Table 2.

 Safety profiles in pregnancy and breast feeding for drugs commonly used for preventing migraine^{23 24}

Drug	Fetal risk			Breast feeding
	FDA	TERIS
β blockers
Atenolol	D	Undetermined		Caution
Metoprolol	C**	Undetermined		Compatible
Nadolol	C**	Undetermined		Compatible
Propranolol	C**	Undetermined		Compatible
Timolol	C**	Undetermined		Compatible
Neuromodulators
Gabapentin	C	Undetermined		Probably compatible
Topiramate	C	Undetermined		Caution
Semisodium valproate	D	Moderate		Compatible
Serotonin antagonists
Pizotifen	NA	Safety not established		Caution
Methysergide	X	Safety not established		Contraindicated
Calcium channel blockers
Flunarizine	NA	Safety not established		Contraindicated
Tricylics
Amitriptyline	C	Unlikely		Concern
Imipramine	C	Unllikely		Concern
Nortriptyline	C	Undetermined		Concern

FDA=US Food and Drug Administration.

NA= not applicable.

TERIS=Teratogen Information System (a consensus of expert opinion and literature that assesses teratogenic risk from drug exposure).

FDA ratings: A=controlled studies show no risk; B=no evidence of risk in humans; C=risk cannot be ruled out—use if benefit justifies potential risk; D=positive evidence of risk—use if benefits outweigh risk; X=contraindicated in pregnancy—risk outweighs any possible benefit. ** = rating D if used when pregnancy is prolonged or at term.

The FDA categories provide therapeutic guidance.