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 treatments36 92: Adequate hydration Reduced caffeine Sleep hygiene Behavioural medicine approaches and non-invasive stimulation devices93	Greater occipital nerve blocks36 94