Table 4 Summarizing table on treatment of headache in pregnant women
Medication | Adverse effects | Concerns | Comments |
|---|---|---|---|
Paracetamol | – | Possible increased risk for asthma, ADHD | Preferred acute treatment |
Nsaids (non-selective): ibuprofen, naproxen, diclofenac, indomethacin | - TR1: miscarriage - TR3: premature closure ductus arteriosus, impaired renal function, cerebral palsy, intraventricular haemorrhage | TR1: possible associated CM | - can be used safely during TR2 - avoid in TR3 - selective COX-inhibitors contra-indicated |
Triptans: sumatriptan, zolmitriptan, eletriptan, rizatriptan | No major congenital defects | TR1: possible link with behavioral problems | Appropriate if benefit outweighs risk |
Aspirin (ASA) | > 100 mg/d or TR3: premature closure of ductus arteriosus, oligohydramnios, neonatal bleeding | – | - < 100 mg/day seems safe - caution in TR1 and TR2 - avoid in TR3 |
Caffeine | – | Moderate to high daily doses: possible association with miscarriage, low birth weight, preterm delivery | – |
Combined preparations: paracetamol, aspirin and caffeine | – | – | Not recommended |
High flow oxygen | – | – | Preferred acute treatment in CH |
Lidocaine | – | – | - second line acute treatment in CH - intranasal formulation preferred |
Corticosteroids: prednisone, prednisolone | – | Possible early lung maturation | - avoid during first semester - low doses recommended - reserved for CH or status migrainosus |
Weak opioids: tramadol, codeine | - MOH - withdrawal symptoms and respiratory depression in the newborn | – | - not considered first line treatment in primary headaches - caution in TR1 and TR2 - avoid in TR3 |
Ergots/Ergots Alkaloids | - uterotonic and vasoconstrictive effect - fetal distress - CM | – | Avoid in any trimester |
Β-blockers: metoprolol, propranolol | Neonatal bradycardia, hypotension, hypoglycaemia when exposed in TR3 | - intrauterine growth retardation - preterm birth - respiratory distress | - first line migraine prophylaxis - if possible tapper off TR3 - monitor newborn exposed in TR3 |
ACE- I, ARB | CM | – | Avoid in any trimester |
Verapamil | – | – | First line CH profylaxis |
TCA | – | - possible CM (not confirmed) - withdrawal symptoms in the newborn | - second line migraine prophyaxis when β-blocker ineffective/contra-indicated - amytriptiline preferred |
Venlafaxine | CM | – | Should be avoided |
Duloxetine | – | – | No reported AE |
Valproate | Neural tube defects, cardiac defects, urinary tract defects, cleft palate, lower IQ scores | – | Avoid in any trimester |
Topiramate | Cleft lip/palate, low birth weight | – | Avoid in any trimester |
Gabapentin | – | Osteological deformities | Limited data |
Lamotrigine | No major congenital defects | Increased occurrence of autism/dyspraxia | Safest antiepileptic drug |
Magnesium | - high dose I.V.: bone abnormalities - possible transient neurological symptoms and hypotonia after delivery | Possible bone abnormalities in lower dosage or when taken orally | - appropriate in any trimester; caution directly before delivery - chronic use of oral magnesium: controversial |
Coenzyme Q10 | – | – | No reported AE |
Feverfew, butterbur, high dosed riboflavine | – | Possible CM | Not recommended |
Flunarizine | – | – | Not recommended (no data available) |
Lithium | - congenital cardiac malformations and cardiac arrhythmias - anomalies of the CNS and endocrine system - polyhydramnios - stillbirth | – | Not recommended but can be considered in uncontrolled CH refractory to Verapamil |
Botulinum toxin A | – | – | No reported AE when injected correctly |
Nerve blocks | – | – | - no reported AE when injected correctly - preferred agent: lidocaine |