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 Coordinated neurologic-obstetric care replaces outdated risk-averse practices with evidence-informed strategies that support maternal health.