- Migraine headaches are common in pregnancy and associated with complications, but clear treatment protocols are lacking, as this systematic review emphasises.
Why this matters
- Migraine headaches are common in women of reproductive age; obstetrician/gynecologists should be aware of epidemiology, diagnosis, and treatment options.
- Normal hormonal fluctuations in women may trigger migraine headaches.
- Combined oral contraceptives (OCs) are generally contraindicated in women with a history of migraine headaches.
- Women with migraine headaches are susceptible to pregnancy complications and should be followed closely.
- The overall incidence of migraines in women was 12.15%.
- Gynecologic patients: 11.7%-12.5%,
- Obstetric patients: 9%-38.5%, and
- Patients on combined OCs: 16.7%-54.7%.
- Pregnancy complications related to migraines: low birth weight (1.8-fold increase), preterm birth (1.72-fold increase), preeclampsia (3.3-fold increase), placental abruption (2.14-fold increase), and hypertensive disorder (2.85-fold increase).
- Diagnostic issues: history of spontaneous miscarriage and migraines should alert to the possibility of antiphospholipid syndrome.
- The guidelines for treatment of migraine headaches in pregnant women are not clear.
- Treatments include: triptans, progesterone-only contraception, low-dose OCs with supplemental estrogen, and paracetamol.
- More research is needed to confirm safety during pregnancy and lactation.
- Systematic review.
- Funding: None disclosed.
- Related to limitations of original studies.