Migraine in pregnancy: an integrative review

BackgroundMigraine is the most prevalent primary headache disorder in pregnancy, with unique clinical implications requiring specialized management approaches.ObjectiveTo provide a comprehensive review of migraine pathophysiology, clinical course, diagnosis, and management during pregnancy, postpartum, and lactation.MethodsSelective literature search of PubMed, Scopus, and Web of Science databases, complemented by AI-assisted tools (Elicit and Consensus) to ensure comprehensive coverage of emerging evidence, from 2003 to 2025.Key FindingsHormonal fluctuations drive migraine pathophysiology, with pregnancy's hormonal stability typically improving symptoms in 60-70% of women with migraine without aura during the second and third trimesters. However, migraine with aura shows less predictable improvement, and de novo attacks may occur. Maternal migraine, particularly with aura, is associated with hypertensive disorders, preterm birth, cesarean delivery, fetal growth restriction, and increased ischemic stroke risk. Psychiatric comorbidities, including depression and anxiety, are frequent and linked to poorer outcomes. Management Non-pharmacological interventions form the foundation of treatment. When pharmacological therapy is required, acetaminophen is first-line, NSAIDs may be used only in the second trimester, and sumatriptan is the safest triptan option. Preventive treatment should be reserved for severe, refractory cases, with magnesium, propranolol, and amitriptyline as evidence-based options.ConclusionMigraine during pregnancy and postpartum requires a multidisciplinary approach prioritizing safe pharmacological strategies, individualized monitoring, and lifestyle optimization to ensure optimal maternal and fetal outcomes.