Navigating migraine care during pregnancy and lactation

Purpose of review The purpose of this study is to review recent evidence and provide guideline-based recommendations for the acute and preventive management of migraine during pregnancy, with focused consideration of lactation safety of migraine-specific therapies and guidance on preconception medication discontinuation. Recent findings Migraine management during pregnancy, postpartum, and lactation requires nuanced, evidence-based decision-making that extends beyond reflexive medication avoidance. Drawing on recent literature and guidance from the American College of Obstetricians and Gynecologists, we advance a collaborative, individualized care framework that integrates pharmacologic and procedural strategies to preserve maternal function while minimizing fetal and neonatal risk. Summary Effective migraine care during pregnancy is achievable and necessary. Structured preconception planning, thoughtful selection of therapies with established reproductive safety, and incorporation of low-exposure procedural interventions can substantially reduce migraine-related disability without compromising fetal outcomes. Coordinated neurologic–obstetric care replaces outdated risk-averse practices with evidence-informed strategies that support maternal health.