Pregnancy & migraine don’t go together
WASHINGTON, APRIL 1, 2011: Gynecologists have recommended pregnant women having migraine history to opt for non-pharmacological options rather than going for the medications and drugs. The non-pharmacological alternatives include healthy lifestyles; daily exercise; regular and wholesome diet; massage; physical therapy; stress-reduction programs; and keeping oneself hydrated. Dr Susan Hutchinson has referred to also biofeedback and acupuncture (in her blog) as alternatives to medications.
It has also come to light that most pregnant women get good riddance of migraines. These patients are the ones having migraine without aura, i.e., sharp bouts of headaches accompanied by tingling feelings, seeing lights and nausea. What acts as shields are the steady and rather high levels of estrogen these women possess during that stage!
Nonetheless, there are many instances of pregnant women who do suffer from bouts of migraine. And, it is against this backdrop that they need to know about the various treatment plans which are to be put in place after due consultation with the doctor. Dr Hutchinson asks the patients to seek medical advice from the primary care provider or a specialist on headache.
The word ‘migraine’ refers to a severe form of headache that keeps on recurring. Migraine affects only one side of the head. It is generally accompanied by vomiting, sharp pain, visual disturbances and nausea.
The term ‘migraine’ is adopted from other terms tracing their roots to Middle English, Old French, and Late Latin hēmicrānia, and Greek hēmikrāniā where ‘hēmi-’ or ‘hemi-’ + ‘krānion’, refers to the head.
So, what is the ideal migraine treatment plan for pregnant women?
Basically, such a strategy involves having a fair idea of 1H and 3Ws much before one is pregnant. These are:
(a) How can pre-emptive measures be taken?
(b) What are the non-pharmacological treatments against migraine?
(c) What steps are to be initiated to tackle migraine during pregnancy?
Once you know the answers to these posers you can be sure of tackling this acute form of nagging headache.
Dr. Hutchinson, M.D., is a board-certified family practice physician and a headache specialist besides being the Director of the Orange County Migraine & Headache Center which she founded in January 2007. She is also in-charge of a panel in American Headache Society. The organization is formulating guidelines for the treatment of migraine during pregnancy. The project is the first of its kind as there are no such established guidelines on this score.
Dr Hutchinson prescribes the ‘occipital nerve block’ procedure for long bouts of migraine during pregnancy. She personally uses bupivacaine. This anesthetic is superficially injected in the “occipitalis” portion of the posterior scalp at the back of the head. It has triple benefit: the anesthetic generally brings instant relief for the patient; it does not affect the fetus; nor does it not get into the bloodstream of the patient. The effect of the anesthetic stays for one-two weeks.
Each obstetrician has customized medications to offer patients suffering acute migraine bouts during pregnancy. Dr. Hutchinson mentions some medications which can be a guide-list.
1. Imitrex and other Triptans (with prior approval from the obstetrician)
2. Phenergan, Reglan, and Zofran (to tackle nausea)
3. Caffeine (to lessen acute migraine strike)
4. Tylenol (acetaminophen)
5. Fioricet (Butalbital); Vicodin (hydrocodone); Tylenol with Codeine (To bale out patient in severe migraine bouts)
6. IV Zofran or Reglan IV Cortisone; IV Magnesium
7. IV (Intravenous) fluids
Among the drugs to be strictly avoided by the pregnant women having migraine are:
(a) Topamax. Studies have found this drug increasing the risk of cleft palate.
(b) Depakote
(c) Blood pressure medications like ACE inhibitors and ARB’s.
Similarly, the following medications need to be avoided:
(a) Hydrocodone and other narcotics
(b) Aspirin
(c) Migranal Nasal Spray; Ergostat; and Cafergot and similar ergotamines
(d) Motrin (Ibuprofen) and Aleve (Naproxen) and other anti-inflammatories
