Library
OB/GYN
·
easy
Migraines in Pregnancy
Flowchart
Play
Step-wise: lifestyle → acetaminophen → antiemetics/butalbital → NSAIDs (2nd trimester) → opioids.
Decision
Outcome
Decision
Pregnant patient with migraine. First-line?
✓
Non-pharmacologic: rest, hydration, heat
✗
Triptan
✗
Ergot
Decision
Next?
✓
Acetaminophen
Decision
Still refractory?
✓
Antiemetic (promethazine) ± codeine ± caffeine/butalbital
Decision
Still refractory?
✓
NSAIDs (2nd trimester only)
Decision
Refractory severe?
✓
Opioid (oxycodone) sparingly
Outcome
Reserve opioids for severe refractory; consider preventive therapy if frequent
Preventives: β-blockers (labetalol/propranolol), magnesium, cyproheptadine; avoid valproate.