Managing Migraine During Pregnancy and Lactation

  • Rebecca Erwin Wells
  • Dana P. Turner
  • Michelle Lee
  • Laura Bishop
  • Lauren Strauss
Headache (R. B. Halker, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Headache


While over half of women with migraine report improvement during pregnancy, having a history of migraine may increase the chance of negative health outcomes. The state of pregnancy increases the risk of several dangerous secondary headache disorders, especially those associated with hypertensive disorders of pregnancy, and providers need to know the red flags to diagnose and treat emergently. Non-pharmacological migraine treatments can be instituted in advance of pregnancy as many are considered the safest options during pregnancy, but understanding the safety of medications and dietary supplements ensures appropriate care for the refractory migraine patient. New controversy exists over the safety of several historically routine and safe migraine treatment options in pregnancy, such as magnesium, acetaminophen, ondansetron, and butalbital. While it is not clear if breastfeeding decreases the postpartum recurrence of migraine, understanding safe treatment options during lactation can allow women to continue breastfeeding while achieving migraine relief.


Migraine Pregnancy Lactation Headache 


Compliance with Ethical Standards

Conflict of Interest

Rebecca Erwin Wells, Dana P. Turner, Michelle Lee, Laura Bishop, and Lauren Strauss declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


  1. 1.
    Kvisvik EV, Stovner LJ, Helde G, Bovim G, Linde M. Headache and migraine during pregnancy and puerperium: the MIGRA-study. J Headache Pain. 2011;12(4):443–51.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Sances G, Granella F, Nappi RE, Fignon A, Ghiotto N, Polatti F, et al. Course of migraine during pregnancy and postpartum: a prospective study. Cephalalgia. 2003;23(3):197–205.PubMedCrossRefGoogle Scholar
  3. 3.
    Marcus DA. Headache in pregnancy. Curr Pain Headache Rep. 2003;7(4):288–96.PubMedCrossRefGoogle Scholar
  4. 4.
    Marcus DA. Managing headache during pregnancy and lactation. Expert Rev Neurother. 2008;8(3):385–95.PubMedCrossRefGoogle Scholar
  5. 5.
    Silberstein S. Sex hormones & headache. Philadelphia, PA: Current Medicine Group LLC, a division of Springer Science + Business Media LLC; 2007.Google Scholar
  6. 6.
    Granella F, Sances G, Pucci E, Nappi RE, Ghiotto N, Napp G. Migraine with aura and reproductive life events: a case control study. Cephalalgia. 2000;20(8):701–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Cupini LM, Matteis M, Troisi E, Calabresi P, Bernardi G, Silvestrini M. Sex-hormone-related events in migrainous females. A clinical comparative study between migraine with aura and migraine without aura. Cephalalgia. 1995;15(2):140–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Turner DP, Smitherman TA, Eisenach JC, Penzien DB, Houle TT. Predictors of headache before, during, and after pregnancy: a cohort study. Headache. 2012;52(3):348–62. This large longitudinal cohort study of pregnant women showed that those with a history of headache prior to pregnancy were at greater risk of experiencing headache during pregnancy. PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Frederick IO, Qiu C, Enquobahrie DA, Aurora SK, Peterlin BL, Gelaye B, et al. Lifetime prevalence and correlates of migraine among women in a pacific northwest pregnancy cohort study. Headache. 2014;54(4):675–85.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Chen HM, Chen SF, Chen YH, Lin HC. Increased risk of adverse pregnancy outcomes for women with migraines: a nationwide population-based study. Cephalalgia. 2010;30(4):433–8.PubMedGoogle Scholar
  11. 11.
    Marozio L, Facchinetti F, Allais G, Nappi RE, Enrietti M, Neri I, et al. Headache and adverse pregnancy outcomes: a prospective study. Eur J Obstet Gynecol Reprod Biol. 2012;161(2):140–3.PubMedCrossRefGoogle Scholar
  12. 12.
    Facchinetti F, Allais G, Nappi RE, D’Amico R, Marozio L, Bertozzi L, et al. Migraine is a risk factor for hypertensive disorders in pregnancy: a prospective cohort study. Cephalalgia. 2009;29(3):286–92.PubMedCrossRefGoogle Scholar
  13. 13.
    Czerwinski S, Gollero J, Qiu C, Sorensen TK, Williams MA. Migraine-asthma comorbidity and risk of hypertensive disorders of pregnancy. J pregnancy. 2012;2012:858097.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Adeney KL, Williams MA, Miller RS, Frederick IO, Sorensen TK, Luthy DA. Risk of preeclampsia in relation to maternal history of migraine headaches. J Matern Fetal Neonatal Med. 2005;18(3):167–72.PubMedCrossRefGoogle Scholar
  15. 15.
    Gelaye B, Larrabure-Torrealva GT, Qiu C, Luque-Fernandez MA, Peterlin BL, Sanchez SE, et al. Fasting lipid and lipoproteins concentrations in pregnant women with a history of migraine. Headache. 2015;55(5):646–57.PubMedCrossRefGoogle Scholar
  16. 16.
    Wabnitz A, Bushnell C. Migraine, cardiovascular disease, and stroke during pregnancy: systematic review of the literature. Cephalalgia. 2015;35(2):132–9. This systematic review shows that women with a history of migraine have an increased risk of gestational hypertension, preeclampsia, ischemic stroke, acute myocardial infarction, heart disease, and thromboembolic events during pregnancy. PubMedCrossRefGoogle Scholar
  17. 17.
    Qiu C, Frederick IO, Sorensen T, Aurora SK, Gelaye B, Enquobahrie DA, et al. Sleep disturbances among pregnant women with history of migraines: a cross-sectional study. Cephalalgia. 2015;35:1092.PubMedCrossRefGoogle Scholar
  18. 18.
    Orta OR, Gelaye B, Qiu C, Stoner L, Williams MA. Depression, anxiety and stress among pregnant migraineurs in a pacific-northwest cohort. J Affect Disord. 2014;172c:390–6.Google Scholar
  19. 19.
    David PS, Kling JM, Starling AJ. Migraine in pregnancy and lactation. Curr Neurol Neurosci Rep. 2014;14(4):439.PubMedCrossRefGoogle Scholar
  20. 20.
    Digre KB. Headaches during pregnancy. Clin Obstet Gynecol. 2013;56(2):317–29.PubMedCrossRefGoogle Scholar
  21. 21.
    Brandes JL. Migraine in women. Continuum (Minneapolis, Minn). 2012;18(4):835–52.Google Scholar
  22. 22.
    Martin SR, Foley MR. Approach to the pregnant patient with headache. Clin Obstet Gynecol. 2005;48(1):2–11.PubMedCrossRefGoogle Scholar
  23. 23.
    Robbins MS, Farmakidis C, Dayal AK, Lipton RB. Acute headache diagnosis in pregnant women: a hospital-based study. Neurology. 2015;85(12):1024–30. This retrospective review demonstrated that 35% of pregnant women presenting with an acute headache have a secondary headache disorder, suggesting the importance of neuroimaging and close monitoring in this population. PubMedCrossRefGoogle Scholar
  24. 24.
    ACOG Committee on Obstetric Practice. ACOG Committee Opinion. Number 299, September 2004 (replaces No. 158, September 1995). Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol. 2004;104(3):647–51.CrossRefGoogle Scholar
  25. 25.
    Schoen JC, Campbell RL, Sadosty AT. Headache in pregnancy: an approach to emergency department evaluation and management. West J Emerg Med. 2015;16(2):291–301.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Lee SY, Rhee CM, Leung AM, Braverman LE, Brent GA, Pearce EN. A review: Radiographic iodinated contrast media-induced thyroid dysfunction. J Clin Endocrinol Metab. 2015;100(2):376–83.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    MacGregor EA. Migraine in pregnancy and lactation. Neurol Sci. 2014;35 Suppl 1:61–4.PubMedCrossRefGoogle Scholar
  28. 28.
    Kesler A, Kupferminc M. Idiopathic intracranial hypertension and pregnancy. Clin Obstet Gynecol. 2013;56(2):389–96.PubMedCrossRefGoogle Scholar
  29. 29.
    Digre KB, Varner MW, Corbett JJ. Pseudotumor cerebri and pregnancy. Neurology. 1984;34(6):721–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Bateman BT, Olbrecht VA, Berman MF, Minehart RD, Schwamm LH, Leffert LR. Peripartum subarachnoid hemorrhage: nationwide data and institutional experience. Anesthesiology. 2012;116(2):324–33.PubMedCrossRefGoogle Scholar
  31. 31.
    Kasper EM, Hess PE, Silasi M, Lim KH, Gray J, Reddy H, et al. A pregnant female with a large intracranial mass: reviewing the evidence to obtain management guidelines for intracranial meningiomas during pregnancy. Surg Neurol Int. 2010;1:95.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Hayes AR, O’Sullivan AJ, Davies MA. A case of pituitary apoplexy in pregnancy. Endocrinol, Diabetes Metab Case Rep. 2014;2014:140043.Google Scholar
  33. 33.
    Piantanida E, Gallo D, Lombardi V, Tanda ML, Lai A, Ghezzi F, et al. Pituitary apoplexy during pregnancy: a rare, but dangerous headache. J Endocrinol Investig. 2014;37(9):789–97.CrossRefGoogle Scholar
  34. 34.
    Ducros A. Reversible cerebral vasoconstriction syndrome. Lancet Neurology. 2012;11(10):906–17.PubMedCrossRefGoogle Scholar
  35. 35.
    Klein AM, Loder E. Postpartum headache. Int J Obstet Anesth. 2010;19(4):422–30.PubMedCrossRefGoogle Scholar
  36. 36.
    Al-Safi Z, Imudia AN, Filetti LC, Hobson DT, Bahado-Singh RO, Awonuga AO. Delayed postpartum preeclampsia and eclampsia: demographics, clinical course, and complications. Obstet Gynecol. 2011;118(5):1102–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Hoshiyama E, Tatsumoto M, Iwanami H, Saisu A, Watanabe H, Inaba N, et al. Postpartum migraines: a long-term prospective study. Intern Med. 2012;51(22):3119–23.PubMedCrossRefGoogle Scholar
  38. 38.
    Serva WA, Serva VM, Caminha Mde F, Figueiroa JN, Serva GB, Valenca MM. Exclusive breastfeeding protects against postpartum migraine recurrence attacks? Arq Neuropsiquiatr. 2012;70(6):428–34.PubMedCrossRefGoogle Scholar
  39. 39.
    Airola G, Allais G, Castagnoli Gabellari I, Rolando S, Mana O, Benedetto C. Non-pharmacological management of migraine during pregnancy. Neurol Sci. 2010;31 Suppl 1:S63–5.PubMedCrossRefGoogle Scholar
  40. 40.
    Mauskop A. Nonmedication, alternative, and complementary treatments for migraine. Continuum (Minneapolis, Minn). 2012;18(4):796–806.Google Scholar
  41. 41.
    Penzien DB, Irby MB, Smitherman TA, Rains JC, Houle TT. Well-established and empirically supported behavioral treatments for migraine. Curr Pain Headache Rep. 2015;19(7):34. This paper provides an overview of the well-established and empirically supported behavioral interventions for the treatment of migraine, all very important treatment options during pregnancy. PubMedCrossRefGoogle Scholar
  42. 42.
    Nestoriuc Y, Martin A. Efficacy of biofeedback for migraine: a meta-analysis. Pain. 2007;128(1-2):111–27.PubMedCrossRefGoogle Scholar
  43. 43.
    Nestoriuc Y, Martin A, Rief W, Andrasik F. Biofeedback treatment for headache disorders: a comprehensive efficacy review. Appl Psychophysiol Biofeedback. 2008;33(3):125–40.PubMedCrossRefGoogle Scholar
  44. 44.
    Scharff L, Marcus DA, Turk DC. Maintenance of effects in the nonmedical treatment of headaches during pregnancy. Headache. 1996;36(5):285–90.PubMedCrossRefGoogle Scholar
  45. 45.
    Int J Gynaecol Obstet. ACOG committee opinion. Exercise during pregnancy and the postpartum period. Number 267, January 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 2002;77(1):79–81.CrossRefGoogle Scholar
  46. 46.
    John PJ, Sharma N, Sharma CM, Kankane A. Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial. Headache. 2007;47(5):654–61.PubMedCrossRefGoogle Scholar
  47. 47.
    Posadzki P, Ernst E, Terry R, Lee MS. Is yoga effective for pain? A systematic review of randomized clinical trials. Complement Ther Med. 2011;19(5):281–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Wells RE, Burch R, Paulsen RH, Wayne PM, Houle TT, Loder E. Meditation for migraines: a pilot randomized controlled trial. Headache. 2014;54(9):1484–95.PubMedCrossRefGoogle Scholar
  49. 49.
    Jiang Q, Wu Z, Zhou L, Dunlop J, Chen P. Effects of yoga intervention during pregnancy: a review for current status. Am J Perinatol. 2015;32(6):503–14.PubMedCrossRefGoogle Scholar
  50. 50.
    Narendran S, Nagarathna R, Narendran V, Gunasheela S, Nagendra HR. Efficacy of yoga on pregnancy outcome. J Altern Complement Med. 2005;11(2):237–44.PubMedCrossRefGoogle Scholar
  51. 51.
    Gong H, Ni C, Shen X, Wu T, Jiang C. Yoga for prenatal depression: a systematic review and meta-analysis. BMC Psychiatry. 2015;15:14.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Beddoe AE, Lee KA, Weiss SJ, Kennedy HP, Yang CP. Effects of mindful yoga on sleep in pregnant women: a pilot study. Biol Res Nurs. 2010;11(4):363–70.PubMedCrossRefGoogle Scholar
  53. 53.
    Davis K, Goodman SH, Leiferman J, Taylor M, Dimidjian S. A randomized controlled trial of yoga for pregnant women with symptoms of depression and anxiety. Complement Ther Clin Pract. 2015;21(3):166–72.PubMedCrossRefGoogle Scholar
  54. 54.
    Peroutka SJ. What turns on a migraine? A systematic review of migraine precipitating factors. Curr Pain Headache Rep. 2014;18(10):454.PubMedCrossRefGoogle Scholar
  55. 55.
    Satyapriya M, Nagendra HR, Nagarathna R, Padmalatha V. Effect of integrated yoga on stress and heart rate variability in pregnant women. Int J Gynaecol Obstet. 2009;104(3):218–22.PubMedCrossRefGoogle Scholar
  56. 56.
    Bruehl S, Chung OY, Jirjis JN, Biridepalli S. Prevalence of clinical hypertension in patients with chronic pain compared to nonpain general medical patients. Clin J Pain. 2005;21(2):147–53.PubMedCrossRefGoogle Scholar
  57. 57.
    Whitten CE, Donovan M, Cristobal K. Treating chronic pain: new knowledge, more choices. Perm J. 2005;9(4):9–18.PubMedPubMedCentralGoogle Scholar
  58. 58.
    Govindappagari S, Grossman TB, Dayal AK, Grosberg BM, Vollbracht S, Robbins MS. Peripheral nerve blocks in the treatment of migraine in pregnancy. Obstet Gynecol. 2014;124(6):1169–74.PubMedCrossRefGoogle Scholar
  59. 59.
    Silberstein SD. Migraine and pregnancy. Neurol Clin. 1997;15(1):209–31.PubMedCrossRefGoogle Scholar
  60. 60.
    Content and format of labeling for human prescription drug and biological products; requirements for pregnancy and lactation labeling. Federal Register, the Daily Journal of the United States Government: FDA; [11-12-2015]. Available from:
  61. 61.
    Holland S, Silberstein SD, Freitag F, Dodick DW, Argoff C, Ashman E. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78(17):1346–53.PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    Hale TW, Rowe HE. Medications & mothers’ milk. 16th ed. Plano: Hale Publishing; 2014.Google Scholar
  63. 63.
    Marmura MJ, Silberstein SD, Schwedt TJ. The acute treatment of migraine in adults: the American Headache Society evidence assessment of migraine pharmacotherapies. Headache. 2015;55(1):3–20.PubMedCrossRefGoogle Scholar
  64. 64.
    Silberstein SD, Holland S, Freitag F, Dodick DW, Argoff C, Ashman E. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78(17):1337–45.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Li DK, Liu L, Odouli R. Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: population based cohort study. BMJ. 2003;327(7411):368.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Loder E, Weizenbaum E, Frishberg B, Silberstein S. Choosing wisely in headache medicine: the American Headache Society’s list of five things physicians and patients should question. Headache. 2013;53(10):1651–9. This report recommends against the use of opioids and barbiturates for the treatment of migraines. PubMedCrossRefGoogle Scholar
  67. 67.
    Lee RV. In: Burrow GN, Ferris TF, editors. Medical complications during pregnancy. 4th ed. Philadelphia, PA: WB Saunders Company; 1994.Google Scholar
  68. 68.
    Cunningham FG, MacDonald PC, Gant NF, Leveno KJ, Gilstrap LC. In: Cunningham FG, MacDonald PC, Leveno KF, editors. Williams obstetrics. 19th ed. Norwalk, CT: Appleton & Lange; 1993.Google Scholar
  69. 69.
    Mangurten HH, Benawra R. Neonatal codeine withdrawal in infants of nonaddicted mothers. Pediatrics. 1980;65(1):159–60.PubMedGoogle Scholar
  70. 70.
    Loder E. Safety of sumatriptan in pregnancy: a review of the data so far. CNS Drugs. 2003;17(1):1–7.PubMedCrossRefGoogle Scholar
  71. 71.
    Ephross SA, Sinclair SM. Final results from the 16-year sumatriptan, naratriptan, and treximet pregnancy registry. Headache. 2014;54(7):1158–72.PubMedCrossRefGoogle Scholar
  72. 72.
    Marchenko A, Etwel F, Olutunfese O, Nickel C, Koren G, Nulman I. Pregnancy outcome following prenatal exposure to triptan medications: a meta-analysis. Headache. 2015;55(4):490–501.PubMedCrossRefGoogle Scholar
  73. 73.
    Nezvalova-Henriksen K, Spigset O, Nordeng H. Triptan safety during pregnancy: a Norwegian population registry study. Eur J Epidemiol. 2013;28(9):759–69.PubMedCrossRefGoogle Scholar
  74. 74.
    Hunt S, Russell A, Smithson WH, Parsons L, Robertson I, Waddell R, et al. Topiramate in pregnancy: preliminary experience from the UK Epilepsy and Pregnancy Register. Neurology. 2008;71(4):272–6.PubMedCrossRefGoogle Scholar
  75. 75.
    Castilla-Puentes R, Ford L, Manera L, Kwarta Jr RF, Ascher S, Li Q. Topiramate monotherapy use in women with and without epilepsy: pregnancy and neonatal outcomes. Epilepsy Res. 2014;108(4):717–24.PubMedCrossRefGoogle Scholar
  76. 76.
    Buettner C, Nir RR, Bertisch SM, Bernstein C, Schain A, Mittleman MA, et al. Simvastatin and vitamin D for migraine prevention: a randomized controlled trial. Ann Neurol. 2015;78:970.PubMedCrossRefGoogle Scholar
  77. 77.
    Koren G, Pastuszak A, Ito S. Drugs in pregnancy. N Engl J Med. 1998;338(16):1128–37.PubMedCrossRefGoogle Scholar
  78. 78.
    Evers S, Afra J, Frese A, Goadsby PJ, Linde M, May A, et al. EFNS guideline on the drug treatment of migraine—revised report of an EFNS task force. Eur J Neurol. 2009;16(9):968–81.PubMedCrossRefGoogle Scholar
  79. 79.
    Huang L, Bocek M, Jordan JK, Sheehan AH. Memantine for the prevention of primary headache disorders. Ann Pharmacother. 2014;48(11):1507–11.PubMedCrossRefGoogle Scholar
  80. 80.
    Holden SC, Gardiner P, Birdee G, Davis RB, Yeh GY. Complementary and alternative medicine use among women during pregnancy and childbearing years. Birth. 2015;42(3):261–9.PubMedCrossRefGoogle Scholar
  81. 81.
    Saper RB, Phillips RS, Sehgal A, Khouri N, Davis RB, Paquin J, et al. Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the Internet. Jama. 2008;300(8):915–23.PubMedPubMedCentralCrossRefGoogle Scholar
  82. 82.
    Dunlop AL, Gardiner PM, Shellhaas CS, Menard MK, McDiarmid MA. The clinical content of preconception care: the use of medications and supplements among women of reproductive age. Am J Obstet Gynecol. 2008;199(6 Suppl 2):S367–72.PubMedCrossRefGoogle Scholar
  83. 83.
    Pringsheim T, Davenport W, Mackie G, Worthington I, Aube M, Christie SN, et al. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci. 2012;39(2 Suppl 2):S1–59.PubMedGoogle Scholar
  84. 84.
    Tepper SJ. Nutraceutical and other modalities for the treatment of headache. Continuum (Minneapolis, Minn). 2015;21(4 Headache):1018–31.Google Scholar
  85. 85.
    Schurks M, Diener HC, Goadsby P. Update on the prophylaxis of migraine. Curr Treat Options Neurol. 2008;10(1):20–9.PubMedCrossRefGoogle Scholar
  86. 86.
    Ma AG, Schouten EG, Zhang FZ, Kok FJ, Yang F, Jiang DC, et al. Retinol and riboflavin supplementation decreases the prevalence of anemia in Chinese pregnant women taking iron and folic acid supplements. J Nutr. 2008;138(10):1946–50.PubMedGoogle Scholar
  87. 87.
    Elsen C, Rivas-Echeverria C, Sahland K, Sanchez R, Molma L, Pahl L, et al. Vitamins E, A and B as possible risk factors for preeclampsia—under consideration of the PROPER study (“Prevention of Preeclampsia by High-Dose Riboflavin Supplementation”). Geburtshilfe Frauenheilkd. 2012;72(9):846–52.PubMedPubMedCentralCrossRefGoogle Scholar
  88. 88.
    Elsen C, Rivas-Echeverria C, Sahland K, Bogucki P, Rivas-Echeverria F, Molina L, et al. Prevention of preeclampsia by high dose riboflavin supplementation. Proc World Med Conf. 2011.Google Scholar
  89. 89.
    Teran E, Hernandez I, Nieto B, Tavara R, Ocampo JE, Calle A. Coenzyme Q10 supplementation during pregnancy reduces the risk of pre-eclampsia. Int J Gynaecol Obstet. 2009;105(1):43–5.PubMedCrossRefGoogle Scholar
  90. 90.
    Loder E, Burch R, Rizzoli P. The 2012 AHS/AAN guidelines for prevention of episodic migraine: a summary and comparison with other recent clinical practice guidelines. Headache. 2012;52(6):930–45.PubMedCrossRefGoogle Scholar
  91. 91.
    McGuffin M, Hobbs C, Upton R, Goldberg A, editors. American Herbal Products Association’s botanical safety handbook. Boca Raton: CRC Press LLC; 1997.Google Scholar
  92. 92.
    Lea R, Colson N, Quinlan S, Macmillan J, Griffiths L. The effects of vitamin supplementation and MTHFR (C677T) genotype on homocysteine-lowering and migraine disability. Pharmacogenet Genomics. 2009;19(6):422–8.PubMedCrossRefGoogle Scholar
  93. 93.
    Menon S, Lea RA, Roy B, Hanna M, Wee S, Haupt LM, et al. Genotypes of the MTHFR C677T and MTRR A66G genes act independently to reduce migraine disability in response to vitamin supplementation. Pharmacogenet Genomics. 2012;22(10):741–9.PubMedCrossRefGoogle Scholar
  94. 94.
    Sadeghi O, Nasiri M, Maghsoudi Z, Pahlavani N, Rezaie M, Askari G. Effects of pyridoxine supplementation on severity, frequency and duration of migraine attacks in migraine patients with aura: a double-blind randomized clinical trial study in Iran. Iranian J Neurol. 2015;14(2):74–80.Google Scholar
  95. 95.
    Salam RA, Zuberi NF, Bhutta ZA. Pyridoxine (vitamin B6) supplementation during pregnancy or labour for maternal and neonatal outcomes. Cochrane Database Syst Rev. 2015;6:Cd000179.PubMedGoogle Scholar
  96. 96.
    Generally recognized as safe (GRAS) substances database [Internet]. [cited October 23, 2015].Google Scholar
  97. 97.
    Slaughter SR, Hearns-Stokes R, van der Vlugt T, Joffe HV. FDA approval of doxylamine-pyridoxine therapy for use in pregnancy. N Engl J Med. 2014;370(12):1081–3.PubMedCrossRefGoogle Scholar
  98. 98.
    Geiger CJ, Fahrenbach DM, Healey FJ. Bendectin in the treatment of nausea and vomiting in pregnancy. Obstet Gynecol. 1959;14:688–90.PubMedGoogle Scholar
  99. 99.
    McGuinness BW, Binns DT. ‘Debendox’ in pregnancy sickness. J R Coll Gen Pract. 1971;21(109):500–3.PubMedPubMedCentralGoogle Scholar
  100. 100.
    Wheatley D. Treatment of pregnancy sickness. Br J Obstet Gynaecol. 1977;84(6):444–7.PubMedCrossRefGoogle Scholar
  101. 101.
    Einarson TR, Leeder JS, Koren G. A method for meta-analysis of epidemiological studies. Drug Intell Clin Pharm. 1988;22(10):813–24.PubMedGoogle Scholar
  102. 102.
    McKeigue PM, Lamm SH, Linn S, Kutcher JS. Bendectin and birth defects: I. A meta-analysis of the epidemiologic studies. Teratology. 1994;50(1):27–37.PubMedCrossRefGoogle Scholar
  103. 103.
    Nulman I, Rovet J, Barrera M, Knittel-Keren D, Feldman BM, Koren G. Long-term neurodevelopment of children exposed to maternal nausea and vomiting of pregnancy and diclectin. J Pediatr. 2009;155(1):45–50. e1-2.PubMedCrossRefGoogle Scholar
  104. 104.
    FDA. FDA recommends against prolonged use of magnesium sulfate to stop pre-term labor due to bone changes in exposed babies 2013 [July 31, 2015]. Available from: • The FDA no longer recommends IV magnesium for the treatment of pre-term labor in pregnancy and has changed its risk categorization from A to D during pregnancy.
  105. 105.
    Holcomb Jr WL, Shackelford GD, Petrie RH. Magnesium tocolysis and neonatal bone abnormalities: a controlled study. Obstet Gynecol. 1991;78(4):611–4.PubMedGoogle Scholar
  106. 106.
    Yokoyama K, Takahashi N, Yada Y, Koike Y, Kawamata R, Uehara R, et al. Prolonged maternal magnesium administration and bone metabolism in neonates. Early Hum Dev. 2010;86(3):187–91.PubMedCrossRefGoogle Scholar
  107. 107.
    Lamm CI, Norton KI, Murphy RJ, Wilkins IA, Rabinowitz JG. Congenital rickets associated with magnesium sulfate infusion for tocolysis. J Pediatr. 1988;113(6):1078–82.PubMedCrossRefGoogle Scholar
  108. 108.
    FDA. FDA drug safety communication: abnormal heart rhythms may be associated with use of Zofran (ondansetron) 2011 [Nov. 11, 2015]. Available from:
  109. 109.
    FDA. Potential signals of serious risks/new safety information identified by the FDA Adverse Event Reporting System (FAERS) between January-March 2013. 2014.Google Scholar
  110. 110.
    Einarson A, Maltepe C, Navioz Y, Kennedy D, Tan MP, Koren G. The safety of ondansetron for nausea and vomiting of pregnancy: a prospective comparative study. BJOG. 2004;111(9):940–3.PubMedCrossRefGoogle Scholar
  111. 111.
    Anderka M, Mitchell AA, Louik C, Werler MM, Hernandez-Diaz S, Rasmussen SA. Medications used to treat nausea and vomiting of pregnancy and the risk of selected birth defects. Birth Defects Res A Clin Mol Teratol. 2012;94(1):22–30.PubMedPubMedCentralCrossRefGoogle Scholar
  112. 112.
    Abstracts of the 29th International Conference on Pharmacoepidemiology & Therapeutic Risk Management. August 25-28, 2013. Montreal, Canada. Pharmacoepidemiology and drug safety. 2013;22 Suppl 1:1-521.Google Scholar
  113. 113.
    Pasternak B, Svanstrom H, Hviid A. Ondansetron in pregnancy and risk of adverse fetal outcomes. N Engl J Med. 2013;368(9):814–23.PubMedCrossRefGoogle Scholar
  114. 114.
    Koren G. Treating morning sickness in the United States—changes in prescribing are needed. Am J Obstet Gynecol. 2014;211(6):602–6.PubMedCrossRefGoogle Scholar
  115. 115.
    [11/6/2015]. Update on Motherisk Program at The Hospital for Sick Children. Available from:
  116. 116.
    Lipton RB, Baggish JS, Stewart WF, Codispoti JR, Fu M. Efficacy and safety of acetaminophen in the treatment of migraine: results of a randomized, double-blind, placebo-controlled, population-based study. Arch Intern Med. 2000;160(22):3486–92.PubMedCrossRefGoogle Scholar
  117. 117.
    Werler MM, Mitchell AA, Hernandez-Diaz S, Honein MA. Use of over-the-counter medications during pregnancy. Am J Obstet Gynecol. 2005;193(3 Pt 1):771–7.PubMedCrossRefGoogle Scholar
  118. 118.
    Brandlistuen RE, Ystrom E, Nulman I, Koren G, Nordeng H. Prenatal paracetamol exposure and child neurodevelopment: a sibling-controlled cohort study. Int J Epidemiol. 2013;42(6):1702–13.PubMedPubMedCentralCrossRefGoogle Scholar
  119. 119.
    Liew Z, Ritz B, Rebordosa C, Lee PC, Olsen J. Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatr. 2014;168(4):313–20.PubMedCrossRefGoogle Scholar
  120. 120.
    Migliore E, Zugna D, Galassi C, Merletti F, Gagliardi L, Rasero L, et al. Prenatal paracetamol exposure and wheezing in childhood: causation or confounding? PLoS One. 2015;10(8):e0135775.PubMedPubMedCentralCrossRefGoogle Scholar
  121. 121.
    Streissguth AP, Treder RP, Barr HM, Shepard TH, Bleyer WA, Sampson PD, et al. Aspirin and acetaminophen use by pregnant women and subsequent child IQ and attention decrements. Teratology. 1987;35(2):211–9.PubMedCrossRefGoogle Scholar
  122. 122.
    Gilmore B, Michael M. Treatment of acute migraine headache. Am Fam Physician. 2011;83(3):271–80.PubMedGoogle Scholar
  123. 123.
    Silberstein SD. Migraine: preventive treatment. Curr Med Res Opin. 2001;17 Suppl 1:s87–93.PubMedCrossRefGoogle Scholar
  124. 124.
    Goldman AS. Birth defects and drugs in pregnancy. Am J Hum Genet. 1977;29(5):546–8.PubMedCentralGoogle Scholar
  125. 125.
    Browne ML, Van Zutphen AR, Botto LD, Louik C, Richardson S, Druschel CM. Maternal butalbital use and selected defects in the national birth defects prevention study. Headache. 2014;54(1):54–66.PubMedCrossRefGoogle Scholar
  126. 126.
    Marcus DA, Scharff L, Turk DC. Nonpharmacological management of headaches during pregnancy. Psychosom Med. 1995;57(6):527–35.PubMedCrossRefGoogle Scholar
  127. 127.
    Luedtke K, Allers A, Schulte LH, May A. Efficacy of interventions used by physiotherapists for patients with headache and migraine—systematic review and meta-analysis. Cephalalgia. 2015.Google Scholar
  128. 128.
    Bryans R, Descarreaux M, Duranleau M, Marcoux H, Potter B, Ruegg R, et al. Evidence-based guidelines for the chiropractic treatment of adults with headache. J Manip Physiol Ther. 2011;34(5):274–89.CrossRefGoogle Scholar
  129. 129.
    Alcantara J, Cossette M. Intractable migraine headaches during pregnancy under chiropractic care. Complement Ther Clin Pract. 2009;15(4):192–7.PubMedCrossRefGoogle Scholar
  130. 130.
    Wells RE. Spinal manipulation for headaches: will better quality trials do the trick? Headache. 2011;51(7):1149–51.PubMedCrossRefGoogle Scholar
  131. 131.
    Green C, Martin CW, Bassett K, Kazanjian A. A systematic review of craniosacral therapy: biological plausibility, assessment reliability and clinical effectiveness. Complement Ther Med. 1999;7(4):201–7.PubMedCrossRefGoogle Scholar
  132. 132.
    Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado ML, Miangolarra JC, Barriga FJ, Pareja JA. Are manual therapies effective in reducing pain from tension-type headache?: a systematic review. Clin J Pain. 2006;22(3):278–85.PubMedCrossRefGoogle Scholar
  133. 133.
    Jakel A, von Hauenschild P. A systematic review to evaluate the clinical benefits of craniosacral therapy. Complement Ther Med. 2012;20(6):456–65.PubMedCrossRefGoogle Scholar
  134. 134.
    Mataran-Penarrocha GA, Castro-Sanchez AM, Garcia GC, Moreno-Lorenzo C, Carreno TP, Zafra MD. Influence of craniosacral therapy on anxiety, depression and quality of life in patients with fibromyalgia. Evid Based Complement Alternat Med. 2011;2011:178769.PubMedPubMedCentralGoogle Scholar
  135. 135.
    Phillips CJ, Meyer JJ. Chiropractic care, including craniosacral therapy, during pregnancy: a static-group comparison of obstetric interventions during labor and delivery. J Manip Physiol Ther. 1995;18(8):525–9.Google Scholar
  136. 136.
    Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev. 2009;21(1):Cd001218.Google Scholar
  137. 137.
    Neri I, Allais G, Schiapparelli P, Blasi I, Benedetto C, Facchinetti F. Acupuncture versus pharmacological approach to reduce hyperemesis gravidarum discomfort. Minerva Ginecol. 2005;57(4):471–5.PubMedGoogle Scholar
  138. 138.
    Park J, Sohn Y, White AR, Lee H. The safety of acupuncture during pregnancy: a systematic review. Acupunct Med. 2014;32(3):257–66.PubMedPubMedCentralCrossRefGoogle Scholar
  139. 139.
    Ashkenazi A, Matro R, Shaw JW, Abbas MA, Silberstein SD. Greater occipital nerve block using local anaesthetics alone or with triamcinolone for transformed migraine: a randomised comparative study. J Neurol Neurosurg Psychiatry. 2008;79(4):415–7.PubMedCrossRefGoogle Scholar
  140. 140.
    Blumenfeld A, Ashkenazi A, Napchan U, Bender SD, Klein BC, Berliner R, et al. Expert consensus recommendations for the performance of peripheral nerve blocks for headaches—a narrative review. Headache. 2013;53(3):437–46.PubMedCrossRefGoogle Scholar
  141. 141.
    (WHO) WHO. Breastfeeding health topics [October 19, 2015]. Available from:
  142. 142.
    Johnston M, Landers S, Noble L, Szucs K, Viehmann L. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827–41.CrossRefGoogle Scholar
  143. 143.
    Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev. 2012;8:Cd003517.PubMedGoogle Scholar
  144. 144.
    Duffy LC, Byers TE, Riepenhoff-Talty M, La Scolea LJ, Zielezny M, Ogra PL. The effects of infant feeding on rotavirus-induced gastroenteritis: a prospective study. Am J Public Health. 1986;76(3):259–63.PubMedPubMedCentralCrossRefGoogle Scholar
  145. 145.
    Dewey KG, Heinig MJ, Nommsen-Rivers LA. Differences in morbidity between breast-fed and formula-fed infants. J Pediatr. 1995;126(5 Pt 1):696–702.PubMedCrossRefGoogle Scholar
  146. 146.
    Hauck FR, Thompson JM, Tanabe KO, Moon RY, Vennemann MM. Breastfeeding and reduced risk of sudden infant death syndrome: a meta-analysis. Pediatrics. 2011;128(1):103–10.PubMedCrossRefGoogle Scholar
  147. 147.
    Sachs HC. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013;132(3):e796–809.PubMedCrossRefGoogle Scholar
  148. 148.
    American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108(3):776–89.CrossRefGoogle Scholar
  149. 149.
    Drugs and lactation database [Internet]. Available from:
  150. 150.
    Kearns GL, Abdel-Rahman SM, Alander SW, Blowey DL, Leeder JS, Kauffman RE. Developmental pharmacology—drug disposition, action, and therapy in infants and children. N Engl J Med. 2003;349(12):1157–67.PubMedCrossRefGoogle Scholar
  151. 151.
    Hutchinson S, Marmura MJ, Calhoun A, Lucas S, Silberstein S, Peterlin BL. Use of common migraine treatments in breast-feeding women: a summary of recommendations. Headache. 2013;53(4):614–27.PubMedPubMedCentralCrossRefGoogle Scholar
  152. 152.
    Wojnar-Horton RE, Hackett LP, Yapp P, Dusci LJ, Paech M, Ilett KF. Distribution and excretion of sumatriptan in human milk. Br J Clin Pharmacol. 1996;41(3):217–21.PubMedCrossRefGoogle Scholar
  153. 153.
    Budzynska K, Gardner ZE, Low Dog T, Gardiner P. Complementary, holistic, and integrative medicine: advice for clinicians on herbs and breastfeeding. Pediatr Rev. 2013;34(8):343–52. quiz 52-3.PubMedPubMedCentralCrossRefGoogle Scholar
  154. 154.
    Giuliani M, Grossi GB, Pileri M, Lajolo C, Casparrini G. Could local anesthesia while breast-feeding be harmful to infants? J Pediatr Gastroenterol Nutr. 2001;32(2):142–4.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Rebecca Erwin Wells
    • 1
  • Dana P. Turner
    • 2
  • Michelle Lee
    • 3
  • Laura Bishop
    • 1
  • Lauren Strauss
    • 1
  1. 1.Department of NeurologyWake Forest Baptist HealthWinston-SalemUSA
  2. 2.Department of AnesthesiologyWake Forest Baptist HealthWinston-SalemUSA
  3. 3.Wake Forest School of MedicineWinston-SalemUSA

Personalised recommendations