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Migrain treatment in pregnancy

Qingmei Nie, Baohua Su, Jianping Wei
Epilepsy is one of the few neurologic disorders that requires a constant treatment during pregnancy. Epilepsy affects 0.3-0.8% of pregnant women. Prescription of antiepileptic drugs (AEDs) to pregnant women with epilepsy requires monitoring and maintaining a balance between limiting seizures and decreasing fetal exposure to the potential teratogenic effects. AEDs are also commonly used for psychiatric disorders, pain disorders, and migraines. The types of malformations that can result in fetuses exposed to AEDs include minor anomalies, major congenital malformations, intrauterine growth retardation, cognitive dysfunction, low IQ, microcephaly, and infant mortality...
October 2016: Experimental and Therapeutic Medicine
Mollie E Wood, Jean A Frazier, Hedvig M E Nordeng, Kate L Lapane
OBJECTIVE: This study sought to determine whether changes in neurodevelopmental outcomes between 18 and 36 months of age were associated with prenatal exposure to triptan medications, a class of 5-HT receptor agonists used in the treatment of migraine. METHOD: Using data from the Norwegian Mother and Child Cohort Study, a prospective birth cohort that includes nearly 40% of all pregnancies in Norway from 1999 to 2008, we identified 50 469 mother-child dyads who met inclusion criteria and were present for at least one follow-up assessment at 18 or 36 months postpartum...
September 13, 2016: BMJ Open
Siri Amundsen, Torunn G Øvrebø, Netta Marie S Amble, Anne Christine Poole, Hedvig Nordeng
PURPOSE: Migraine is highly prevalent among women of fertile age. The main objectives of this study were to describe the prevalence and patterns of use of antimigraine medications during pregnancy and breastfeeding and to identify maternal and migraine-related factors associated with medication use during pregnancy. METHODS: The study is a cross-sectional internet-based survey among pregnant women and new mothers with migraine conducted in Norway from October 1, 2013 to February 1, 2014...
September 13, 2016: European Journal of Clinical Pharmacology
(no author information available yet)
MHRA: avoid live vaccines in immunosuppressed patients ● Topical NSAIDs for musculoskeletal pain in adults ● Adherence to pregnancy prevention measures during isotretinoin treatment ● Impact of the NHS Health Check programme ● Ibuprofen: first choice for migraine in young people? ● Neuropsychiatric safety of ▼ varenicline and bupropion ● Effects of anticholinergic medication in cognitively normal older adults ● New NICE guidance for controlled drugs.
July 2016: Drug and Therapeutics Bulletin
Carlos Alberto Bordini, Célia Roesler, Deusvenir de Souza Carvalho, Djacir Dantas P Macedo, Élcio Piovesan, Eliana Meire Melhado, Fabiola Dach, Fernando Kowacs, Hilton Mariano da Silva Júnior, Jano Alves de Souza, Jayme Antunes Maciel, João José de Freitas de Carvalho, José Geraldo Speciali, Liselotte Menke Barea, Luiz Paulo Queiroz, Marcelo Cedrinho Ciciarelli, Marcelo Moraes Valença, Márcia Maria Ferreira Lima, Maurice Borges Vincent
In this article, a group of experts in headache management of the Brazilian Headache Society developed through a consensus strategic measurements to treat a migraine attack in both the child and the adult. Particular emphasis was laid on the treatment of migraine in women, including at pregnancy, lactation and perimenstrual period.
March 2016: Arquivos de Neuro-psiquiatria
Rebecca Erwin Wells, Dana P Turner, Michelle Lee, Laura Bishop, Lauren Strauss
While over half of women with migraine report improvement during pregnancy, having a history of migraine may increase the chance of negative health outcomes. The state of pregnancy increases the risk of several dangerous secondary headache disorders, especially those associated with hypertensive disorders of pregnancy, and providers need to know the red flags to diagnose and treat emergently. Non-pharmacological migraine treatments can be instituted in advance of pregnancy as many are considered the safest options during pregnancy, but understanding the safety of medications and dietary supplements ensures appropriate care for the refractory migraine patient...
April 2016: Current Neurology and Neuroscience Reports
Angelo A Izzo, Sung Hoon-Kim, Rajan Radhakrishnan, Elizabeth M Williamson
Systematic reviews and meta-analyses represent the uppermost ladders in the hierarchy of evidence. Systematic reviews/meta-analyses suggest preliminary or satisfactory clinical evidence for agnus castus (Vitex agnus castus) for premenstrual complaints, flaxseed (Linum usitatissimum) for hypertension, feverfew (Tanacetum partenium) for migraine prevention, ginger (Zingiber officinalis) for pregnancy-induced nausea, ginseng (Panax ginseng) for improving fasting glucose levels as well as phytoestrogens and St John's wort (Hypericum perforatum) for the relief of some symptoms in menopause...
May 2016: Phytotherapy Research: PTR
Rezvan Noruzzadeh, Amirhossein Modabbernia, Vajiheh Aghamollaii, Majid Ghaffarpour, Mohammad Hossein Harirchian, Sarvenaz Salahi, Nikta Nikbakht, Nahid Noruzi, Abbas Tafakhori
BACKGROUND: Uncontrolled studies in human have suggested that memantine might be a suitable option for migraine prophylaxis. OBJECTIVE: To assess the efficacy and tolerability of memantine for migraine prophylaxis. METHODS: This was a 12-week randomized double-blind placebo-controlled parallel-group study. Sixty patients with migraine without aura were randomized using a computer-generated list to receive memantine (10 mg/day) or placebo for 12 weeks...
January 2016: Headache
Sonia Parial
Bipolar affective disorder in women is a challenging disorder to treat. It is unique in its presentation in women and characterized by later age of onset, seasonality, atypical presentation, and a higher degree of mixed episodes. Medical and psychiatric co-morbidity adversely affects recovery from the bipolar disorder (BD) more often in women. Co-morbidity, particularly thyroid disease, migraine, obesity, and anxiety disorders occur more frequently in women while substance use disorders are more common in men...
July 2015: Indian Journal of Psychiatry
Markus Kraemer, Ralph Weber, Michèle Herold, Peter Berlit
Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by acute thunderclap headache, evidence of vasoconstriction in conventional angiography or magnetic resonance angiography and reversibility of these phenomena within 12 weeks. Some triggering factors, for example drugs such as selective serotonin reuptake inhibitors, sumatriptan, tacrolimus, cyclophosphamide and cocaine, or states such as pregnancy, puerperium or migraine have been described. We describe the case of a 29-year-old woman with RCVS associated with fingolimod three months after childbirth...
October 2015: Multiple Sclerosis: Clinical and Laboratory Research
Werner J Becker
PURPOSE OF REVIEW: This article provides a systematic, evidence-based approach to acute medication choices for the patient with migraine. RECENT FINDINGS: Recent clinical trials, meta-analyses, and practice guidelines have confirmed that four nonsteroidal anti-inflammatory drugs (NSAIDs) with randomized controlled trial evidence for efficacy in migraine (ibuprofen, naproxen sodium, diclofenac potassium, and acetylsalicylic acid) and seven triptans (sumatriptan, rizatriptan, eletriptan, zolmitriptan, almotriptan, frovatriptan, and naratriptan) are appropriate medications for acute migraine treatment...
August 2015: Continuum: Lifelong Learning in Neurology
(no author information available yet)
Ischaemic disorders, ruptured aneurysm, aortic dissection, gastrointestinal or spinal necrosis. And placental infarction in exposed pregnant women.
October 2014: Prescrire International
Werner J Becker
There are many options for acute migraine attack treatment, but none is ideal for all patients. This study aims to review current medical office-based acute migraine therapy in adults and provides readers with an organized approach to this important facet of migraine treatment. A general literature review includes a review of several recent published guidelines. Acetaminophen, 4 nonsteroidal anti-inflammatory drugs (NSAIDs) (ibuprofen, acetylsalicylic acid [ASA], naproxen sodium, and diclofenac potassium), and 7 triptans (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan) have good evidence for efficacy and form the core of acute migraine treatment...
June 2015: Headache
Zachary A Flake, Becky S Linn, Jaime R Hornecker
Nausea and vomiting are mediated primarily by three neurotransmitter pathways: visceral stimulation releases dopamine and serotonin; vestibular and central nervous system activation release histamine and acetylcholine; and chemoreceptor trigger zone activation releases dopamine and serotonin. Clinicians can improve the effectiveness and cost-effectiveness of treatments by targeting the appropriate pathways. Antihistamines and anticholinergics are most effective in patients with vestibular-mediated nausea secondary to vertigo...
March 1, 2015: American Family Physician
Abdulaziz M S Alsaad, Shahnaz Akthar Chaudhry, Gideon Koren
Topiramate (TPM) is an increasingly used drug during childbearing ages for treatment of epilepsy, migraine, and appetite suppression as well as for off-label indications such as sleep and psychiatric disorders. Presently, while some reports suggested an increased risk of oral cleft (OC), these reports are balanced by studies that could not confirm such association. We conducted a meta-analysis of all studies reporting on women exposed to TPM during pregnancy. Of the 2327 publications reviewed, 6 articles met the inclusion criteria including 3420 patients and 1,204,981 controls...
June 2015: Reproductive Toxicology
Siri Amundsen, Hedvig Nordeng, Kateřina Nezvalová-Henriksen, Lars Jacob Stovner, Olav Spigset
Migraine affects up to 25% of women of reproductive age. In the majority of these women, migraine improves progressively during pregnancy, but symptoms generally recur shortly after delivery. As suboptimally treated migraine in pregnancy could have negative consequences for both mother and fetus, the primary aim of clinicians should be to provide optimal treatment according to stage of pregnancy, while minimising possible risks related to drug therapy. Nonpharmacological approaches are always first-line treatment, and should also be used to complement any required drug treatment...
April 2015: Nature Reviews. Neurology
Olivia R Orta, Bizu Gelaye, Chungfang Qiu, Lee Stoner, Michelle A Williams
BACKGROUND: The co-occurrence of migraine and unipolar psychiatric disorders has been well documented in non-pregnant populations, however little is known in pregnant populations. METHODS: A cohort of 1321 women was interviewed during the first trimester of pregnancy. At the time of interview lifetime migraine status was ascertained using International Classification of Headache Disorders diagnostic criteria (ICHD-II). Information regarding unipolar depression, anxiety and stress during pregnancy was collected using the Patient Health Questionnaire Depression Module-9 (PHQ-9), and the Depression Anxiety Stress Scales 21-item Short Form (DASS-21)...
February 1, 2015: Journal of Affective Disorders
Shravya Govindappagari, Tracy B Grossman, Ashlesha K Dayal, Brian M Grosberg, Sarah Vollbracht, Matthew S Robbins
OBJECTIVE: To describe the use of peripheral nerve blocks in a case series of pregnant women with migraine. METHODS: A retrospective chart review of all pregnant patients treated with peripheral nerve blocks for migraine over a 5-year period was performed. Injections targeted greater occipital, auriculotemporal, supraorbital, and supratrochlear nerves using local anesthetics. RESULTS: Peripheral nerve blocks were performed 27 times in 13 pregnant women either in a single (n=6) or multiple (n=7) injection series...
December 2014: Obstetrics and Gynecology
Michael J Marmura
INTRODUCTION: Migraine is a very common medical disorder characterized by attacks of moderate-severe headache, nausea and disability. Topiramate is an effective, popular prophylactic migraine treatment, which is approved for use in adults and adolescents. Due to its multiple mechanisms of action, topiramate has multiple potential safety issues, including systemic and CNS adverse events, which may complicate therapy. AREAS COVERED: This review evaluates common adverse events as seen in the pivotal trials of topiramate for migraine as well as those observed in postmarketing studies...
September 2014: Expert Opinion on Drug Safety
Rebecca Luckett, William Rodriguez, Daniel Katz
BACKGROUND: Babesiosis is an emerging infectious disease caused by a tick-borne parasite that infects red blood cells. Pregnancy is a relatively immunocompromised state that can underlie severe manifestations of parasitic disease. CASE: A healthy primiparous patient in the second trimester developed nonspecific symptoms after a tick bite. Evaluation by obstetrics, primary care, and neurology over 4 weeks yielded diagnoses of Lyme disease, upper respiratory infection, migraine, and medication overuse headache...
August 2014: Obstetrics and Gynecology
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