Management of Postpartum Headaches

First-Line Treatment Options for Postpartum Headaches

• The American College of Obstetricians and Gynecologists (ACOG) recommends NSAIDs such as ibuprofen as first-line treatment for postpartum pain after vaginal delivery 3
• ACOG recommends a stepwise approach starting with acetaminophen and NSAIDs before considering short-acting, low-potency opioids for the shortest duration possible for more severe pain after cesarean delivery 3

Role of Antiemetics in Postpartum Headache Management

• Prochlorperazine (Compazine) has fair evidence supporting its use as monotherapy for acute migraine attacks, particularly beneficial in patients with nausea and vomiting 1

Medications to Avoid in Postpartum Period

• Ergotamine and ergot alkaloids are contraindicated during pregnancy and should be used with caution in the postpartum period 1
• Opioids and butalbital-containing medications should be limited due to risks of dependency and medication-overuse headache 1, 3

Special Considerations

• Medication overuse headache can occur with frequent use of acute medications (≥15 days/month with NSAIDs; ≥10 days/month with triptans) 2
• For women with frequent and disabling migraines postpartum, propranolol has the best safety profile if preventive medication is required 2