As women found to
have more incidence of migraine as compared to men, after the puberty and up to
70% of the women patients showed progression in headache severity during
menstruation, pregnancy, menopause, and also during lactation. The management
of migraine in pregnancy and lactation is a major challenge, and therefore
investigations were made and found noteworthy evidence regarding some abortive
and preventive treatments.
Evidence regarding
abortive treatment for migraine during pregnancy and lactation:
During pregnancy -
- Ibuprofen shows significant efficacy during the first trimester.
- Metoclopramide is safe to use in pregnancy.
- Triptans also did not exhibit any significant adverse events, and
Sumatriptan provides the most supporting evidence.
During Lactation -
- Ibuprofen is known to reflect very low levels of medicine in
breast milk, even after administrating in high doses and therefore is a
preferred NSAID.
- Eletriptan and Sumatriptan also exhibited low levels in breast
milk.
- Naproxen is associated with adverse events such as vomiting and
drowsiness in infants.
- Aspirin is associated with the risk of Reye’s syndrome.
Evidence regarding
preventive treatment for migraine during pregnancy and lactation:
During
pregnancy -
- Out of nutraceutical, 100 mg 3×/day Coenzyme Q10 and 400 mg/day
Riboflavin provides significant outcomes if started three months ere pregnancy.
- Anticonvulsants, Topiramate and Valproic acid, should be avoided
due to the associated risk of congenital birth defects, and cognitive and motor impairment,
respectively.
- Atenolol, a beta-blocker administration during the first trimester
showed the risk of low birth weight. Other beta-blockers also need close fetal
monitoring.
- Tricyclic antidepressants are known to lead craniofacial and cardiac
malformations; however, serotonin-norepinephrine reuptake inhibitors not
associated with such results.
- The use of Angiotensin receptor blockers and
Angiotensin-converting enzyme inhibitors should also be avoided as it may lead
to the skull, pulmonary, and renal malformations.
During Lactation -
- Propranolol is safe because of their low maternal plasma levels.
- Topiramate is also safe during this period; however, valproic acid
should be avoided.
- Angiotensin receptor blockers and Angiotensin-converting enzyme
inhibitors are related to the risk of having renal toxicity in premature
infants.
- While using tricyclic antidepressants, infants should be monitored
for poor feeding, anticholinergic side effects and sedation.
- Clinicians should think thoroughly before prescribing the
medication for migraine in pregnancy, as prescriptions of true teratogens might
cause undesirable manifestations, whereas, prescriptions misattributed as
teratogens or as a lactation risk could not manage migraine properly.
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