How can you prevent migraines during pregnancy?
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No randomized controlled trials (RCT) have addressed pharmacologic prophylaxis of migraine for pregnant women. Two studies suggest that nonpharmacologic therapies (combinations of skin warming, relaxation, biofeedback, and physical therapy) not only relieved acute pain, but also decreased the frequency of headaches (strength of recommendation [SOR]: B, poor-quality cohort and RCTs). Practice guidelines and most review articles recommend avoiding prophylactic medications if possible. If a medication must be used, base the selection on both effectiveness for nonpregnant patients and established pregnancy safety from surveillance studies (SOR: C, expert opinion).
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