A Systematic Review

Management of Primary Headaches During Pregnancy, Postpartum, and Breastfeeding

Ian J. Saldanha MBBS, MPH, PhD; Wangnan Cao PhD; Monika Reddy Bhuma BDS, MPH; Kristin J. Konnyu PhD; Gaelen P. Adam MLIS, MPH; Shivani Mehta BA; Andrew R. Zullo PharmD, PhD; Kenneth K. Chen MD; Julie L. Roth MD; Ethan M. Balk MD, MPH


Headache. 2021;61(1):11-43. 

In This Article


Despite a comprehensive SR of the evidence, we could make only a few conclusions, which were tempered by the low-to-moderate SoE. For prevention of primary headache, use of antiepileptics (except lamotrigine), venlafaxine, tricyclic antidepressants, benzodiazepines, β-blockers, prednisolone, or oral magnesium may be associated with fetal/child adverse effects, although use of calcium channel blockers or antihistamines may not be. For treatment of primary headache, the combination of metoclopramide and diphenhydramine may be more effective than codeine. Use of acetaminophen, prednisolone, indomethacin, ondansetron, antipsychotics, and intravenous magnesium may be associated with fetal/child adverse effects, but use of triptans or low-dose aspirin may not be. Future research is urgently needed to identify effective and safe interventions to prevent and treat primary headaches in pregnancy.