Treatment of migraine during pregnancy and lactation

Migraine is often benign during pregnancy. Many women report a decrease in the intensity and frequency of migraines during this period, although some person inform about an increase in the frequency of headaches. After childbirth or during lactation migraine recurrences. This is due to hormonal changes and other physiological processes occurring in the woman’s body. A systematic literature search was conducted in Pub Med, Scopus, and Web of Science. Inclusion criteria included studies covering clinical trials and observational studies related to the treatment of migraine during pregnancy and lactation. Articles in languages other than Russian and English were excluded. First-line medications include paracetamol in any trimester and nonsteroidal anti-inflammatory drugs only in the second trimester (ibuprofen has the best safety profile and can be used during breastfeeding) for the acute treatment. Triptans can only be used as second-line agents throughout pregnancy and lactation, because of the limited availability of data. For the prevention of seizures during pregnancy, propranolol can be considered as a first-line drug after assessing the benefit-risk ratio. Propranolol, verapamil, or magnesium may be recommended as the first-line preventive treatment during lactation. There are guidelines for prescribing medications that can be used to acute treatment and prevent migraine attacks in women during pregnancy and lactation presently. However, their use requires particular caution. It is important to carefully assess the potential risk to both the mother and fetus. Every decision regarding the use of medications for migraine treatment should be made individually, taking into account the frequency and severity of attacks. Only recommended medications should be prescribed, taking into account the current trimester and lactation period.