Advertisement

International Headache Management in Pregnancy and Lactation

  • Necdet KarlıEmail author
  • Nevra Öksüz
Chapter
Part of the Headache book series (HEAD)

Abstract

Headache is a common complaint in pregnancy and the postpartum period. Fortunately, most headaches seen during pregnancy are primary headache disorders (migraine, tension-type headache, and occasionally cluster headache). Secondary headache disorders (cerebral venous thrombosis, benign intracranial hypertension, posterior reversible encephalopathy syndrome, pituitary apoplexy, and preeclampsia) require a strict differential diagnosis for every case. As many drugs have potential harmful effects on the fetus and breast-fed infant, the management of headaches in these periods is difficult. It is essential for clinicians to make the diagnosis correctly regarding whether there is a primary or secondary headache and to be aware of the possible treatments of headaches during pregnancy without harming the fetus. The number of studies on medication use during pregnancy and lactation is limited, and pharmacological therapy and interventional management should therefore be considered and selected carefully in the absence of a response to non-pharmacological methods. Currently, there is no drug that has been proven to be reliable and efficacious in the treatment of primary and secondary headaches. In this respect, interventional options with less drug side effects such as nerve blocks and trigger point injections can be the method of choice.

Keywords

Headache Pregnancy Lactation Peripheral nerve block Interventional management 

References

  1. 1.
    Pearce CF, Hansen WF. Headache and neurologic disease in pregnancy. Clin Obstet Gynecol. 2012;55(3):810–28.CrossRefGoogle Scholar
  2. 2.
    Menon R, Bushnell CD. Headache and pregnancy. Neurologist. 2008;14(2):108–19.CrossRefGoogle Scholar
  3. 3.
    Robbins MS. Headache in pregnancy. Continuum (Minneap Minn). 2018;24(4, Headache):1092–107.  https://doi.org/10.1212/CON.0000000000000642.CrossRefGoogle Scholar
  4. 4.
    Govindappagari S, Grossman TB, Dayal AK, Grosberg BM, et al. Peripheral nerve blocks in the treatment of migraine in pregnancy. Obstet Gynecol. 2014;124(6):1169–74.CrossRefGoogle Scholar
  5. 5.
    Govindappagari S, Grossman TB, Dayal A, et al. Peripheral nerve blocks in pregnant patients with headache. Obstet Gynecol. 2014;123(5(Suppl)):147S.CrossRefGoogle Scholar
  6. 6.
    Blumenfeld A, Ashkenazi A, Grosberg B, Napchan U, et al. Patterns of use of peripheral nerve blocks and trigger point injections among headache practitioners in the USA: results of the American Headache Society Interventional Procedure Survey (AHS-IPS). Headache. 2010;50:937–42.CrossRefGoogle Scholar
  7. 7.
    Wells ER, Turner DP, Lee M, et al. Managing migraine during pregnancy and lactation. Curr Neurol Neurosci Rep. 2016;16:40.CrossRefGoogle Scholar
  8. 8.
    Robbins MS, Kuruvilla D, Blumenfeld A, Charleston IV, et al. Trigger point injections for headache disorders: expert consensus methodology and narrative review. Headache. 2014;54:1441–59.CrossRefGoogle Scholar
  9. 9.
    Morgan JC, Iyer SS, Moser ET, Singer C, Sethi KD. Botulinum toxin a during pregnancy: a survey of treating physicians. J Neurol Neurosurg Psychiatry. 2006;77:117–9.CrossRefGoogle Scholar
  10. 10.
    Miller S, Sinclair AJ, Davies B, et al. Neurostimulation in the treatment of primary headaches. Pract Neurol. 2016;16:362–75.CrossRefGoogle Scholar
  11. 11.
    Ambrosini A, Vandenheede M, Rossi P, et al. Suboccipital injection with a mixture of rapid- and long-acting steroids in cluster headache: a double-blind placebo-controlled study. Pain. 2005;118:92–6.CrossRefGoogle Scholar
  12. 12.
    Calandre EP, Hidalgo J, Garcia-Leiva JM, et al. Myofascial trigger points in cluster headache patients: a case series. Head Face Med. 2008;4:32.CrossRefGoogle Scholar
  13. 13.
    Antonaci F, Pareja JA, Caminero AB, Sjaastad O. Chronic paroxysmal hemicrania and hemicrania continua: anaesthetic blocks of pericranial nerves. Funct Neurol. 1997;12:11–5.PubMedGoogle Scholar
  14. 14.
    Guerrero AL, Herrero-Velazquez S, Penas ML, et al. Peripheral nerve blocks: a therapeutic alternative for hemicrania continua. Cephalalgia. 2012;32:505–8.CrossRefGoogle Scholar
  15. 15.
    Yalın OÖ, Uludüz D, Özge A. Peripheral nerve blocks for the treatment of short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) during pregnancy. Ağrı. 2018;30(1):28–30.PubMedGoogle Scholar
  16. 16.
    Inan N, Ceyhan A, Inan L, Kavaklioglu O, Alptekin A, Unal N. C2/C3 nerve blocks and greater occipital nerve block in cervicogenic headache treatment. Funct Neurol. 2001;16(3):239–43.PubMedGoogle Scholar
  17. 17.
    Karadaş Ö, Özön AÖ, Özçelik F, Özge A. Greater occipital nerve block in the treatment of triptan-overuse headache: a randomized comparative study. Acta Neurol Scand. 2017;15(4):426–33.CrossRefGoogle Scholar
  18. 18.
    Kent S, Mehaffey G. Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in obstetric patients. J Clin Anesth. 2016;34:194–6.CrossRefGoogle Scholar
  19. 19.
    Evans RW, Lee AG. Idiopathic intracranial hypertension in pregnancy. Headache. 2010;50:1513–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Uludag University Medical Faculty, Department of NeurologyBursaTurkey
  2. 2.Mersin University Medical Faculty, Department of NeurologyMersinTurkey

Personalised recommendations