Treatment of Pregnant and Breastfeeding Patients with Acute Headache in the ED


Key Chapter Points

Most headaches occurring during pregnancy and breastfeeding are benign, ­primary headaches. Secondary headaches should be ruled out in pregnant and nursing women using necessary testing, including spinal fluid examination and neuroimaging, when appropriate. The anti-emetic of choice for pregnant and lactating women is ondansetron. Pain medication treatments of choice for pregnant women include intravenous therapy with ketorolac (second trimester only), magnesium, or hydromorphone. Intranasal lidocaine drops are safe and sometimes helpful for migraine. Pain medication treatments of choice for lactating women include subcutaneous sumatriptan or intravenous therapy with ketorolac, valproate (provided that reliable contraception can be ensured), magnesium, or hydromorphone. Ketorolac may also be given intramuscularly. Prochlorperazine can be used to help relieve both nausea and other migraine symptoms during lactation. Patients with residual headache after standard treatments may benefit from trigger point injections, a greater occipital nerve block, or a short course of prednisone.


Breastfeeding Conception Dehydration Lactation Nursing Pregnancy 


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of AnesthesiologyUniversity of PittsburghPittsburghUSA
  2. 2.Dean Health SystemsMadisonUSA

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