We offer a dedicated Headache in Pregnancy and Lactation Program for patients who are pregnant, planning pregnancy, or breastfeeding and living with migraine or other headache disorders.
Individualized, evidence-based care tailored to pregnancy and breastfeeding
Care grounded in the best available safety data, not blanket “avoid everything” advice
Thoughtful discussion of benefits, risks, and uncertainties for each treatment option
Support for patients who require ongoing headache control, not just reassurance
Understanding how pregnancy and lactation may affect headache patterns
Selecting safe acute treatments during pregnancy and breastfeeding
Choosing or adjusting preventive strategies when migraine is frequent or disabling
Navigating Botox ® for migraine during pregnancy or lactation on an individualized basis
Identifying red flags and secondary causes of headache unique to pregnancy
Coordinating care with family physicians, obstetrics, and anesthesia when needed
Our clinic does offer Botox ® for migraine during pregnancy in selected cases.
Decisions are made using:
A careful review of the available safety and outcome data
Assessment of migraine severity and functional impact
Consideration of alternative options
This program is appropriate if you:
Have migraine that continues during pregnancy or breastfeeding
Have migraine severe enough to interfere with daily function
Are unsure which medications are safe
Have been told conflicting or overly restrictive advice
Need help balancing symptom control with fetal or infant safety
Pregnancy and lactation should not mean unmanaged pain.
Our goal is to help patients:
Feel heard and supported
Receive clear, evidence-based guidance
Make informed decisions that reflect their values and clinical needs
Pregnancy and breastfeeding are times of major hormonal and physiologic change, and headache patterns often change as well. Many people worry about which treatments are safe and whether they must “just suffer” during pregnancy or lactation.
The good news is:
Many people experience improvement in migraine during pregnancy
Safe treatment options exist
Our clinic helps patients navigate pregnancy and lactation using the best available evidence, balancing symptom control with fetal and infant safety.
Migraine often improves during pregnancy, especially in the second and third trimesters
Improvement is most common in people with menstrual-related migraine
Some people continue to have migraine, and a small number may worsen
Hormonal stability (particularly estrogen) is thought to play a major role.
Migraine patterns vary. Some people remain improved, while others notice recurrence as sleep disruption and hormonal changes occur.
Many migraine treatments are compatible with breastfeeding, and timing doses can further reduce infant exposure.
First-line acute medication in pregnancy
Can be used throughout pregnancy
Often combined with non-medication strategies
Always encouraged, especially in pregnancy:
Rest in a dark, quiet room
Hydration
Cold packs
Relaxation breathing or mindfulness
Sumatriptan is the best-studied triptan in pregnancy
May be used when needed, especially if migraine is severe or disabling
Use is individualized and based on symptom burden and response
May be used with caution in early pregnancy
Avoid in the third trimester
Use should always be discussed with a healthcare provider
Gepants (e.g., ubrogepant, rimegepant)
Ergot derivatives (e.g., dihydroergotamine)
Opioids (generally avoided)
Sleep regularity
Hydration
Gentle exercise
Stress management
Some supplements are often considered:
Magnesium
Riboflavin (Vitamin B2)
These are generally regarded as low risk, though dosing and formulation should be discussed.
The two oral preventives with the most widely available safety data in pregnancy are:
Metoprolol
Amitriptyline
The following are generally avoided:
Topiramate
Candesartan
Valproate
Gepants (atogepant)
CGRP monoclonal antibodies (e.g. erenumab, eptinezumab, fremanezumab, and galcanezumab)
These should be stopped at least 6 months before pregnancy
Botox ® use in pregnancy is an area of growing evidence. It is not routinely started during pregnancy, but may be considered in selected cases where:
Migraine is severe or disabling
Other options are ineffective or not tolerated
The potential benefits outweigh theoretical risks
Important:
Botox ® does not cross the blood–brain barrier, does not seem to cross the placenta, does not circulate systemically in meaningful amounts, and does not suppress the immune system.
We do offer Botox ® during pregnancy using an individualized, evidence-informed decision-making process.
We:
Review the available safety data
Discuss uncertainties openly
Consider migraine severity and alternatives
Make decisions collaboratively
Botox ® use in pregnancy is an area of growing evidence. It is not routinely started during pregnancy, but may be considered in selected cases where:
Migraine is severe or disabling
Other options are ineffective or not tolerated
The potential benefits outweigh theoretical risks
Important:
Botox ® does not cross the blood–brain barrier, does not seem to cross the placenta, does not circulate systemically in meaningful amounts, and does not suppress the immune system.
We do offer Botox ® during pregnancy using an individualized, evidence-informed decision-making process.
We:
Review the available safety data
Discuss uncertainties openly
Consider migraine severity and alternatives
Make decisions collaboratively
Many acute medications are compatible with breastfeeding, including:
Acetaminophen
NSAIDs (e.g., ibuprofen)
Sumatriptan
In some cases, timing breastfeeding after a dose can further reduce infant exposure. We help guide this on an individual basis.
Not all headache in pregnancy is migraine.
Seek urgent medical evaluation if headache is:
Sudden and severe (“worst headache of life”)
New or very different from usual migraine
Associated with high blood pressure
Accompanied by visual changes, confusion, weakness, or seizures
Associated with fever or signs of infection
Eclampsia and preeclampsia are serious pregnancy-related conditions that can present with:
Severe or persistent headache
Visual disturbances
Elevated blood pressure
Neurologic symptoms
Any concern for these conditions requires urgent assessment in the emergency department.
Post-dural puncture headache (PDPH) can occur after:
Epidural anesthesia
Spinal anesthesia
Lumbar puncture
Typical features include:
Headache that is worse when upright
Improvement when lying flat
Onset within days of a procedure
This is a treatable condition, often with an epidural blood patch, and should be assessed promptly.