Headache and Neurological Disease in Pregnancy

Abstract

A review of the approach in pregnancy to a very commonly encountered neurological disorder (headache), along with less commonly encountered neurological entities that none the less deserve the obstetrician's attention. Definitions of specific disorders and differential diagnoses are reviewed, along with treatment options and pregnancy-associated morbidities. Headache is reviewed first including the common primary headaches migraine and tension-type headache. The disabling neurological disorders-multiple sclerosis, cerebral palsy, and spinal cord injury are grouped due to common morbidities affecting pregnancy. Finally, Bell palsy is also reviewed.

Association of Migraine Headaches With Suicidal Ideation Among Pregnant Women in Lima, Peru

“…The burden of migraine is particularly high among pregnant women, since migraine headaches are more prevalent among women of childbearing age . The prevalence and frequency of headaches, including migraines, can also be altered during pregnancy and is thought to be influenced by hormonal changes across the menstrual cycle and during pregnancy . In addition to migraine, additional risk factors make women in low‐ and middle‐income countries particularly vulnerable to suicidal behaviors during pregnancy .…”

“…6,33 The prevalence and frequency of headaches, including migraines, can also be altered during pregnancy and is thought to be influenced by hormonal changes across the menstrual cycle and during pregnancy. 34 In addition to migraine, additional risk factors make women in low-and middle-income countries particularly vulnerable to suicidal behav-iors during pregnancy. 35 In our study, the association between migraine and suicidal ideation remained even when we adjusted for multiple confounders including depression.…”

Metoclopramide and Diphenhydramine: A Randomized Controlled Trial of a Treatment for Headache in Pregnancy when Acetaminophen Alone Is Ineffective (MAD Headache Study)

“…We did not find a difference in the primary outcome of at least a two-point difference in numerical pain score at the 6-hour assessment. Patients in the MAD group perceived relief sooner after treatment 2). A significant interaction effect between group and time was found (p < 0.05), indicating that the pattern of change in pain scores differed significantly between the MAD and codeine groups, with the MAD group experiencing a faster decrease in pain scores than the codeine group.…”

Primary care assessment and management of common physical symptoms in pregnancy

“…This may be continuation of an underlying headache, a new headache syndrome unrelated to pregnancy, or a headache specific to pregnancy. Migraine, tension headaches, and to a lesser extent cluster headaches are common in pregnancy 45…”

“…Approximately two thirds of headaches in pregnancy have no underlying pathology and usually occur in the first trimester 78. However, increased coagulability in pregnancy can increase the risk of underlying pathology,5 including stroke and cerebral venous thrombosis, at any gestation.…”