As women found to have more incidence of migraine as compared to men, after the puberty and up to 70% of the women patients showed progression in headache severity during menstruation, pregnancy, menopause, and also during lactation. The management of migraine in pregnancy and lactation is a major challenge, and therefore investigations were made and found noteworthy evidence regarding some abortive and preventive treatments.

Evidence regarding abortive treatment for migraine during pregnancy and lactation:

During pregnancy -

• Ibuprofen shows significant efficacy during the first trimester.
• Metoclopramide is safe to use in pregnancy.
•  Triptans also did not exhibit any significant adverse events, and Sumatriptan provides the most supporting evidence.

During Lactation -

• Ibuprofen is known to reflect very low levels of medicine in breast milk, even after administrating in high doses and therefore is a preferred NSAID.
•  Eletriptan and Sumatriptan also exhibited low levels in breast milk.
• Naproxen is associated with adverse events such as vomiting and drowsiness in infants.
• Aspirin is associated with the risk of Reye’s syndrome.

Evidence regarding preventive treatment for migraine during pregnancy and lactation:

During pregnancy -

• Out of nutraceutical, 100 mg 3×/day Coenzyme Q10 and 400 mg/day Riboflavin provides significant outcomes if started three months ere pregnancy.
• Anticonvulsants, Topiramate and Valproic acid, should be avoided due to the associated risk of congenital birth defects,  and cognitive and motor impairment, respectively.
• Atenolol, a beta-blocker administration during the first trimester showed the risk of low birth weight. Other beta-blockers also need close fetal monitoring.
• Tricyclic antidepressants are known to lead craniofacial and cardiac malformations; however, serotonin-norepinephrine reuptake inhibitors not associated with such results.
• The use of Angiotensin receptor blockers and Angiotensin-converting enzyme inhibitors should also be avoided as it may lead to the skull, pulmonary, and renal malformations.

During Lactation -

•  Propranolol is safe because of their low maternal plasma levels.
• Topiramate is also safe during this period; however, valproic acid should be avoided. 
• Angiotensin receptor blockers and Angiotensin-converting enzyme inhibitors are related to the risk of having renal toxicity in premature infants.
• While using tricyclic antidepressants, infants should be monitored for poor feeding, anticholinergic side effects and sedation.
• Clinicians should think thoroughly before prescribing the medication for migraine in pregnancy, as prescriptions of true teratogens might cause undesirable manifestations, whereas, prescriptions misattributed as teratogens or as a lactation risk could not manage migraine properly.