Skip to main content

Advertisement

SpringerLink
Log in

Headache in pregnancy

  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

Conventional wisdom teaches that chronic headaches typically improve and often abate during pregnancy, leading many clinicians to take a wait-and-see approach of delaying treatment in hopes of seeing spontaneous improvement. Although headaches do improve in later pregnancy for up to 50% of chronic headache sufferers, headaches persist and may even worsen for the remainder. Clinicians must recognize that treating headache during pregnancy is important in order to limit excessive use of over-the-counter pain remedies, dehydration, and painrelated disability. Safe and effective medication and nonmedication treatment options are available for the pregnant headache sufferer, including both acute care and preventive therapies. Care of the pregnant headache patient should begin before she is known to be pregnant, when the fertile female is initially established as a patient. Preconception planning should include modification of medication regimes to include medications safe for use during early pregnancy, when the woman may not yet realize she is pregnant, and effective nonmedication therapies, such as relaxation, biofeedback, and lifestyle modification.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Dalsgaard-Nielsen T: Some aspects of the epidemiology of migraine in Denmark. Headache 1970, 10:14–23.

    Article  PubMed  CAS  Google Scholar 

  2. Kelman L: Women’s issues of migraine in tertiary care. Headache 2004, 44:2–7.

    Article  PubMed  Google Scholar 

  3. Amir BY, Yaacov B, Guy B, et al.: Headaches in women undergoing in vitro fertilization and embryo-transfer treatment. Headache 2005, 45:215–219.

    Article  PubMed  Google Scholar 

  4. Callaghan N: The migraine syndrome in pregnancy. Neurology 1968, 18:197–199.

    PubMed  CAS  Google Scholar 

  5. Granella F, Sances G, Zanferrari C, et al.: Migraine without aura and reproductive life events: a clinical epidemiological study in 1300 women. Headache 1993, 33:385–389.

    Article  PubMed  CAS  Google Scholar 

  6. Chen TC, Leviton A: Headache recurrences in pregnant women with migraine. Headache 1994, 34:107–110.

    Article  PubMed  CAS  Google Scholar 

  7. Maggioni F, Alessi C, Maggino T, et al.: Primary headaches and pregnancy. Cephalalgia 1995, 15:54.

    Article  Google Scholar 

  8. Sances G, Granella F, Nappi RE, et al.: Course of migraine during pregnancy and postpartum: a prospective study. Cephalalgia 2003, 23:197–205.

    Article  PubMed  CAS  Google Scholar 

  9. Marcus DA, Scharff L, Turk DC: Longitudinal prospective study of headache during pregnancy and postpartum. Headache 1999, 39:625–632.

    Article  PubMed  CAS  Google Scholar 

  10. Stein GS: Headaches in the first post partum week and their relationship to migraine. Headache 1981, 21:201–205.

    Article  PubMed  CAS  Google Scholar 

  11. Stein GS, Morton J, Marsh A, et al.: Headaches after childbirth. Acta Neurol Scand 1984, 69:74–79.

    Article  PubMed  CAS  Google Scholar 

  12. Thompson JF, Roberts CL, Currie M, Ellwood DA: Prevalence and persistence of health problems after childbirth: associations with parity and method of birth. Birth 2002, 29:89–94.

    Article  Google Scholar 

  13. James AH, Bushnell CD, Jamison MG, Myers ER: Incidence and risk factors for stroke in pregnancy and the puerperium. Obstet Gynecol 2005, 106:509–516.

    PubMed  Google Scholar 

  14. Marcus DA: Headache in pregnancy. Curr Pain Headache Rep 2003, 7:288–296.

    Article  PubMed  Google Scholar 

  15. Davis LE: Normal laboratory values of CSF during pregnancy. Arch Neurol 1979, 36:443.

    PubMed  CAS  Google Scholar 

  16. American College of Radiology. ACR white paper on magnetic resonance (MR) safety. Combined papers of 2002 and 2004. Available at: www.acr.org. Accessed April 5, 2006.

  17. Gomes KR, Moron AF, Silva R, Siqueira AA: Prevalence of use of medicines during pregnancy and its relationship to maternal factors [in Portuguese]. Rev Saude Publica 1999, 33:246–254.

    PubMed  CAS  Google Scholar 

  18. Damase-Michel C, Lapeyre-Mestre M, Moly C, et al.: Drug use during pregnancy: survey in 250 women consulting at a university hospital center [in French]. J Gynecol Obstet Biol Reprod (Paris) 2000, 29:77–85.

    CAS  Google Scholar 

  19. Fonseca MR, Fonseca E, Bergsten-Mendes G: Prevalence of drug use during pregnancy: a pharmacoepidemiological approach [in Portuguese]. Rev Saude Publica 2002, 36:205–212.

    PubMed  Google Scholar 

  20. Medina JL, Diamond S: The role of diet in migraine. Headache 1978, 18:31–34.

    Article  PubMed  CAS  Google Scholar 

  21. Mosek A, Korczyn AD: Yom Kippur headache. Neurology 1995, 45:1953–1955.

    PubMed  CAS  Google Scholar 

  22. Topacoglu H, Karcioglu O, Yuruktumen A, et al.: Impact of Ramadan on demographics and frequencies of disease-related visits in the emergency department. Int J Clin Pract 2005, 59:900–905.

    Article  PubMed  CAS  Google Scholar 

  23. Kohlenberg RT, Cahn T: Self-help treatment for migraine headaches: a controlled outcome study. Headache 1981, 21:196–200.

    Article  PubMed  CAS  Google Scholar 

  24. Mitchell KR, White RG: Control of migraine headache by behavioral self-management: a controlled case study. Headache 1976, 16:178–184.

    Article  PubMed  CAS  Google Scholar 

  25. Cordingley G, Holrody K, Pingel J, et al.: Amitriptyline versus stress management therapy in the prophylaxis of chronic tension headache. Headache 1990, 30:300.

    Google Scholar 

  26. French DJ, Holroyd KA, Pinell C, et al.: Perceived self-efficacy and headache-related disability. Headache 2000, 40:647–656.

    Article  PubMed  CAS  Google Scholar 

  27. Christian P, West KP Jr, Katz J, et al.: Cigarette smoking during pregnancy in rural Nepal. Risk factors and effects of beta-carotene and vitamin A supplementation. Eur J Clin Nutr 2004, 58:204–211.

    Article  PubMed  CAS  Google Scholar 

  28. Kallen B, Lygner PE: Delivery outcome in women who used drugs for migraine during pregnancy with special reference to sumatriptan. Headache 2001, 41:351–356.

    Article  PubMed  CAS  Google Scholar 

  29. Drug use and dependence. In The Merck Manual of Diagnostics and Therapeutics, edn 17, section 15, chapter 195. Edited by Beers MH, Berkow R. Available at: www.merck.com/pubs. Accessed October 13, 2006.

  30. Jones J, Pack S, Chun E: Intramuscular prochlorperazine versus metoclopramide as single-agent therapy for the treatment of acute migraine headache. Ann Emerg Med 1996, 14:262–264.

    Article  CAS  Google Scholar 

  31. Coppola M, Yealy DM, Leibold RA: Randomized, placebo-controlled evaluation of prochlorperazine versus metochlorpramide for emergency department treatment of migraine headache. Ann Emergy Med 1995, 26:541–546.

    Article  CAS  Google Scholar 

  32. Linde K, Rossnagel K: Propranolol for migraine prophylaxis. Cochrane Database Syst Rev 2004, 2:CD003225.

  33. Van de Venn LL, Franke CL, Koehler PJ: Prophylactic treatment of migraine with bisoprolol: a placebo-controlled study. Cephalalgia 1997, 17:596–599.

    Article  Google Scholar 

  34. Hemels ME, Einarson A, Koren G, et al.: Antidepressant use during pregnancy and the rates of spontaneous abortions: a meta-analysis. Ann Pharmacother 2005, 39:803–809.

    Article  PubMed  Google Scholar 

  35. Bank J: A comparative study of amitriptyline and fluvoxamine in migraine prophylaxis. Headache 1994, 34:476–478.

    Article  PubMed  CAS  Google Scholar 

  36. D’Amato CC, Pizza V, Marmolo T, et al.: Fluoxetine for migraine prophylaxis: a double-blind study. Headache 1999, 39:716–719.

    Article  PubMed  CAS  Google Scholar 

  37. Amelin AV, Skoromets AA, Korenko KA, et al.: A comparative efficiency of amitriptyline, fluoxetine, and maprotiline in prevention of migraine in attack-free period [in Russian]. Zh Nevrol Psikhiatr Im S S Korsakova 2000, 100:20–23.

    PubMed  CAS  Google Scholar 

  38. Kulin NA, Pastuszak A, Sage SR, et al.: Pregnancy outcome following maternal use of the new selective serotonin reuptake inhibitors: a prospective controlled multicenter study. JAMA 1998, 279:609–610.

    Article  PubMed  CAS  Google Scholar 

  39. Simpkins JW, Field FP, Torosian G, Soltis EE: Effects of prenatal exposure to tricyclic antidepressants on adrenergic responses in progeny. Dev Pharmacol Ther 1985, 8:17–33.

    PubMed  CAS  Google Scholar 

  40. Goodman JF: Treatment of headache with bupropion. Headache 1997, 37:256.

    Article  PubMed  CAS  Google Scholar 

  41. Pinsker W: Potentially safe and effective new treatment for migraine? Headache 1998, 38:58.

    PubMed  CAS  Google Scholar 

  42. Bupropion (amfebutaone): caution during pregnancy. Prescrire Int 2005, 14:225.

  43. Chun-Fai-Chan B, Koren G, Fayez I, et al.: Pregnancy outcome of women exposed to bupropion during pregnancy: a prospective comparative study. Am J Obstet Gynecol 2005, 192:932–936.

    Article  PubMed  CAS  Google Scholar 

  44. Mathew NT, Rapoport A, Saper J, et al.: Efficacy of gabapentin in migraine prophylaxis. Headache 2001, 41:119–128.

    Article  PubMed  CAS  Google Scholar 

  45. Montouris G: Gabapentin exposure in human pregnancy: results from the Gabapentin Pregnancy Registry. Epilepsy Behav 2003, 4:310–317.

    Article  PubMed  Google Scholar 

  46. Wilton LV, Shakir S: A postmarketing surveillance study of gabapentin as add-on therapy for 3,100 patients in England. Epilepsia 2002, 43:983–992.

    Article  PubMed  Google Scholar 

  47. Hedman C, Pohjasvaara T, Tolonen U, et al.: Effects of pregnancy on mothers’ sleep. Sleep Med 2002, 3:37–42.

    Article  PubMed  CAS  Google Scholar 

  48. Kelman L, Rains JC: Headache and sleep: examination of sleep patterns and complaints in a large clinical sample of migraineurs. Headache 2005, 45:904–910.

    Article  PubMed  Google Scholar 

  49. Bag B, Karabulut N: Pain-relieving factors in migraine and tension-type headache. Int J Clin Pract 2005, 59:760–763.

    Article  PubMed  CAS  Google Scholar 

  50. Peres MP, Zukerman E, da Cunha Tanuri F, et al.: Melatonin, 3 mg, is effective for migraine prevention. Neurology 2004, 63:757.

    PubMed  CAS  Google Scholar 

  51. Holroyd KA, Penzien DB: Pharmacological versus nonpharmacological prophylaxis of recurrent migraine headache: a meta-analytic review of clinical trials. Pain 1990, 42:1–13.

    Article  PubMed  CAS  Google Scholar 

  52. Marcus DA, Scharff L, Turk DC: Nonpharmacological management of headaches during pregnancy. Psychosom Med 1995, 57:527–535.

    PubMed  CAS  Google Scholar 

  53. Scharff L, Marcus DA, Turk DC: Maintenance of effects in the nonmedical treatment of headaches during pregnancy. Headache 1996, 36:285–290.

    Article  PubMed  CAS  Google Scholar 

  54. Marcus DA: 10 Simple Solutions to Migraine. Recognize Triggers, Control Symptoms & Reclaim Your Life. Oakland, CA: New Harbinger Publications; 2006.

    Google Scholar 

  55. Marcus DA: Nonpharmacologic treatment of migraine. Econ Neurosci 2001, 3:1–6.

    Google Scholar 

  56. Marcus DA, Scharff L, Mercer S, Turk DC: Nonpharmacological treatment for migraine: incremental utility of physical therapy with relaxation and thermal biofeedback. Cephalalgia 1998, 18:266–272.

    Article  PubMed  CAS  Google Scholar 

  57. Köseoglu E, Akboyraz A, Soyuer A, Ersoy AÖ: Aerobic exercise and plasma beta endorphin levels in patients with migrainous headache without aura. Cephalalgia 2003, 23:972–976.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pain Evaluation and Treatment Institute, 5750 Centre Avenue, Pittsburgh, PA, 15206, USA

    Dawn A. Marcus

Authors
  1. Dawn A. Marcus
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dawn A. Marcus.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Marcus, D.A. Headache in pregnancy. Curr Treat Options Neurol 9, 23–30 (2007). https://doi.org/10.1007/s11940-007-0027-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11940-007-0027-0

Keywords

Search

Navigation