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Clinical Summary

Migraine in pregnancy tied to complications

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.

References


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