Managing Migraine During Pregnancy and Lactation

According to doctors at Wake Forest Baptist Medical Center, medications and treatments long considered safe to treat pregnant women with migraines may not be.

“We hope this review of medical treatments will serve as a guide for doctors and patients on how to interpret new findings, especially regarding four treatment options that doctors have commonly used for their pregnant patients with migraines,” said Rebecca Erwin Wells, M.D., assistant professor of neurology at Wake Forest Baptist and lead author of the paper.

“Patients and doctors need to be aware that concerns exist and they should carefully weigh the risks and benefits of these treatments.”

The review is published in the online issue of the journal Current Neurology and Neuroscience Reports.

The four treatment options of concern are:

  • Magnesium. Previously considered one of the safest supplements that could be used during pregnancy it is now rated at level D by the Food and Drug Administration (FDA), meaning that it may not be safe.
  • Ondansetron. It is not FDA approved for migraines but is frequently used off-label to treat the nausea and vomiting of pregnancy and migraines. Use during pregnancy has recently become a controversial issue due to concerns over fetal and maternal safety, but the data is not conclusive.
  • Acetaminophen. More than 65 percent of pregnant women in the United States report using it, but recent evidence suggests possible links between maternal acetaminophen use and pediatric development of attention deficit hyperactivity disorder.
  • Butalbital. A barbiturate used to treat headache in combination with caffeine, acetaminophen, aspirin and/or codeine, it is routinely prescribed for migraines in pregnancy. A small study suggests a potential increased risk of congenital heart defects.

Most women with migraines actually experience fewer headaches during pregnancy, especially during second and third trimesters, Wells said. And there are safe treatment options for women who keep having migraines during pregnancy and lactation. Headaches during pregnancy and lactation need to be taken seriously, and not all are migraines and may be due to a serious underlying condition.

“The most important thing is to talk to your doctor about your headaches during pregnancy and lactation. He or she can guide you on the available treatments and their safety, including non-pharmacologic options, such as healthy lifestyle habits, relaxation training, stress management, biofeedback, and possibly even meditation and yoga,” she said.

“There are many available treatment options for migraine during pregnancy and lactation, so patients can be assured that they will not suffer during this important time in their lives.”

New hope on headache ‘worse than childbirth’: world’s first fast track clinic for cluster condition opens.

Health experts today launch a world first as a major boost for people who suffer what is ranked the most painful medical condition known to humankind, with its pain described by a majority of female sufferers as worse than childbirth.

A new fast track clinic opens its doors to sufferers of cluster headache, who often must wait for their next appointment with a consultant, despite the start of a bout, the period during which individual attacks occur, or worsening symptoms. Instead, the clinic at Guy’s and St Thomas’s hospital in London, will see them within a week, after referral from their family doctor, and offer treatment and support intended to get their cluster headache under control.

It coincides with the first-ever awareness day on the condition, which affects four in 1,000 people and is as prevalent as multiple sclerosis and Parkinson’s disease. The day is staged by OUCH (UK), the Organisation for the Understanding of Cluster Headache, a member and partner of the European Headache Alliance, and the European Headache Federation. The clinic follows close liaison between OUCH (UK), sufferers, supporters and the pain management center at the hospital.

The word “cluster” refers to a period of time, lasting weeks or months, during which attacks come on a daily basis, with an increased number associated with seasonal changes and light hours in the day, peaking at the equinox.

People experience acute, sharp pain, usually behind the eye, together with other facial symptoms, such as a running or blocked nose, eye tears and facial swelling. Attacks, as many as eight a day, last up to three hours. Though most patients may have a remission period for a few months, without attacks, about 20 per cent face a chronic pattern of attacks, without any significant remission.

While no specific medication has yet been developed for the condition, a number of techniques and treatments can ease the pain and help people through their bout of attacks. But the biggest issue for patients is obtaining a correct diagnosis and timely access to a headache specialist.

Scott Bruce, a trustee of OUCH (UK), said: “As an episodic sufferer, being able to quickly and effectively seek assistance from specialist medical help is vital for good management of a condition that impacts greatly on my quality of life.

“As a trustee, who assists well over 2000 individual sufferers in Britain, this service will mean so much to every single one of them and their families”.

Dr Giorgio Lambru, headache neurologist in the headache centre at at Guy’s and St Thomas’s hospital, said: “There is an urgent need to significantly improve cluster headache care. We are adopting a new clinical approach, with a patient-initiated clinic, and we hope to foster collaboration at all levels of care, so we can manage this devastating condition better.”

Dr Anna Andreou, research director of the headache centre, said: “The ultimate cluster headache treatment is yet to be found. However, a number of interventions, delivered in a timely fashion, can help to provide relief for such a devastating condition.”

Professor Dimos Mitsikostas, president of the European Headache Federation, said that more than 600,000 people in Europe live with cluster headache, with under half seeing a specialist and more than a third missing work, costing €7 billion a year.

Professor Mitsikostas added: “Cluster headache is a brain disorder, requiring specific management, that only a specialist headache centre can offer.

“Such centres are highly lacking currently and the condition often remains undiagnosed for years, before a patient can get the right treatment.

“A fast-track cluster headache clinic is a great idea, since this is the major complaint of these patients. They need to be seen by an expert as soon as possible”.

Audrey Craven, past president of the European Headache Alliance, said: “We are pleased to support the launch of this fast track cluster headache clinic.

“Cluster headache is one of the worst pains known to man and it is vital that all those affected have access to appropriate treatment and care, to manage this devastating disorder.”

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