Treatment of Headache in Special Populations

Headaches and Migraine is common among females in their childbearing years. For patients with headache, the fetal safety of maternal headache treatment is necessary and extremely important. Each provider treating a patient during pregnancy or while lactating should be familiar with ICDH-II to avoid health complications to the fetus and or mother.
In pregnancy all medications should be utilized minimally if possible. Vomiting and dehydration may be injurious. Non Pharmacological measures are the treatments of choice.
Evidence has shown that anywhere between 50 – 80% of women who have migraines without aura and or menstrual associated migraine will have significant reduction in headache attacks by the end of the first trimester.
With any worsening of headache pattern the clinician should always consider the possibility of secondary headache. Acute therapy in pregnancy includes Acetaminophen (Tylenol ), suppository may be preferable than oral route. Additionally, anti-emetics such as metoclopramide, prochlorperazine and promethazine may be useful.
During acute severe attacks, IV infusion with magnesium and or occipital nerve blocks with 1% lidocaine can be reasonable. Furthermore, selective triptans ie (sumatriptan) has no increased occurrence of birth defects and can help abort headache pain.
When necessary, several medications are category C: propranolol, amitriptyline, topiramate.
The Manhattan Center for Headache and Neurology has exceptional providers to treat you. Contact the center for further evaluation and potential treatment options.

By: Jordan Shankle, PA