What is the recommended approach to migraine medications during pregnancy?

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The main idea is that safety for both mother and baby guides migraine treatment in pregnancy. Acetaminophen is the first-line option for acute relief because it has the most favorable safety profile in pregnancy when used at the recommended doses. If acetaminophen alone doesn’t control the migraine, a triptan can be considered if needed, but this should be done after discussing risks with obstetrics since data exist but are more limited than for acetaminophen. Ergot alkaloids are avoided due to their potent vasoconstrictive effects and potential fetal harm. Valproate is avoided because of high teratogenic risk and long-term neurodevelopmental concerns. Nonsteroidal anti-inflammatory drugs are not preferred in all trimesters, particularly later in pregnancy, due to risks to fetal renal function and the ductus arteriosus. Across all options, using the lowest effective dose for the shortest duration and consulting obstetric care ensures safety for both mother and fetus.