Migraine treatment in pregnancy: A survey of comfort and treatment practices of women's healthcare providers
- 25 January 2023
- journal article
- research article
- Published by Wiley in Headache: The Journal of Head and Face Pain
- Vol. 63 (2), 211-221
- https://doi.org/10.1111/head.14436
Abstract
ObjectiveThe objective of this study was to assess women's healthcare providers' treatment practices for pregnant women with migraine. BackgroundMigraine is associated with several maternal and fetal complications during pregnancy, including preeclampsia and preterm birth. Migraine treatment during pregnancy can present significant challenges due to lack of controlled clinical trials and risks associated with specific medications. MethodsWomen's healthcare providers were queried regarding practice patterns and comfort with use of acute and preventive migraine treatments during pregnancy. The survey was distributed online. ResultsThe survey was completed by 92 women's healthcare providers (response rate 22.9% [92/402]), with most specializing in general obstetrics and gynecology (91% [83/92]). Approximately one-fourth (26% [24/92]) of respondents indicated they counseled women on migraine treatment in pregnancy as early as before pregnancy contemplation, while over one-third (35% [32/92]) counseled on migraine treatment once the patient became pregnant. The majority of respondents reported feeling somewhat or very comfortable with recommending (63% [58/92]) or continuing (64% [59/92]) acute treatments for pregnant patients with migraine, with highest comfort levels for acetaminophen (100% [92/92] for prescribing or continuing) and caffeine (94% [85/90] prescribing, 91% [82/90] continuing). Higher levels of discomfort were reported with triptans (88% [80/91] rarely or never prescribe during pregnancy). Survey respondents felt less comfortable with recommending preventive migraine treatments to pregnant patients (40% [37/92] somewhat or very comfortable), compared with a higher comfort level with continuing preventive medications (63% [58/92] somewhat or very comfortable). Highest comfort levels were reported with use of magnesium (69% [63/91] comfortable prescribing, 82% [75/92] comfortable continuing) and non-pharmacologic approaches (70% [62/89] comfortable prescribing, 84% [75/89] comfortable continuing). Nearly 40% (35/92) of respondents reported that they typically refer to neurologists or headache specialists for migraine treatment during pregnancy. ConclusionThis survey of women's healthcare providers revealed varying levels of comfort regarding migraine management during pregnancy, and highlights the need for additional education regarding migraine treatment safety data during pregnancy.Keywords
This publication has 64 references indexed in Scilit:
- Lifetime Prevalence and Correlates of Migraine Among Women in a Pacific Northwest Pregnancy Cohort StudyHeadache: The Journal of Head and Face Pain, 2013
- Sex Differences in the Prevalence, Symptoms, and Associated Features of Migraine, Probable Migraine and Other Severe Headache: Results of the American Migraine Prevalence and Prevention (AMPP) StudyHeadache: The Journal of Head and Face Pain, 2013
- Predictors of Headache Before, During, and After Pregnancy: A Cohort StudyHeadache: The Journal of Head and Face Pain, 2012
- Migraine-Asthma Comorbidity and Risk of Hypertensive Disorders of PregnancyJournal of Pregnancy, 2012
- Use of nonaspirin nonsteroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortionCMAJ : Canadian Medical Association Journal, 2011
- Non-pharmacological management of migraine during pregnancyNeurological Sciences, 2010
- Biofeedback Treatment for Headache Disorders: A Comprehensive Efficacy ReviewApplied Psychophysiology and Biofeedback, 2008
- Headaches in pregnancyThe Journal of Headache and Pain, 2005
- Maintenance of Effects in the Nonmedical Treatment of Headaches During PregnancyHeadache: The Journal of Head and Face Pain, 1996
- Sex-Hormone-Related Events in Migrainous Females. A Clinical Comparative Study Between Migraine With Aura and Migraine Without AuraCephalalgia, 1995