Caution Urged for Pregnant Women with Migraine Choosing Treatment Medication

BY MAURY M. BREECHER
Contributing Writer

ORLANDO - (ECCC) Although pregnancy may provide some relief for women with migraines, it is important to carefully choose the medications to take when there is pain during this period, said Dr. Merle L. Diamond on July 19 at a symposium sponsored by the Diamond Headache Clinic Research and Education Foundation.

Dr. Diamond, associate director of the Diamond Headache Clinic of Chicago, had good news for the 25% of women who experience migraine during the childbearing years of ages 18-49. She reported that about 60% of all female migraine patients will experience less frequent migraines during their pregnancies, especially during their second and third trimesters.

"I always tell pregnant women that if we can get through the first 12 or 14 weeks, 'you'll do a lot better after that,'" said Dr. Diamond.

As many as 85% of migraine patients reported an improvement in headache during early pregnancy when three specific factors were present: their migraines began at menarche, their headaches were related to onset of menstruation menses, and their headaches were not accompanied by an aura.

Unfortunately, Dr. Diamond noted, pre-pregnancy headache patterns return almost immediately postpartum, and women with ongoing headache at the end of their first trimester are unlikely to have further headache reduction (Headache 1999;39:625-32).

While the impact of pregnancy on migraine is generally favorable, the impact of migraine on pregnancy appears benign.

Studies have shown no evidence of altered fertility, no increased incidence of toxemia, abnormal labor, miscarriage, congenital malformation, or still births (Neurology 1999;53:S26-S28 and Neurol. Clin. 1997;15:209-31).

Dr. Diamond reported that although some prescription and over-the-counter drugs may pose a small degree of risk to the fetus, few pregnant migraine sufferers can go 9 months without treatment for migraine pain, and there are headache pain medications that are proven safer than others.

Still, there are some prescription medications that should not be taken during pregnancy because of their known adverse effects, reported Dr. Diamond. Among those are phenytoin, valproic acid, and lithium carbonate.

While aspirin also is generally not recommended during pregnancy, acetaminophen remains the pain reliever of choice because it has shown no evidence of teratogenicity and only transient adverse effects on the uterus and on platelet function (Neurol. Clin. 1997;15:209-31). Caution is urged on the use of NSAIDs such as ibuprofen, ketoprofen, and naproxen in the first and second trimesters of pregnancy because the NSAID analgesic has been shown to cross the placenta. The use of these NSAIDS should be avoided in the third trimester.

Dr. Diamond said pregnant women should be recommended nonpharmacological treatments for migraines during all trimesters, such as rest, biofeedback, ice/heat, massage, exercise, folate, and avoiding migraine triggers.

It is also important for primary care providers to encourage their patients to use headache diaries to keep track of when a migraine might occur. If migraine is suspected, patients should start treatment 2 days before the anticipated headache and continue treatment through the vulnerable period.

Dr. Merle Diamond has indicated that she has served as a speaker and/or consultant, or has conducted research for AstraZeneca, GlaxoSmithKline, Merck, Ortho-McNeil, and Pfizer.

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