What are the best therapies for acute migraine in pregnancy?
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No randomized controlled trials of pharmacologic therapy for acute migraine in pregnant women are available. Three treatment studies suggest that nonpharmacological therapies (combinations of skin warming, relaxation, biofeedback, and physical therapy) were effective for pain relief (strength of recommendation [SOR]: C, poor-quality cohort and case-control studies). Practice guidelines and most review articles recommend acetaminophen as the first-line therapy (SOR: C, expert opinion). Treatment modalities, including medications, should be chosen based on both effectiveness for nonpregnant patients and established pregnancy safety from surveillance studies.
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