An Update in the Treatment of Neurologic Disorders During Pregnancy—Focus on Migraines and Seizures

Williams, Shannon H; Kehr, Heather A.

doi:10.1177/0897190012442068

Cited by 5 publications

(3 citation statements)

References 47 publications

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“…In the rizatriptan registry 4 major birth malformations occurred in 56 pregnancies (7.1%). Also in this case data are currently too scarce to draw any conclusion [ 56 , 70 ]. Observational studies conducted in Denmark, Sweden and Norway reported no increased risk for fetal malformations under triptan use [ 67 , 71 – 73 ].…”

Section: Treatment Of Headaches In Pregnancy and Breastfeeding Womenmentioning

confidence: 99%

Headache and pregnancy: a systematic review

et al. 2017

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This systematic review summarizes the existing data on headache and pregnancy with a scope on clinical headache phenotypes, treatment of headaches in pregnancy and effects of headache medications on the child during pregnancy and breastfeeding, headache related complications, and diagnostics of headache in pregnancy. Headache during pregnancy can be both primary and secondary, and in the last case can be a symptom of a life-threatening condition. The most common secondary headaches are stroke, cerebral venous thrombosis, subarachnoid hemorrhage, pituitary tumor, choriocarcinoma, eclampsia, preeclampsia, idiopathic intracranial hypertension, and reversible cerebral vasoconstriction syndrome. Migraine is a risk factor for pregnancy complications, particularly vascular events. Data regarding other primary headache conditions are still scarce. Early diagnostics of the disease manifested by headache is important for mother and fetus life. It is especially important to identify “red flag symptoms” suggesting that headache is a symptom of a serious disease. In order to exclude a secondary headache additional studies can be necessary: electroencephalography, ultrasound of the vessels of the head and neck, brain MRI and MR angiography with contrast ophthalmoscopy and lumbar puncture. During pregnancy and breastfeeding the preferred therapeutic strategy for the treatment of primary headaches should always be a non-pharmacological one. Treatment should not be postponed as an undermanaged headache can lead to stress, sleep deprivation, depression and poor nutritional intake that in turn can have negative consequences for both mother and baby. Therefore, if non-pharmacological interventions seem inadequate, a well-considered choice should be made concerning the use of medication, taking into account all the benefits and possible risks.

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Section: Treatment Of Headaches In Pregnancy and Breastfeeding Womenmentioning

confidence: 99%

Headache and pregnancy: a systematic review

et al. 2017

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“…In our current pharmacologic armamentarium, there are many medications that are approved by the US Food and Drug Administration (FDA) for migraine prophylaxis or that are commonly used off label for this indication. However, valproates, topiramate, carbamazepine, oxcarbazepine, phenytoin, and amitriptyline should be avoided in pregnant women due to their potential for teratogenicity 1–8 9–16 .…”

Section: Introductionmentioning

confidence: 99%

“…However, valproates, topiramate, carbamazepine, oxcarbazepine, phenytoin, and amitriptyline should be avoided in pregnant women due to their potential for teratogenicity. [1][2][3][4][5][6][7][8] Gabapentin, lamotrigine, levetiracetam, zonisamide, metoprolol, propranolol, and onabotulinumtoxinA should only be used in pregnant women if the potential benefits outweigh the risks due to the potential for fetal harm in animal studies. [9][10][11][12][13][14][15][16] Pregnancy information is limited with calcitonin gene-related peptide (CGRP) receptor or ligand-directed therapies.…”

Section: Introductionmentioning

confidence: 99%

The use of erenumab for migraine prophylaxis during pregnancy: A case report and narrative review

2022

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Objective To report a case of a woman who continued erenumab for migraine prophylaxis throughout her pregnancy and to review the literature for pregnancy safety data for the calcitonin gene‐related peptide (CGRP) receptor and ligand‐directed therapies currently approved for migraine prophylaxis in the United States. Background Migraine is a common headache disorder that can be significantly disabling. Many people experiencing migraine seek out preventative therapies to improve their quality of life. Unfortunately, currently approved prophylactic agents may not be safe to use during pregnancy, potentially limiting the use of these agents in women of childbearing potential. As the newest class of prophylactic agents for migraine, CGRP agents have limited pregnancy safety data in humans. Methods A review of the literature was conducted through the PubMed database using the terms pregnancy and either erenumab, fremanezumab, galcanezumab, eptinezumab, rimegepant, or atogepant. Additional sources of information such as prescribing information, assessment reports submitted to the European Medicines Agency (EMA), and manufacturer data were sought. Results One case report was found in the literature documenting a human pregnancy with no adverse effects in the baby after exposure to erenumab. However, the last dose was administered in the second week of pregnancy and discontinued thereafter. The evaluation of 92 safety reports describing maternal exposure prior to or during pregnancy to either erenumab, galcanezumab, or fremanezumab was located. Incidence of miscarriage and congenital anomalies appear to be similar to rates in the general population. Conclusions The use of erenumab during pregnancy in our patient resulted in no known harm to the child. This case is unique in that the mother continued to receive erenumab throughout the pregnancy. Safety data is lacking regarding the use of these agents during pregnancy, despite their frequent use in women of childbearing potential.

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