Migraine in pregnancy

Migraine is the headache disorder that most commonly complicates pregnancy. Migraine often, but not always, improves during pregnancy. Postdelivery migraine flares are common, and it can be difficult to distinguish these from dangerous causes of postpartum headache. Many pregnant or lactating migraineurs require intermittent use of medication for treatment of individual headache attacks, and some also need preventive treatment aimed at decreasing the number or severity of headache attacks. In general, medication use should be limited and nonpharmacologic approaches are preferred. Appropriate treatment choices also vary with the stage of pregnancy, and may differ for pregnancy and lactation. Risk rating systems are available that help guide decisions. Women with migraine have an increased risk for several serious pregnancy complications, but there is little convincing evidence of an increase in neonatal complications. Migraine is not a contraindication to breast-feeding.