As well as trying to identify and avoid migraine triggers, NICE offers some guidance on drug treatments in its Clinical Knowledge Summaries (CKS). Recommendations include:11

·      in adults: oral sumatriptan or other triptan (oro-dispersible ‘melt’ preparations if vomiting is likely), or NSAIDs such as ibuprofen, tolfenamic acid, naproxen, or diclofenac, but avoid ergot or opioids. An anti-emetic may be beneficial.

·      in people under 18 years: nasal sumatriptan or an NSAID may be suitable, but note that oral triptans are not licensed for use in people under 18 years. Metoclopramide may be used as an anti-emetic in people aged 12 and over, while prochlorperazine can be used by children under that age. Suppositories may be a better dosing option than oral routes.

Around 60-70 per cent of women migraineurs find that migraine symptoms improve during pregnancy, with a fifth experiencing no attacks. However, migraine can increase in severity for some or appear for the first time when pregnant. Drug treatment should be limited both in pregnancy and breast feeding, with non-pharmacological interventions used where possible.11

If medication is necessary for acute migraine in pregnancy, paracetamol is the first line option. A triptan (preferably sumatriptan) or ibuprofen (not in the third trimester) may be considered but discuss associated risks. No anti-emetics are licensed for use in pregnancy.