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Headache and pregnancy: a systematic review.

A Negro1, Z Delaruelle2, T A Ivanova3

  • 1Department of Clinical and Molecular Medicine, Regional Referral Headache Centre, Sapienza University of Rome, Sant'Andrea Hospital, 00189, Rome, Italy. andrea.negro@uniroma1.it.

The Journal of Headache and Pain
|October 21, 2017
PubMed
Summary

Headaches during pregnancy require careful diagnosis, distinguishing primary from secondary causes. Early identification of serious conditions and prioritizing non-pharmacological treatments are crucial for maternal and fetal well-being.

Keywords:
Adverse eventsBreastfeedingComplicationsHeadacheMigrainePregnancyTreatment

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Area of Science:

  • Neurology
  • Obstetrics & Gynecology
  • Pharmacology

Background:

  • Headache during pregnancy encompasses primary and secondary types, with secondary headaches potentially indicating life-threatening conditions.
  • Common secondary headaches include stroke, cerebral venous thrombosis, subarachnoid hemorrhage, and preeclampsia.
  • Migraine is a known risk factor for pregnancy complications, particularly vascular events.

Purpose of the Study:

  • To systematically review current data on headache in pregnancy.
  • To analyze clinical phenotypes, diagnostic approaches, and treatment strategies.
  • To evaluate the effects of headache medications on the fetus and infant.

Main Methods:

  • Systematic literature review of existing data on headache and pregnancy.
  • Analysis of clinical presentations, diagnostic tools, and therapeutic interventions.
  • Assessment of medication safety during pregnancy and breastfeeding.

Main Results:

  • Early diagnosis is critical, emphasizing the identification of "red flag symptoms" for serious secondary headaches.
  • Diagnostic tools include EEG, ultrasound, MRI, MR angiography, ophthalmoscopy, and lumbar puncture.
  • Non-pharmacological treatments are preferred for primary headaches; medication use requires careful risk-benefit assessment.

Conclusions:

  • Headache in pregnancy necessitates prompt and accurate diagnosis to differentiate benign from dangerous causes.
  • Non-pharmacological interventions should be the first line of treatment for primary headaches.
  • Medication decisions during pregnancy and breastfeeding must balance maternal needs with fetal/infant safety.