Neuromodulation for Headache Management in Pregnancy

Curr Pain Headache Rep. 2025 Jan 7;29(1):14. doi: 10.1007/s11916-024-01344-1.

Abstract

Purpose of review: Management of primary headache disorders during pregnancy is limited due to known teratogenicity or unknown safety of many currently available pharmaceutical therapies. Here, we explore the safety and efficacy of non-invasive neuromodulatory devices as another treatment modality for pregnant patients.

Recent findings: There are six FDA-cleared, non-invasive neuromodulatory devices currently available for the management of headache that include remote electrical neuromodulation (REN), noninvasive vagal nerve stimulation (nVNS), external trigeminal nerve stimulation (eTNS), single-pulse transcranial magnetic stimulation (sTMS), and external concurrent occipital and trigeminal neurostimulation (eCOT-NS). Neuromodulatory devices are a safe, effective, and well tolerated non-pharmacological option for migraine and other primary headache disorders. Although evidence of safety and tolerability use in pregnancy is limited, they may serve as a therapeutic alternative or adjunct to improve the care of our pregnant patients.

Keywords: Migraine; Neuromodulation; Non-pharmacological treatment; Pregnancy; Women’s health.

Publication types

  • Review

MeSH terms

  • Electric Stimulation Therapy / adverse effects
  • Electric Stimulation Therapy / instrumentation
  • Electric Stimulation Therapy / methods
  • Female
  • Headache* / therapy
  • Humans
  • Pregnancy
  • Pregnancy Complications* / therapy
  • Transcranial Magnetic Stimulation / adverse effects
  • Transcranial Magnetic Stimulation / instrumentation
  • Transcranial Magnetic Stimulation / methods
  • Vagus Nerve Stimulation / adverse effects
  • Vagus Nerve Stimulation / instrumentation
  • Vagus Nerve Stimulation / methods