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Am Fam Physician. 2023;108(1):97-99

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Key Points for Practice

• Calcium channel blockers and antihistamines are the safest migraine prophylactic medications in pregnancy.

• Acetaminophen, with or without caffeine, is the recommended treatment for acute headaches in pregnancy.

• Metoclopramide is recommended for the treatment of persistent headache, especially if associated with nausea.

From the AFP Editors

During pregnancy and after delivery, headaches can be signs of secondary disorders including preeclampsia, dural puncture, pituitary apoplexy, and infection. The American College of Obstetricians and Gynecologists (ACOG) has published guidelines for the evaluation and management of headaches in pregnancy.

Primary Headaches in Pregnancy

Up to 80% of pregnant patients with primary headaches experience spontaneous reduction in frequency by the second trimester. Specific causes unique to pregnancy can trigger a headache.

Medications taken for the prevention of headache should be reviewed before pregnancy, if possible, or early in pregnancy. Some medications for the prevention of migraine increase risk in pregnancy and should not be used. Calcium channel blockers and antihistamines are safe and can be continued or started during pregnancy. Oral magnesium has some evidence of increasing the risk of neonatal death and congenital anomalies in pregnancy, despite the obstetric use of magnesium. Lifestyle modifications such as trigger avoidance, relaxation techniques, sleep hygiene, stress management, hydration, and cognitive behavior therapy have limited evidence of benefit but are safe in pregnancy. Similarly, acupuncture and biofeedback are also safe in pregnancy.

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Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at

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