How to effectively manage primary Headaches in Pregnancy?
Effective Health Care Program has released pharmacologic and nonpharmacologic interventions to prevent or treat attacks of primary headaches (migraine, tension headache, cluster headache, and other trigeminal autonomic cephalgias) in women who are pregnant (or attempting to become pregnant), postpartum, or breastfeeding.
Evidence regarding the benefits and harms of all interventions in women who are pregnant (or attempting to become pregnant), postpartum, or breastfeeding is insufficient, or at best of low strength of evidence. Future research is needed to identify the most effective and safe interventions for preventing or treating primary headaches in these populations of women.of all interventions in women who are pregnant (or attempting to become pregnant), postpartum, or breastfeeding is insufficient, or at best of low strength of evidence. Future research is needed to identify the most effective and safe interventions for preventing or treating primary headaches in these populations of women.
- Prevention of primary headache in women who are pregnant (or attempting to become pregnant), postpartum, or breastfeeding with a history of primary headache
- Pharmacologic and nonpharmacologic interventions
- There is no evidence regarding the effectiveness of any pharmacologic or nonpharmacologic intervention in women who are pregnant (or attempting to become pregnant), postpartum, or breastfeeding.
- A single primary study provided insufficient (direct) evidence to make conclusions about the harms of topiramate when used for preventing primary headache during pregnancy, but use during pregnancy outside the primary headache context (indirect evidence) suggests increased risk of fetal/child adverse effects. Indirect evidence also suggests that other antiepileptics, such as carbamazepine, gabapentin, and valproate may have similar adverse effect profiles, but lamotrigine may have a low risk of adverse effects.
- Venlafaxine, tricyclic antidepressants (any), benzodiazepines (any), beta blockers (any), prednisolone, and oral magnesium use during pregnancy may have increased risk of fetal/child adverse effects, but calcium channel blockers (any, but nifedipine in particular) and antihistamines (any) may have a low risk of adverse effects (indirect evidence).
- Treatment of patients with acute attacks of primary headache in women who are pregnant (or attempting to become pregnant), postpartum, or breastfeeding
- Pharmacologic interventions
- Use of triptans for migraine during pregnancy may not be more harmful than their use before pregnancy (both direct and systematic review evidence). Compared with nonuse (either during or before pregnancy), triptan use may not be associated with spontaneous abortions or congenital anomalies, but may be associated with worse child emotionality and activity outcomes at 3 years of age.
- A single primary study found that compared with oral codeine, combination metoclopramide and diphenhydramine may be more effective to reduce migraine or tension headache severity during pregnancy, and may not be associated with greater serious or nonserious maternal harms; fetal/child harms were not reported. Indirect evidence found that antihistamines (any) during pregnancy (used for indications other than primary headache) may have a low risk of adverse effects.
- Systematic reviews of harms (regardless of indication) report that acetaminophen, prednisolone, indomethacin, ondansetron, antipsychotics (any), and intravenous magnesium use during pregnancy may be associated with fetal/child adverse effects, but low-dose aspirin use may not be associated with increased risk of adverse effects.
- Nonpharmacologic interventions
- There is insufficient direct evidence to make conclusions about the benefits or harms of acupuncture, thermal biofeedback, relaxation therapy, physical therapy, peripheral nerve blocks, and transcranial magnetic stimulation when used for treatment of primary headache during pregnancy.
- No indirect evidence regarding harms of nonpharmacologic interventions in pregnancy was identified.
https://effectivehealthcare.ahrq.gov/products/headaches-pregnancy/research
