Migraine in pregnancy tied to complications

  • Eur J Obstet Gynecol Reprod Biol

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • 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.

Key results

  • 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.
  • Management:
    • 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.

Study design

  • Systematic review.
  • Funding: None disclosed.

Limitations

  • Related to limitations of original studies.