Headaches in Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 3

Obstet Gynecol. 2022 May 1;139(5):944-972. doi: 10.1097/AOG.0000000000004766.


Purpose: To provide updated evidence-based recommendations for the evaluation and treatment of primary and secondary headaches in pregnancy and postpartum.

Target population: Pregnant and postpartum patients with a history of or experiencing primary or new secondary headaches.

Methods: This guideline was developed using an a priori protocol in conjunction with a writing team consisting of two specialists in obstetrics and gynecology appointed by the ACOG Committee on Clinical Practice Guidelines-Obstetrics and one external subject matter expert. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements.

Recommendations: This Clinical Practice Guideline includes recommendations on interventions to prevent primary headache in individuals who are pregnant or attempting to become pregnant, postpartum, or breastfeeding; evaluation for symptomatic patients presenting with primary and secondary headaches during pregnancy; and treatment options for primary and secondary headaches during pregnancy and lactation. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.

Publication types

  • Practice Guideline

MeSH terms

  • Breast Feeding
  • Female
  • Headache / diagnosis
  • Headache / etiology
  • Headache / therapy
  • Humans
  • Lactation
  • Obstetrics*
  • Postpartum Period*
  • Pregnancy