoprolol: 100–200 mg daily	Beta-blockers can lead to decreased placental perfusion, fetal and neonatal bradycardia and hypoglycemia, intrauterine growth restriction. Not reported to be associated with congenital defects or adverse maternal outcomes.	The best oral option compared to others in terms of safety.	No special concerns.	Can be used throughout pregnancy. To be discontinued at the end of the third trimester to avoid fetal and neonatal bradycardia and hypoglycemia.
Beta blockers (propranolol, metoprolol) (24,30,59)			The best oral option compared to others in terms of safety.	No special concerns.
Amitriptyline (24,30)	25–150 mg daily	The potential for harm to the human fetus or neonate exists, even though it does not lead to malformations.	The safest option after beta blockers.	No special concerns.	Can be used throughout pregnancy.
Topiramate, valproate (24,69)	Topiramate: 100 mg daily	Associated with neurodevelopmental disorders, neural tube defects and cleft palate. Topiramate can cause fetal harm and major congenital malformations.		To be avoided in women who can become pregnant.	To be avoided.
Topiramate, valproate (24,69)	Valproate: 20 mg / kg body weight			To be avoided in women who can become pregnant.	To be avoided.
ACE-inhibitors (lisinopril) and angiotensin receptor blockers (candesartan) (24,69)	Lisinopril: 10 mg daily	Risk of miscarriages, renal and pulmonary malformation, and oligohydramnios.		To be avoided in pregnant women. Contraception should be advised in women who can become pregnant.	To be avoided.
	Candesartan: 8–32 mg daily				To be avoided.

In humans, CGRP plays a critical role in vascular regulation, placental development, and decidualization. Its levels naturally rise during pregnancy, peaking in gestation and decreasing postpartum to nonpregnant levels (74). Animal evidence shows that during pregnancy systemic vascular resistance drops because of increased levels of CGRP and by increased sensitivity to CGRP, both driven by sex steroid-induced mechanisms and upregulation of CGRP receptors (75). The heightened sensitivity of the uterine artery to CGRP, along with adrenomedullin and adrenomedullin-2, involves interactions with nitric oxide and endothelium-derived factors. This regulation maintains low vascular resistance in the fetoplacental circulation, essential for normal pregnancy outcomes. Reduced CGRP activity is linked to hypertensive disorders of pregnancy like pre-eclampsia, characterized by impaired vascular relaxation and increased resistance (Figure 3) (76). Placental vessels in pre-eclamptic pregnancies exhibit decreased CGRP receptor expression and reduced relaxation to CGRP, suggesting compromised CGRP-dependent vascular modulation. In pregnant rats, CGRP receptor blockade increases uterine contractility, indicating a role in uterine quiescence and preterm labor prevention (75); near-term infusion of the CGRP receptor antagonist CGRP₈₋₃₇ reduced offspring weight and increased mortality, highlighting the importance of CGRP in fetal survival and vascular adaptation (77). Preclinical studies in cynomolgus monkeys using erenumab did not demonstrate any adverse effects on pregnancy, fetal development, or postnatal growth at clinical doses (78). The maternal and developmental “no-observed-effect level” was the highest dose tested, with a 17-fold safety margin compared to clinical exposure (78), supporting the absence of significant safety concerns to date. However, placental transfer was observed, with measurable serum levels in infants up to three months postpartum. CGRP-mAbs can cross the placenta, and it is likely to occur during the second half of pregnancy. In fact, IgG antibodies are known to cross the placenta via the neonatal Fc receptor in syncytiotrophoblast cells, which are present after 20–22 weeks of pregnancy (79). Conversely, data on placental crossing by gepants are currently lacking.

Figure 3.

The role of the calcitonin gene related peptide pathway in the fetoplacental circulation during physiological pregnancy (orange) and in pre-eclampsia (blue).

Current human evidence on potential risks to maternal or fetal/neonatal health from exposure to CGRP-mAbs and gepants during pregnancy remains limited. The information we have so far originates from case reports (80,81) and pharmacovigilance studies based on spontaneous safety reports (Table 4) (82 –84), as pregnant women were excluded from randomized controlled trials. Case reports on women exposed to CGRP-mAbs during pregnancy have not identified significant adverse events directly attributable to the drugs (80,81). A 2024 pharmacovigilance study analyzing VigiBase data included 467 safety reports on CGRP-mAbs or gepants, with 86% of exposures occurring during pregnancy. Comparisons with triptan safety reports revealed no disproportionate reporting of pregnancy-related or fetal/neonatal outcomes (84). Ongoing pregnancy registries for ubrogepant (85), rimegepant, and atogepant (86) will provide valuable data on those drugs. While findings on CGRP-mAbs are somewhat reassuring, they are constrained by significant limitations, including the possibility of reporting bias of adverse outcomes, the lack of precise exposure timelines and clinical details in spontaneous safety reports, and challenges in distinguishing adverse events related to treatments from those unrelated. It is also worth mentioning that potential effects such as changes in maternal blood pressure (82,83) and potential risk of maternal adverse outcomes should be carefully considered given the critical role of CGRP in regulating uteroplacental blood flow (87).

Table 4.

Use of treatments targeting the calcitonin gene-related peptide (CGRP) pathway in women of childbearing age, women planning pregnancy and during pregnancy.

Treatment	Half-life	Relevant clinical data related to pregnancy	Recommendations for women of childbearing age and in those planning pregnancy	Recommendations during pregnancy
Monoclonal antibodies acting on the CGRP pathway
Eptinezumab	≈ 27 days	VigiBase safety reports (82,84) (erenumab n = 147, galcanezumab n = 185, fremanezumab n = 54) key adverse events outcome: spontaneous abortion (n = 72), induced abortion (n = 1), fetal death/stillbirth (n = 2), preterm birth (n = 4), jaundice (n = 2), congenital anomalies (n = 7), genetic abnormalities (n = 1), fetal growth restriction (n = 3).	Contraception is recommended. Treatment should be discontinued at least 5 months prior to conception.	Avoid prescription in pregnant women. Discontinue treatment immediately upon pregnancy confirmation.
Erenumab	≈28 days	One case of exposure to 70 mg erenumab monthly regime in the first 2 weeks of pregnancy (88) and one during all pregnancy (89) with no mother or fetal/neonatal abnormalities, except from baby jaundice.
Fremanezumab	≈31 days	Three case reports (66) of erenumab 70 mg exposure with two full-term deliveries without abnormalities, and one case of spontaneous abortion (confounder: gestational trophoblastic neoplasia).
Galcanezumab	≈27 days	Six case reports (67) with one case exposure to erenumab 140 mg with cardiorespiratory arrest at delivery (confounder: dystocia); and one case exposure to galcanezumab 120 mg, with deferred abortion during first trimester (confounder: 39-year-old woman).
Gepants
Atogepant	≈11 h	VigiBase safety reports (68,70) with gepants (rimegepant n = 61, atogepant n = 10, ubrogepant n = 5). Key adverse events outcome: spontaneous abortion (n = 2), induced abortion (n = 1), Fallot's tetralogy (n = 1).	Contraception is recommended. Treatment should be discontinued at least 3 days – i.e., 5 half-lives – prior to conception.	Avoid prescription in pregnant women. Discontinue treatment to be immediately discontinued upon pregnancy confirmation.
Rimegepant	6.55 h (zavegepant)
Ubrogepant
Zavegepant

To summarize, CGRP-mAbs and gepants should best be avoided during pregnancy due to insufficient safety data. Additionally, it is important that cases of unintended exposure are reported in pregnancy registries, as this will help improve our understanding of the safety profiles of these treatments.

Nutraceuticals

Nutraceuticals, derived from food or plants, are potential options for migraine treatment and include plant-based therapies, vitamins, minerals, and supplements (90). Some of these substances have been evaluated in small, generally low-quality, clinical trials for migraine prevention that did not include pregnant women. Nevertheless, given the limited alternative treatment options and the potential risks associated with pharmacological therapies during pregnancy, the use of some nutraceuticals may be considered. The placebo effect associated with these agents might also offer additional benefits for pregnant women. However, it is important to exercise caution, as the high doses of nutrients found in supplements – despite being derived from natural sources – might pose unforeseen risks.

Regarding specific nutraceuticals, magnesium is well-studied for migraine prevention and can be considered effective and safe, as reported in clinical trials whose data were pooled in a systematic review (91). It can safely be used in low doses (365 mg daily or less) throughout pregnancy, although high-quality data are scarce (92); it is also an adjunctive treatment for preeclampsia (90), although an associated risk for neonatal hypotonia should be considered (93). Riboflavin (94) and coenzyme-Q10 (95) are other possible nutraceutical options for migraine prevention with limited data available in pregnant women; only one observational study suggested the safety of riboflavin during pregnancy (96), while safety data for coenzyme-Q10 are not available. Melatonin has good safety and efficacy data for migraine prevention (97) while its safety in pregnancy relies on limited and heterogeneous observational data (98). Ginger is probably effective as an acute, but not as a preventive treatment for migraine, as a randomized controlled trial showed that ginger had similar efficacy and better safety compared with sumatriptan (99), while another trial did not show differences between ginger and placebo for migraine prevention (100). As some nutraceuticals such as vitamin D can confer a benefit to both mother and fetus, they might be considered for use in migraine even if supporting evidence for migraine prevention is of low quality (101). Feverfew and butterbur have controversial data for migraine prevention and are also unsafe in pregnancy (90).

OnabotulinumtoxinA

OnabotulinumtoxinA (BTX-A) is a neurotoxin approved for the treatment of chronic migraine plus other indications. Pharmacologically, it is a large 900 kDa complex consisting of a 150 kDa neurotoxin and auxiliary proteins (102,103), administered intramuscularly at predefined sites in the head and neck according to a standardized protocol of injection (104). The toxin disrupts the ability of nerve terminals to release neurotransmitters through the N-ethylmaleimide-sensitive fusion-attachment protein receptor complex and to express new receptor channels in the synaptic membrane, processes essential for pain signaling (102,103). This highly localized action, combined with rapid receptor binding at the injection site and relatively low dosage, minimizes systemic exposure under standard therapeutic conditions.

Preclinical studies demonstrate that BTX-A does not distribute systemically in significant amounts after injection, with undetectable levels in systemic circulation (105). These findings suggest the toxin remains mainly localized to the injection site, even in altered physiological states. However, pregnancy-related changes, including increased cardiac output, expanded blood volume, and altered vascular permeability, could theoretically affect the localized containment of BTX-A. During pregnancy, the pharmacokinetics of BTX-A are influenced by its size and structure, which most likely prevents placental transfer. This is supported by several case reports, where even after systemic poisoning of the mother, the fetus remained unaffected (106).

Clinical data on the use of BTX-A in pregnancy are limited. In a 9-year prospective real-world study, 45 women with chronic migraine were treated with BTX-A; 13 were exposed within three months prior to conception but stopped treatment upon pregnancy confirmation, while 32 continued throughout pregnancy. One miscarriage was reported without any other apparent cause, while the remaining pregnancies resulted in full-term deliveries without abnormalities (107). A subsequent update of the same prospective study including 126 women confirmed the safety of BTX-A during pregnancy (108). A 29-year retrospective analysis of BTX-A safety data from the Allergan Global Safety Database assessed outcomes from 397 pregnancies with known results; notably, only 30.3% of women included in the analysis received BTX-A for chronic migraine, while the other women had other indications for BTX-A treatment. Most BTX-A treatments occurred during the preconception period or first trimester (94.6%), with the majority receiving doses under 200 U (83.5%). The study found that the prevalence of overall fetal defects in women treated with BTX-A was comparable to rates observed in non-treated women (109). Additionally, two case reports of women requesting BTX-A treatment despite knowingly pregnant showed no significant impact of the treatment on pregnancy outcomes (110,111).

To summarize, BTX-A may be considered, given its minimal systemic absorption, in pregnant women with chronic migraine and significant disease burden if other options – such as beta-blockers, low-dose amitriptyline, or non-pharmacological strategies – failed to provide adequate relief. The decision to proceed with treatment should involve a thorough discussion with the patient, carefully weighing potential risks and benefits. Informed consent is essential to ensure shared decision-making and to support the woman in making the best choice for her health and pregnancy.

Peripheral nerve blocks

Peripheral nerve blocks are commonly used for acute and preventive treatment of primary headache disorders, such as migraine and cluster headache, targeting nerves like the greater occipital nerve, lesser occipital nerve, branches of the trigeminal nerve, and the sphenopalatine ganglion; however, greater occipital nerve block is by far the most employed one (112). Peripheral nerve blocks typically involve local anesthetics (e.g., lidocaine, bupivacaine) and sometimes corticosteroids (e.g., betamethasone, triamcinolone), although corticosteroids may not provide additional benefits to migraine compared with anesthetics alone (113).

Systemic absorption of drugs used for peripheral nerve blocks is generally low but influenced by dose, vascularity of the injection site, and drug properties (114,115). During pregnancy, increased plasma volume and cardiac output enhance drug distribution, while elevated tissue vascularity may increase systemic absorption and toxicity risks. Reduced plasma protein levels can also increase free drug concentrations of anesthetics while hepatic metabolism of amide anesthetics may be altered due to changes in liver enzyme activity (115). Corticosteroids undergo altered pharmacokinetics in pregnancy, with increased corticosteroid-binding globulin reducing free active drug levels. Corticosteroids cross the placenta and might cause premature fetal lung maturation.

Clinical evidence on the use of peripheral nerve blocks in pregnancy is limited. A small retrospective study on 27 peripheral nerve blocks performed in 13 pregnant women demonstrated that blocking nerves such as the occipital, auriculotemporal, supraorbital, and supratrochlear with 1-2% lidocaine or 0.5% bupivacaine effectively reduced pain intensity compared with before the injections; adverse pregnancy outcomes included two preterm deliveries and one spontaneous abortion at 17 weeks of gestation (116). Additionally, a single case report described successful treatment of a refractory migraine attack in a woman at 36 weeks of gestation using a sphenopalatine ganglion block with 4% lidocaine, resulting in a significant reduction in pain intensity compared with before the injection (117).

To summarize, although evidence remains limited, peripheral nerve blocks may be a safe and effective option for managing migraine in pregnant women. Given the uncertainty surrounding the benefits of adding steroids to the preparation and potential concerns regarding systemic absorption, the use of anesthetics alone is preferable during pregnancy. Among local anesthetics, lidocaine is safer than other drugs of the class due to its more limited effects on the fetus (118).

Non-invasive neuromodulation

Non-invasive neuromodulation uses external devices to stimulate specific regions of the central or peripheral nervous system associated with migraine pathophysiology. These devices deliver stimuli through the skin to modulate the activity of cortical regions or peripheral nerves, with the advantage of avoiding medication side effects and drug interactions (119).

In the following paragraph, we will focus on portable neuromodulation devices, including single-pulse transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), and external trigeminal nerve stimulation (eTNS). Repetitive TMS and transcranial direct current stimulation (tDCS) do not adopt portable devices. TMS creates a fluctuating magnetic field capable of inducing an electrical current to the underlying cerebral cortex, which in turn has the effect of changing the firing pattern of neurons (120). Clinically, it has shown efficacy as an acute and a preventive option for migraine both with and without aura (121 –123). VNS and eTNS both work via the application of an electrical current to the vagus and supraorbital nerve respectively, which in turn can modulate trigeminal activation (124). A large trial of VNS for the acute treatment of migraine showed effectiveness over placebo (125), while a smaller trial of migraine prevention showed some efficacy of VNS only in the open-label phase (126). Referring to eTNS, the TEAM (127) and ACME (128) trials showed the superiority of active over sham stimulation on 2-h headache relief, while in the PREMICE (129) trial active eTNS decreased monthly migraine days compared with sham stimulation. Remote electrical neuromodulation (REN) is a novel device that activates an endogenous descending analgesic mechanism known as conditioned pain modulation, in which a sub–pain-threshold stimulation (delivered over the arm) inhibits cephalic pain (130). Similarly to TMS, randomized controlled trials showed that REN is effective and safe for both acute and preventive migraine treatment (130,131). So far, no guidelines are available for such treatments in migraine. Table 5 lists the main evidence for neuromodulation for migraine treatment and the data available for pregnant women with migraine.

Table 5.

Data on portable devices for non-invasive neuromodulation and on their use in pregnant women.

Device type	Main available studies and summary of evidence for migraine	Evidence of use in pregnancy
Single-pulse TMS (121 –123)	Post-marketing study, n = 263 subjects for acute and preventive use: significant reduction in monthly headache days.	n = 3 subjects using single pulse TMS during the second and third trimester of pregnancy (123)
	Post-marketing study, n = 164 episodic and chronic migraine, with and without aura, for acute and preventive use: 62% pain relief rates and significant reduction in monthly headache days.
	RCT, n = 164 acute use in migraine with aura: 39% vs 22% 2-h pain free rates in active vs. sham group
Vagus nerve stimulation (125,126)	RCT, n = 248 episodic migraine for acute use: nVNS superior to sham for pain freedom at 30’ and 60’ and pain relief at 120’	No published reports
Vagus nerve stimulation (125,126)	RCT, n = 59 for preventive use: significant reduction in headache days in open-label extension only	No published reports
External trigeminal stimulation (127 –129)	RCT, n = 109 for acute use: The verum group showed a 59% reduction in pain intensity at 1 h compared to 30% in the sham group (p < 0.0001).	No published reports
	RCT, n = 538 for acute use: Pain freedom at 2 h 25.5% in the verum group vs. 18.3% in the sham group (p = 0.043)
	RCT, n = 67 for preventive use: after 3 months of daily use, the verum group showed a significant reduction in monthly migraine days (6.94 to 4.88, p = 0.023), with a 38.1% responder rate compared to 12.1% in the sham group.
Remote electrical neuromodulation (130,131)	RCT, n = 252 episodic migraine for acute use: pain relief, pain-freedom and freedom from most bothersome symptom significantly higher in active group at 2 h	n = 59 subjects using REN during pregnancy and up to 3 months postpartum in one retrospective study (132)
Remote electrical neuromodulation (130,131)	RCT, n = 179 episodic and chronic migraine for prevention: Significant reduction in monthly migraine days at 12 weeks, monthly headache days and 50% responder rates

For the majority of neuromodulation devices, use during pregnancy has not been tested in trials; however, data from animal studies and anecdotal experience in conditions such as depression have not shown any adverse outcomes on fetal development (133,134). For example, clinical studies have reported on the use TMS during pregnancy on a total of 50 subjects and have reported no adverse outcomes (134). A literature review in migraine further concluded that single-pulse TMS applied to the occiput generates a magnetic field of <1 Gauss at around 46 cm from the coil, meaning that the magnetic field reaches part of the pregnant uterus (135). One post-marketing study analyzing the effect of TMS for migraine reported three women who used the device in the second trimester of pregnancy, with no adverse events (123). Importantly, a recent study retrospectively evaluated the safety of REN treatment for migraine during pregnancy and through three months postpartum in 140 women (59 exposed and 81 not exposed to REN). The primary endpoint was gestational age at delivery. Secondary endpoints were baby's birth weight, miscarriage rate, preterm birth rate, birth defect rate, stillbirth rate, rate of babies meeting developmental milestones three months postnatal, and emergency room visits. Results showed no differences in any safety outcome between the group of women who used REN at least three times during pregnancy and those who were not exposed (132). However, many of the secondary endpoints in this study represent inherently rare events, and therefore, potential significant associations with device use may have gone undetected due to the small sample size and the retrospective design.

In summary, when available, non-invasive neuromodulation devices offer an option for managing migraine in pregnant women, particularly TMS and REN, which can be used for both acute treatment and prevention. These devices provide a non-pharmacological alternative, minimizing potential risks to both the mother and the fetus. However, their use is often limited by availability, cost, and coverage, making access inconsistent. Additionally, many physicians have limited experience with these devices, which may further restrict their widespread adoption.

Migraine management during breastfeeding

The use of medications during breastfeeding requires careful consideration to balance the need for effective maternal migraine treatment with potential risks to the nursing infant. Untreated migraine can significantly impact a mother's well-being, causing pain, distress, and reduced functionality, which in turn affects her ability to care for her child.

While most medications have lower concentrations in breast milk than in maternal plasma, even minimal exposure may pose risks, particularly for preterm or medically fragile infants. Whenever possible, treatments with well-established safety profiles during breastfeeding should be prioritized. Adjusting the timing of drug administration, such as taking medication immediately after breastfeeding, can help minimize infant exposure.

Shared decision-making and thorough counselling are crucial when pharmacological treatment is necessary, ensuring that women can make informed choices about their health and breastfeeding. Table 6 summarizes the data on the safety and potential use of pharmacological treatments for migraine during breastfeeding.

Table 6.

Use of treatments for the acute and preventive treatment of migraine during breastfeeding.

Medication	Evidence	Considerations	Recommendation
Acute treatment
Acetaminophen (paracetamol) (23,30,136)	A small amount of acetaminophen passes into breast milk.	-	Can be used; to be considered as the first option.
Ibuprofen	Ibuprofen has a short half-life, appears in breast milk at very low levels, and is safe for infants.	-	Can be used.
NSAIDs other than ibuprofen (diclofenac, naproxen) (23,30,136)	Limited information indicates that diclofenac and naproxen have low levels in breast milk.	It is advisable to withhold breastfeeding for 8–12 h.	Can be used if necessary. NSAIDs with shorter half-life should be considered first.
	Naproxen has a longer half-life so should be used only if truly necessary.	It is advisable to withhold breastfeeding for 8–12 h.
Triptans (23,30,136)	Evidence on triptans is currently insufficient. Sumatriptan is best studied; it has low oral bioavailability and milk concentration. Eletriptan has a very low concentration in breast milk.	It is advisable to withhold breastfeeding for 8–12 h.	Sumatriptan and eletriptan can be used. Triptans with high bioavailability should be avoided.
Metoclopramide (23)	No association with negative effects in breastfed infants in mothers taking metoclopramide during breastfeeding. A case report of a 21-week-old boy who developed acute extrapyramidal syndrome 48 h after maternal exposure to metoclopramide 10 mg rectal suppository (137)	Metoclopramide can cause depression as a side effect. It should probably be avoided in postpartum women with a history of major depression and not used for prolonged periods in any mothers as the postpartum period is associated with high susceptibility to depression.	Use with caution; risk-benefit ratio should be weighed for both mothers and infants.
Gepants	Lack of evidence for their safety during breastfeeding. The drug level in breast milk is supposed to be low (138)	It is advisable to withhold breastfeeding for 8–12 h after drug intake considering the half-life of drugs.	An alternate drug may be preferred until more data become available, especially while nursing a newborn or preterm infant.
Preventive treatment
Beta blockers (propranolol, metoprolol) (24,136)	Pass into breast milk at very low levels – especially metoprolol. Reversible bradycardia and hypoglycemia have been reported in breastfed infants in a prospective real-life survey (139)	-	Can be considered with monitoring of side effects.
Amitriptyline (24,30,136)	Passes in low levels into milk. Generally safe and not associated with adverse effects on infant growth and development.	May be sedative for the infant.	Can be considered with monitoring of side effects.
Candesartan (24,136)	Very low levels in breast milk.	-	Can be considered with monitoring of side effects.
Lisinopril (24,136)	Not enough evidence is available. Low levels in breast milk.	-	Can be considered with monitoring of side effects.
Topiramate (24,30,136)	Sedation and diarrhea are reported. No long-term adverse effects on growth and development have been seen from limited data.	Monitoring for diarrhea, drowsiness and developmental milestones is recommended.	To be used with caution. Potential side effects should be monitored.
Valproate (24,30,136)	Low levels in breast milk are reported. No definite adverse reactions to valproic acid in breastfed infants have been reported.	Breastfed infants are at risk for valproic acid-induced hepatotoxicity, thrombocytopenia, and infant baldness. Infants should be monitored for jaundice, signs of liver damage, and bleeding.	To be used with caution. Potential side effects should be monitored.
OnabotulinumtoxinA (136)	Low levels in breast milk. No risk for infant botulism has been reported. No data available for doses used for migraine prevention.	-	Can be used.
Peripheral nerve blocks (136)	Data available on lidocaine. No adverse effects reported on infants.		Lidocaine can be used.
Monoclonal antibodies targeting the CGRP pathway (136)	No data available. Levels in breast milk are probably low due to high molecular weight of the drugs. Even if present in milk, they are unlikely to be absorbed by infants.	-	Alternate drugs may be preferred until more data become available.

In cases where migraine is severe and requires a medication that is contraindicated during breastfeeding, discontinuation of breastfeeding should be considered to prioritize maternal health while ensuring infant safety. Ultimately, effective migraine management not only benefits the mother, but also enhances her ability to care for her child.

Treating migraine in women of childbearing age or who are planning a pregnancy

Migraine predominantly affects women of childbearing age, requiring physicians to carefully consider the possibility of both unplanned and planned pregnancies when managing treatment.

When prescribing migraine treatments, it is crucial to consider the potential for pregnancy, especially when using medications known to be potentially harmful during gestation or those with insufficient safety data (Table 3). For this reason, contraception should be recommended especially when prescribing certain migraine preventive agents to women of reproductive age, ensuring that any potential risks are minimized. Additionally, women should be informed that if they become unexpectedly pregnant while on a migraine preventive treatment, they should immediately discontinue the medication and promptly consult their physician to discuss the next steps. Open communication and proactive planning are essential to balancing effective migraine management with maternal and fetal safety.

Pregnancy planning is another important aspect to address when considering treatment options for women of childbearing age. Women requiring preventive treatment who wish to conceive should be reassured that, in most cases, migraine symptoms improve during pregnancy. However, conception—whether natural or through assisted reproductive technology—can take months, during which the burden of migraine may remain high, particularly in those with chronic or high-frequency episodic migraine. In such cases, optimizing acute treatment and discussing preventive strategies is essential. Notably, women with migraine with aura referred to assisted reproductive technology should be warned against the risks of migraine worsening associated with those procedures (140).

Ideally, women planning a pregnancy should be free from preventive drugs for many months before pregnancy; however, this is rarely feasible. Those women should be considered as potentially getting pregnant during their treatment. Therefore, non-pharmacological options such as lifestyle interventions or neuromodulation should be prioritized for prevention in women planning pregnancy. When pharmacological prevention is necessary, agents with a shorter half-life and a more favorable safety profile in pregnancy – including beta blockers and amitriptyline – should be preferred whenever possible. Other oral agents, including anti-seizure medications and inhibitors of the angiotensin converting enzyme pathway, should best be avoided because of the risk for the fetus since the first trimester (Table 3), Use of nerve blocks and BTX-A might represent good options. Careful pregnancy planning is particularly important for women receiving CGRP-mAbs. These treatments should be discontinued at least five months before conception to ensure safety. Gepants have a shorter half-life than CGRP-mAbs, with plasmatic levels declining after a few days; for this reason, those drugs might be more suitable than CGRP-mAbs in women who are planning a pregnancy and need a migraine-specific preventive treatment.

Conclusions

Migraine management in women during pregnancy, breastfeeding, and pregnancy planning requires a careful balance between maternal well-being and fetal or infant safety. Non-pharmacological interventions should be prioritized due to their favorable safety profiles. Pharmacological treatments, reserved for severe cases, must be selected with caution, favoring agents with safety records, such as paracetamol for acute treatment and beta-blockers for prevention.

The safety data on newer migraine-specific treatments, particularly CGRP pathway inhibitors, remain limited, necessitating extreme caution when considering these agents during pregnancy and breastfeeding. Women planning pregnancy require an individualized treatment approach that balances disease control with the timing of conception. As most cases of migraine during pregnancy are managed in primary care (141), better education of primary care physicians and women's health providers is advisable (142). In most complex cases, a multidisciplinary approach involving neurologists, obstetricians, and pediatricians is important to ensure safe and effective management. Public education campaigns dedicated to young women might increase awareness on the management of migraine during pregnancy, pregnancy planning, and breastfeeding. Some countries already host websites providing verified information on those topics.

The increased risk of pregnancy-related complications, particularly in women with migraine with aura, highlights the importance of close monitoring throughout pregnancy. Further research, including registry-based studies, is essential to optimize management and improve outcomes for both mothers and their children. In the near future, innovative approaches leveraging advanced technologies may enhance our understanding of the benefits and potential risks of migraine-specific drugs during pregnancy.

Public Health Relevance

Migraine is associated with adverse events during pregnancy such as preeclampsia, stroke, and preterm birth.

Most acute and preventive migraine treatments are contraindicated or require caution for their use during pregnancy. Non-pharmacological treatments are first-line options during pregnancy, while pharmacological treatments should be used cautiously based on known safety profiles.

Drugs targeting the calcitonin gene-related peptide (CGRP) lack sufficient safety data in pregnancy and breastfeeding, necessitating careful planning for women of reproductive age.

Footnotes

Author contributions

SS conceived the review, drafted the manuscript, revised it for intellectual content, and supervised the process. All other Authors participated in manuscript drafting and revising it for intellectual content.

Data availability statement

The data used for this article may be obtained from the authors with a reasonable request.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Raffaele Ornello

Francesca Puledda

Claire H. Sandoe

Luigi Francesco Iannone

Mi Ji Lee

Faraidoon Haghdoost

Patricia Pozo-Rosich

Teshamae S. Monteith

Cristina Tassorelli

Gisela M. Terwindt

Simona Sacco

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Migraine management during pregnancy,breastfeeding and in women planning pregnancy

Abstract

Keywords

Introduction

Search strategy

Migraine and the risk of pregnancy-related adverse events

Migraine management in pregnant women

Lifestyle modification and education

Complementary and integrative therapies

Oral conventional migraine treatments

Calcitonin gene-related peptide pathway inhibitors

Nutraceuticals

OnabotulinumtoxinA

Peripheral nerve blocks

Non-invasive neuromodulation

Migraine management during breastfeeding

Treating migraine in women of childbearing age or who are planning a pregnancy

Conclusions

Public Health Relevance

Footnotes

Author contributions

Data availability statement

Declaration of conflicting interests

Funding

ORCID iDs

References