Acute Migraine Therapy During Pregnancy: A Primer

Anna Pace, MD


February 15, 2019

Editorial Collaboration

Medscape &

Nonpharmacologic therapies should be encouraged and utilized liberally, especially during pregnancy. Occipital, supraorbital, and auriculotemporal peripheral nerve blocks with lidocaine are a good treatment, both acutely and preventively, for migraine during pregnancy. Given that their primary effect is locally in the pericranial regions, they have minimal systemic effects and are presumed safe in pregnancy. Lidocaine (FDA Category B) is preferred to bupivacaine (FDA Category C), but both have been used in dentistry, anesthesiology, and obstetrics for pain relief in pregnant patients.

Relaxation techniques and warm compresses are useful for patients who have prominent neck tension or tenderness. Neuromodulatory devices, such as noninvasive supraorbital nerve stimulation, transcutaneous magnetic stimulation, or the noninvasive cutaneous vagal nerve stimulator, have been approved for the acute and preventive treatment of migraine in the United States, and seem safe for the pregnant population, though there have been no randomized controlled studies of the use of these devices in pregnant patients.

One should take a multidisciplinary approach to the treatment of headache in pregnancy, incorporating nonpharmacologic treatments wherever possible, and encourage good biobehaviors such as adequate hydration, proper sleep hygiene, minimizing caffeine, getting adequate nutrition and not missing meals, and participating in frequent cardiovascular exercise.


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