. 2022 Apr 21;22(4):295–300. doi: 10.1136/practneurol-2021-003152

Table 2.

Acute headache recommendations in pregnancy

First line	Second line	Third line
Analgesic Paracetamol³³—recommended to use the lowest effective dose for the shortest time, as it might alter fetal development⁸⁶	Triptan if severe (sumatriptan has no documented teratogenicity⁸⁷)^{33 36 88}	Opiates—for limited use due to risks including: Medication overuse headache Neonatal abstinence syndrome⁸⁹ Possibly cleft palate⁹⁰
Antiemetic (short-term use) Cyclizine first line³⁶ (alternatives metoclopramide or prochlorperazine)^{36 88 91}	Ibuprofen—avoid in third trimester due to risk of premature closure of ductus arteriosus³³
Non-pharmacological treatments^{36 92}: Adequate hydration Reduced caffeine Sleep hygiene Behavioural medicine approaches and non-invasive stimulation devices⁹³	Greater occipital nerve blocks^{36 94}