Review of and Treatment Considerations for Migraine in Pregnancy and Postpartum

This article seeks to provide updated guidance on migraine management during pregnancy and postpartum along with addressing the influence of migraine on pregnancy and the impact of pregnancy on migraine.

Migraine is a disabling neurologic disorder predominantly impacting females and especially during reproductive years. While migraine without aura can improve during pregnancy especially in the second and third trimesters, many women will experience an episode of migraine at some point during pregnancy. Data regarding the safety of migraine treatments in pregnancy remains limited. In addition, with the advent of many new migraine treatments over the past few years including neuromodulatory devices, calcitonin gene related peptide antagonists among other treatments, it is critical to understand the current state of knowledge regarding their safety in pregnancy.

Nonpharmacologic treatments including mind body medicine and body-based practices should serve as first line migraine treatments given their favorable pregnancy safety profile. Neuromodulatory devices can be considered as expert consensus suggests these are likely safe in pregnancy. CGRP antagonists including erenumab, fremanezumab, galcanezumab, eptinezumab, rimegepant, ubrogepant, atogepant, and zavegepant should be avoided in pregnancy given their potential to increase the risk for adverse pregnancy outcomes and impact fetal development.