San Diego, CA San Diego, CA -Medical professionals is trying to determine the best treatment option for a pregnant woman suffering from headache, it could be beneficial to look over the results of randomized clinical studies (RCTs). So, take the information come from an RCT. There’s just been one, Northwestern Medicine obstetrician-gynecologist Catherine Stika, MD, told colleagues at the annual clinical and scientific meeting of the American College of Obstetricians and Gynecologists.
A single RCT with a high efficacy has looked at headaches during pregnancy, according to Stika. “Overall we’ve only few data on pregnancy to determine how to proceed,” she added.
However, ob.gyns. aren’t totally out of the loop, as per medical experts who participated in the discussion. Expert opinions and fetal health data provide insight into most effective treatments, and so do a brand updated ACOG Clinical Practice Guideline for headaches in pregnancy and postpartum, which was written by the presenters.
There’s a good thing that pregnancy itself can be an effective solution for headaches.
Pregnant women typically experience relief from one type of headache, migraine — as estradiol levels rise, says Laura Mercer, MD, an ob.gyn. located at the University of Arizona, Phoenix. “About half of patients declare that migraines improve from the beginning of the first trimester, and up to 83% of patients will state that their migraines are less severe at the point they’re in the third trimester” the researcher said. “What does this mean for us as obstetricians that we often have to cut off preventative treatments for pregnant patients.”
However, stopping every headache medication during pregnancy might not be the best approach, Mercer said. Instead, she suggested take into consideration the advantages and potential risks.
Divalproex sodium (Depakote) and topiramate (Topamax) should be avoided due to the the risk of fetal harm, she added. “In actual fact, we’ll prefer people to stop taking these drugs before stopping their contraception if they’re thinking of having a baby,” she said.
Other drugs, such as ACE inhibitors, as well as the herbal remedy known as feverfew are not recommended to be taken anytime in pregnancy. added.
On the other hand Antihistamines and calcium channel blockers are okay to take during the pregnancy period, she explained. “These two are the ones to be considered as first-line medications since there’s no risk associated with these drugs.”
Beta-blockers are also utilized “with an eye on the risks we are well-versed in when using these drugs for other reasons,” she said.
There are some questions regarding the dangers of taking oral magnesium during pregnancy, however it is generally regarded to be as safe, she explained as well “nerve blocks as well as nerve stimulators are to be very safe and carry no known dangers.”
Mercer suggested gradually tapering the majority of drugs prior to conception. It’s important to stop all high-risk drugs as soon as possible after the pregnancy is confirmed, she added.
For acute headaches, Stika urged caution if patients report taking headache medication for more than twice every week. “All the medicines we take to treat migraine, in and out of pregnancy, pose the possibility of overuse of medication” which can cause the occurrence of rebound headaches and migraines, she explained.
Excedrin Tension Headache can be used to treat headaches during the pregnancy period, she added however, not Excedrin Migraine since it contains aspirin. Triptans should not be used as the first-line treatment, she said and “should not be utilized for any pregnant woman with a history of hypertension or cardiac disease.”
Stika said that ACOG warns against using medications that contain butalbital, an anti-inflammatory drug that is combined with other drugs to treat headaches. “Butalbital is the medication which is the most frequently linked to the development of this anxiety,” Stika said. “It’s more harmful that opioids.”
Contrary to many other countries as well as the whole European Union, the United States has not banned any compounds that include butalbital, she added.
In some instances the patient might present with nausea, inability maintain a steady diet, or constant headache, regardless of treatment. “This is a very classic case.”
The ACOG clinical practice guidelines provide the flow chart for how to proceed in the event of a medical emergency, she explained. Hydration is essential for a healthy lifestyle, she added and different treatments can be helpful. The referral to neurology could be required in the most extreme instances she added. However “most often you’ll be able to relieve your headache.”
Mercer and Stika report not making any information about disclosures.
The story first appeared on MDedge.com which is one of the Medscape Professional Network.