Prescribing for pregnancy: managing chronic headache and migraine

Globally, headache disorders are an important cause of disability in adults. As many types of headache (eg, migraine, tension-type and medication-overuse) are more common in women and have peak incidence in reproductive years, chronic headache disorders are highly prevalent in pregnant women. Some women with a history of migraine may find that it improves during pregnancy while others may find that their migraines become more unpredictable. Ideally, women with migraine and problematic headache disorder should be offered preconception counselling to address pregnancy-related concerns and advice on the use of medicines, which should be supported by high-quality information. For women with history of headache, the use of effective non-pharmacological options should be maximised, and the smallest number of the safest medicines at the lowest effective doses should be used while preparing for pregnancy and during pregnancy. This article forms part of the series of prescribing for pregnancy and discusses the impact of headache and migraine on pregnancy, the impact of pregnancy on headache and migraine and options for prophylaxis and treatment.