Stimulating discussion: neuromodulation for migraine in pregnancy

Noninvasive neuromodulation is a promising nonpharmaceutical option in migraine treatment during pregnancy due to its well-established safety and efficacy profile in the general population and versatility as adjunctive/alternative therapy to medication. We discuss: the current pivotal trials on neuromodulation for migraine treatment in general and pregnancy populations, why neuromodulation may be unknown and underutilized among clinicians, and neuromodulation's future for migraine in pregnancy.

Evidence for neuromodulation use during pregnancy is limited, especially for migraine treatment. Contributing factors include the exclusion of pregnant women with migraine from clinical trials, the lack of nonpharmaceutical use data in epidemiological studies, and limited research funding. Evidence can be improved through advocacy by professional organizations, systemic funding, and increased patient awareness. Limited clinician knowledge, awareness, and access may contribute to underutilization. Education, insurance coverage advocacy, and multidisciplinary approaches to migraine treatment in pregnancy are needed.

Neuromodulation may already represent a clinically meaningful nonpharmacologic alternative for treating migraine during pregnancy. Neuromodulation offers precision therapy, clinical data tracking, and the potential to treat multiple pregnancy health conditions. Despite its safety potential, it remains underutilized. Increased research, clinician education, and multidisciplinary care could support broader adoption.