“…Oestrogen levels rise during pregnancy and fall precipitously in the puerperium ( Figure 2 ). 7 Figure 2 Oestrogen concentration and its effect on migraine incidence in the menstrual cycle, pregnancy and postpartum. Created with BioRender.com.…”
Section: Progressmentioning
confidence: 99%
“…Safety data for the use of novel treatments that have proven effective for difficult to treat symptoms of classical migraine outside of pregnancy, such as calcitonin gene-related peptide (CGRP) receptor antagonists and neuromodulation and neurostimulation devices, are lacking. 7 …”
Section: Progressmentioning
confidence: 99%
“… 6 It is therefore important that syndromes such as vestibular migraine are promptly diagnosed and healthcare workers remain vigilant to exclude secondary headache disorders when patients present with non-reassuring symptoms during an acute attack. 7 , 8 …”
Vestibular migraine is a leading cause of vertigo in pregnancy and, although not a distinct migraine subtype, is an episodic syndrome associated with migraine. Vestibular migraine is associated with diverse symptoms such as vertigo, aura, allodynia, osmophobia, nausea, vomiting and tinnitus, many of which may be exacerbated by, masked or even dismissed in pregnancy. Vestibular migraine is likely an underdiagnosed and undertreated condition in pregnancy. The aetiology of vestibular migraine remains incompletely understood, although various theories have been proposed, including genetic predisposition, neurochemical dysregulation and pro-inflammatory mechanisms, all of which are derived from the pathophysiology of classical migraine. Physiologic changes to the endocrine, haematologic and vascular systems in pregnancy may affect pathophysiological processes in vestibular migraine, and can alter the course of symptoms experienced in pregnancy. These changes also predispose to secondary headache disorders, which may have similar presentations. There has been considerable progress in therapeutic advances in vestibular migraine prophylaxis and treatment outside of pregnancy. There is currently no significant evidence base for acute treatment or prophylaxis for pregnant patients, with treatment recommendations extrapolated from studies on classical migraine, and offered on a benefit versus risk basis. Challenges commonly encountered include difficulty establishing a diagnosis, in addition to recognising and treating neuropsychiatric and gestational co-morbidities. Anxiety, depression, hypertensive disorders and cardiovascular disease are closely associated with migraine, and important contributors to morbidity and mortality during pregnancy. Identifying and treating vestibular migraine during pregnancy offers a unique opportunity to impact future patient health through screening and early treatment of associated co-morbidities. There have been innovations in classical migraine therapy that may confer benefit in vestibular migraine in pregnancy, with emphasis on lifestyle modification, effective prophylaxis, abortive therapies, cognitive behaviour therapy and management of vestibular migraine-related comorbidities.
“…Oestrogen levels rise during pregnancy and fall precipitously in the puerperium ( Figure 2 ). 7 Figure 2 Oestrogen concentration and its effect on migraine incidence in the menstrual cycle, pregnancy and postpartum. Created with BioRender.com.…”
Section: Progressmentioning
confidence: 99%
“…Safety data for the use of novel treatments that have proven effective for difficult to treat symptoms of classical migraine outside of pregnancy, such as calcitonin gene-related peptide (CGRP) receptor antagonists and neuromodulation and neurostimulation devices, are lacking. 7 …”
Section: Progressmentioning
confidence: 99%
“… 6 It is therefore important that syndromes such as vestibular migraine are promptly diagnosed and healthcare workers remain vigilant to exclude secondary headache disorders when patients present with non-reassuring symptoms during an acute attack. 7 , 8 …”
Vestibular migraine is a leading cause of vertigo in pregnancy and, although not a distinct migraine subtype, is an episodic syndrome associated with migraine. Vestibular migraine is associated with diverse symptoms such as vertigo, aura, allodynia, osmophobia, nausea, vomiting and tinnitus, many of which may be exacerbated by, masked or even dismissed in pregnancy. Vestibular migraine is likely an underdiagnosed and undertreated condition in pregnancy. The aetiology of vestibular migraine remains incompletely understood, although various theories have been proposed, including genetic predisposition, neurochemical dysregulation and pro-inflammatory mechanisms, all of which are derived from the pathophysiology of classical migraine. Physiologic changes to the endocrine, haematologic and vascular systems in pregnancy may affect pathophysiological processes in vestibular migraine, and can alter the course of symptoms experienced in pregnancy. These changes also predispose to secondary headache disorders, which may have similar presentations. There has been considerable progress in therapeutic advances in vestibular migraine prophylaxis and treatment outside of pregnancy. There is currently no significant evidence base for acute treatment or prophylaxis for pregnant patients, with treatment recommendations extrapolated from studies on classical migraine, and offered on a benefit versus risk basis. Challenges commonly encountered include difficulty establishing a diagnosis, in addition to recognising and treating neuropsychiatric and gestational co-morbidities. Anxiety, depression, hypertensive disorders and cardiovascular disease are closely associated with migraine, and important contributors to morbidity and mortality during pregnancy. Identifying and treating vestibular migraine during pregnancy offers a unique opportunity to impact future patient health through screening and early treatment of associated co-morbidities. There have been innovations in classical migraine therapy that may confer benefit in vestibular migraine in pregnancy, with emphasis on lifestyle modification, effective prophylaxis, abortive therapies, cognitive behaviour therapy and management of vestibular migraine-related comorbidities.
“…Important "red flags" to take into account during pregnancy include hypertension, aberrant neurological symptoms, and new or refractory pain. The prevalence of migraine in females is 17.1% and in males is 5.6% for the duration of one year [10,4]. Elevated amounts of estrogen during pregnancy and a sudden drop in those levels during puerperium have an impact on migraines.…”
Section: Introductionmentioning
confidence: 99%
“…Elevated amounts of estrogen during pregnancy and a sudden drop in those levels during puerperium have an impact on migraines. Migraine that goes untreated can cause preterm delivery, preeclampsia, and infants with low birth weights [10,11]. According to Italian research, during pregnancy, 9% of females suffering from headache change the pattern of headaches from tension-type headaches to migraines without aura [12].…”
Headaches are one of the most frequent reasons people visit the neurology department. In 2019, headache issues ranked as the 14th most common cause of disability-adjusted life years globally. According to the International Headache Society, migraine is a particular type of headache that is unilateral, frequently throbbing, associated with vertigo, and sensitive to light, sound, and head movement. A migraine has four stages: premonitory, aura, headache, and postdrome. Migraine is the type of discomfort that most frequently complicates the pregnancy. A migraine is more common in women than in men. Migraines are influenced by increased levels of estrogen during pregnancy and a sharp decrease in those levels during puerperium. Untreated migraine can result in premature labor, hypertension, and low birth weight babies. Menstrual-related events occurred more frequently in migraine sufferers than in non-migraine sufferers. We have explained the relation of sex hormones that trigger migraine. We have also reviewed the therapeutic approach, such as pharmacological and non-pharmacological approaches, for migraine in pregnancy and breastfeeding. A migraine episode during menstruation was slightly more severe and complicated than a headache that wasn't a migraine. Breastfeeding is not prohibited by migraines. The steady estrogen levels brought on by lactating women's lack of menstruation may function as a protective factor. In addition to any required drug therapy, nonpharmacological techniques should always be used as the first line of treatment. Preconception counseling is an essential part of providing headache patients with safe therapy during pregnancy. Supplemental estrogen should not be used by any women who have an aura or who are 35 years of age or older because there is inadequate proof to support any long-term adverse effects. Paracetamol is advised for use in acute therapy during pregnancy. Mothers who used acetaminophen during pregnancy are more likely to have children with hyperkinetic disorders and characteristics resembling attentiondeficit/hyperactivity disorder. Menstrual migraine can be treated in a variety of ways, including acute therapy, non-pharmacological therapy, and preconception counseling. Similar tactics are used to treat migraines during pregnancy, but it's important to take the medications' safety rating into account. Migraines and menstrual problems go together. A safeguarding element is a constant estrogen level during pregnancy and breastfeeding. The preferred method of treatment for migraine is non-pharmacological therapy, followed by prenatal counseling. Sumatriptan and acetaminophen are both effective treatments for transient migraine attacks that occur during pregnancy or breastfeeding.
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