Headaches in pregnancy


Authors: A. Rajdová 1,2;  E. Vlčková 1,2;  I. Niedermayerová 1,3;  A. Šprláková-Puková 2,4;  J. Bednařík 1,2
Authors‘ workplace: Neurologická klinika, Centrum pro, diagnostiku a léčbu bolestí hlavy, FN Brno 1;  LF MU, Brno 2;  Neurologie Brno s. r. o. 3;  Klinika radiologie a nukleární, medicíny FN Brno 4
Published in: Cesk Slov Neurol N 2020; 83/116(3): 269-276
Category: Review Article
doi: https://doi.org/10.14735/amcsnn2020269

Overview

The headache during pregnancy represents a specific issue. This complaint is quite common, but the treatment possibilities are limited at that period. In general, the incidence of secondary headaches including serious or life-threatening conditions may increase during pregnancy. Headache may also represent the first symptom of serious systemic complications of pregnancy. This article thus provides an overview of primary and secondary headache disorders, available diagnostic methods and therapeutic options in pregnant women. If the headache occurs for the first time in a pregnant woman, it is necessary to rule out serious secondary types of headache, e.g., pre-eclampsia, cerebral venous sinus thrombosis or intracerebral haemorrhage, which can be life-threatening. In contrast, primary headaches usually improve during pregnancy. About 70% of female patients suffering from primary headache disorders (especially migraine without aura) report improvement or complete remission of migraine attacks during pregnancy. The rest of women requires proper acute or prophylactic therapy, which is rather complicated with regard to teratogenic effect of many drugs.

Keywords:

headache – pregnancy – Migraine – pre-eclampsia – intracranial sinus thrombosis – diagnostic imaging


Sources

1. Skliut M, Jamieson DG. Imaging of headache in pregnancy. Curr Pain Headache Rep 2016; 20 (10): 56. doi: 10.1007/s11916-016-0585-5.

2. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018; 38 (1): 1–211. doi: 10.1177/0333102417738202.

3. Rasmussen BK, Jensen R, Schroll M et al. J. Epidemiology of headache in a general population – a prevalence study. J Clin Epidemiol 1991; 44 (11): 1147–1157.

4. Faubio­n SS, Batur P, Calhoun AH. Migraine throughout the female reproductive life cycle. Mayo Clin Proc 2018; 93 (5): 639–645. doi: 10.1016/j.mayocp.2017.11.027.

5. Marková J. Migréna. Cesk Slov Neurol N 2009; 72/105 (3): 207–215.

6. Jay GW, Barkin RL. Primary headache disorders – part 2: tension-type headache and medication overuse headache. Dis Mon 2017; 63 (12): 342–367. doi: 10.1016/j.disamonth.2017.05.001.

7. Silberstein SD. Sex hormones and headache. Rev Neurol (Paris) 2000; 156: 4S30–4S41.

8. Kvisvik EV, Stovner LJ, Helde G et al. Headache and migraine during pregnancy and puerperium: the MIGRAstudy. J Headache Pain 2011; 12 (4): 443–451. doi: 10.1007/s10194-011-0329-1.

9. Sances G, Granella F, Nappi RE et al. Course of migraine during pregnancy and postpartum: a prospective study. Cephalalgia 2003; 23 (3): 197–205.

10. Aegidius K, Zwart JA, Hagen K et al. The effect of pregnancy and parity on headache prevalence: the Head-HUNT study. Headache 2009; 49: 851–859. doi: 10.1111/j.1526-4610.2009.01438.x.

11. Peterová V, Kron M, Vojtěchová A et al. Migréna v těhotenství. Cesk Slov Neurol N 2008; 71/104 (3): 336–341.

12. Martin VT, Behbehani M. Ovarian hormones and migraine headache: understanding mechanisms and pathogenesis – part 2. Headache 2006; 46 (3): 365–386.

13. Marcus DA, Scharff L, Turk D. Longitudinal prospective study of headache during pregnancy and postpartum. Headache 1999; 39: 625–632.

14. Státní ústav pro kontrolu léčiv (SUKL). Metamizol – dávkování, použití v těhotenství a během kojení. [online]. Dostupné z URL: http: //www.sukl.cz/metamizol-davkovani-pouziti-v-tehotenstvi-a-behem-kojeni?highlightWords=algifen.

15. Anderka M, Mitchell AA, Louik C et al. Medications used to treat nausea and vomiting of pregnancy and the risk of selected birth defects. Birth Defects Res A Clin Mol Teratol 2012; 94 (1): 22–30. doi: 10.1002/bdra.22865.

16. Ephross SA, Sinclair SM. Final results from the 16-year sumatriptan, naratriptan, and treximet pregnancy registry. Headache 2014; 54: 1158–1172. doi: 10.1111/head.12375.

17. Marchenko A, Etwel F, Olutunfese O et al. Pregnancy outcome following prenatal exposure to triptan medications: a meta-analysis. Headache 2015; 55: 490–501. doi: 10.1111/head.12500.

18. Spielmann K, Kayser A, Beck E et al. Pregnancy outcome after anti-migraine triptan use: a prospective observational cohort study. Cephalalgia 2018; 38 (6): 1081–1092. doi: 10.1177/0333102417724152.

19. Narayan B, Nelson-Piercy C. Medical problems in pregnancy. Clin Med (Lond) 2016; 16 (Suppl 6): s110–s116.

20. Schoen JC, Campbell RL, Sadosty AT. Headache in pregnancy: an approach to emergency department evaluation and management. West J Emerg Med 2015; 16 (2): 291–301. doi: 10.5811/westjem.2015.1.23688.

21. Marková J, Linhartová A. Léčba migrény během gravidity a kojení. Neurol praxi 2010; 11 (5): 300–303.

22. Bussiere JL, Davies R, Dean C et al. Nonclinical safety evaluation of erenumab, a CGRP receptor inhibitor for the prevention of migraine. Regul Toxicol Pharmacol 2019; 106: 224–238. doi: 10.1016/j.yrtph.2019.05.013.

23. Facchinetti F, Allais G, Nappi RE et al. Migraine is a risk factor for hypertensive disorders in pregnancy: a prospective cohort study. Cephalalgia 2009; 29: 286–292. doi: 10.1111/j.1468-2982.2008.01704.x.

24. Wells RE, Turner DP, Lee M et al. Managing migraine during pregnancy and lactation. Curr Neurol Neurosci Rep 2016; 16 (4): 40. doi: 10.1007/s11910-016-0634-9.

25. Bushnell CD, Jamison M, James AH. Migraine during pregnancy linked to stroke and vascular diseases: US population based casecontrol study. BMJ 2009; 338: b664. doi: 10.1136/bmj.b664.

26. Chen HM, Chen SF, Chen YH et al. Increased risk of adverse pregnancy outcomes for women with migraines: a nationwide population-based study. Cephalalgia 2010; 30: 433–438. doi: 10.1111/j.1468-2982.2009.01935.x.

27. Cozzolino M, Bianchi C, Mariani G et al. Therapy and differential dia­gnosis of posterior reversible encephalopathy syndrome (PRES) during pregnancy and postpartum. Arch Gynecol Obstet 2015; 292 (6): 1217–1223. doi: 10.1007/s00404-015-3800-4.

28. Jura R, Šrotová I, Adamová B et al. PRES (Posterior reversible encefalopathy syndrome) in a pre-eclamptic woman with twin pregnancy – case report. Anest intenziv Med 2015; 26 (3): 156–160.

29. Leach JL, Fortuna RB, Jones BV et al. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and dia­gnostic pitfalls. Radiographics 2006; 26: S19–S43.

30. de Heide LJ, van Tol KM, Doorenbos B. Pituitary apoplexy presenting during pregnancy. Neth J Med 2004; 62: 393–396.

31. Macháčková M, Látr I, Hejcmanová D. Oční manifestace u pituitární apoplexie – kazuistika. Cesk Slov Neurol N 2009; 72/105 (5): 456–460.

32. Algra AM, Klijn CJ, Helmerhorst FM et al. Female risk factors for subarachnoid hemorrhage: a systematic review. Neurology 2012; 79: 1230–1236. doi: 10.1212/WNL.0b013e31826aace6.

33. Bateman BT, Olbrecht VA, Berman MF et al. Peripartum subarachnoid hemorrhage: nationwide data and institutional experience. Anesthesiology 2012; 116: 324–333. doi: 10.1097/ALN.0b013e3182410b22.

34. Falardeau J, Lobb BM, Golden S et al. The use of acetazolamide during pregnancy in intracranial hypertension patients. J Neuroophthalmol 2013; 33 (1): 9–12. doi: 10.1097/WNO.0b013e3182594001.

35. Kesler A, Kupferminc M. Idiopathic intracranial hypertension and pregnancy. Obstet Gynecol 2013; 56 (2): 3389–3396. doi: 10.1097/GRF.0b013e31828f2701.

36. Adriani KS, Brouwer MC, van der Ende A et al. Bacterial meningitis in pregnancy: report of six cases and review of the literature. Clin Microbio­l Infec 2012; 18: 345–351. doi: 10.1111/j.1469-0691.2011.03465.x.

37. Sattar A, Manousakis G, Jensen MB. Systematic review of reversible cerebral vasoconstriction syndrome. Expert Rev Cardiovasc Ther 2010; 8 (10): 1417–1421. doi: 10.1586/erc.10.124.

Labels
Paediatric neurology Neurosurgery Neurology General practitioner for adults

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 3

2020 Issue 3

Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account