Table 2.

Pharmacologic recommendations for treatment of cluster headache in pregnant or lactating women

	FDA pregnancy category	AAP lactation category	Authors' recommendation	Note
Acute abortive therapy
Oxygen	N/A	N/A	First line for both pregnancy and lactation	–
Sumatriptan (intranasal)	C	6: usually compatible	Second line for both pregnancy and lactation	If oxygen is not a choice or ineffective, sumatriptan would be an appropriate first-line consideration for both pregnancy and lactation.
Lidocaine (intranasal)	B	6: usually compatible	Second line for both pregnancy and lactation	If oxygen is not a choice or ineffective, lidocaine would be an appropriate first-line consideration for both pregnancy and lactation.
Metoclopramide	B	4: may be of concern	Third line during pregnancy and lactation	Metoclopramide has not been proven effective for CH and thus is listed as third line despite its relative safety in pregnancy; safety is of greater concern in lactation.
Bridge therapy
GON blockade (using lidocaine and betamethasone)	B/C	6: usually compatible	First line for both pregnancy and lactation	Lidocaine is Category B, and betamethasone is Category C in pregnancy.
Steroids	C	6: usually compatible	Second line for both pregnancy and lactation	–
Preventive therapy
Verapamil	C	6: usually compatible	First line for both pregnancy lactation	–
Steroids	C	6: usually compatible	First line for both pregnancy and lactation	–
Topiramate	C	Has not been reviewed by the AAP	Second line for pregnancy; inadequate information to make recommendation for lactation	Studies, limited by open-label design or small numbers, suggest topiramate may be an effective preventive in CH; definitive trials are needed.
Lithium	D	5: caution	Third line for both pregnancy and lactation; should be used only when benefit clearly exceeds risk	–

AAP American Academy of Pediatrics, CH cluster headache, FDA US Food and Drug Administration, GON greater occipital nerve