What To Do For Headache While Pregnant

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If you are a migraine sufferer (female migraine sufferer) and are worried about migraines during pregnancy, you are not alone. About 15 percent of women with migraine are of childbearing age. You may want to know if your migraine is getting worse. You should also know how to treat migraines during pregnancy and discharge.

What To Do For Headache While Pregnant

What To Do For Headache While Pregnant

Headaches are more common in women than in men. One reason is female hormones. There seems to be a link between hormonal changes and migraine attacks in women. This is why headaches often occur with hormonal changes during the menstrual cycle.

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Estrogen levels typically increase 100-fold during pregnancy. You might expect this to mean a significant increase in migraine attacks. The good news is that the opposite is true. About 90 percent of women during pregnancy, especially in the second and third trimesters, experience frequent headaches.

The reason for migraines is that estrogen levels, although increasing, remain stable. Less change means less headache. The natural increase in pain-relieving endorphins that occurs during pregnancy can also help relieve hemorrhoids. Here’s another thing to know about migraines and pregnancy:

Migraines are not a problem during pregnancy, but they can complicate pregnancy, so treatment is still important. Untreated migraines can cause insomnia, poor nutrition, dehydration, stress, and depression. These conditions may affect your pregnancy or breastfeeding.

Migraine treatment includes lifestyle changes, non-pharmacological treatments, prophylactic drugs, pain relievers, and drugs to prevent pregnancy (abortion drugs).

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Always tell your doctor as soon as you become pregnant. You may need to change or increase your medication. Better yet, talk to your doctor before you get pregnant. As with all medications during pregnancy, caution must be exercised by your doctor.

This is a gray area. These medicines are often given on an occasional basis. Some are safer than others, but most doctors prefer to stop contraception after pregnancy and breastfeeding.

The only safe pain reliever is acetaminophen (Tylenol). Acetaminophen is the drug of choice for sedation during pregnancy and breastfeeding. Do not take other over-the-counter medicines or herbal medicines unless you first talk to your doctor.

What To Do For Headache While Pregnant

If you have nausea and vomiting along with a headache, your doctor may prescribe a medicine called Zofran (ondansetron). It won’t help with pain, but it can be safely used for nausea and vomiting during pregnancy.

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If over-the-counter medications and Tylenol don’t help, your doctor may consider using birth control pills called triptan. These drugs – there are many types – work better than acetaminophen because they change the chemicals in the brain that cause headache attacks.

Often tested during pregnancy, Tritan has been around for 20 years. It’s called Sumatriptan. One of the most unusual names is called Imtrex. Several studies have compared pregnant women taking sumatriptan with women not taking sumatriptan. These studies did not find that women taking sumatriptan had an increased risk of birth defects or other fetal effects. A large Norwegian study involved more than 1,500 pregnant women who took this drug during pregnancy.

The American Academy of Pediatrics has approved the use of sumatriptan during breastfeeding. Some sources suggest not taking the drug 24 hours before breastfeeding. If your doctor recommends this method, you can express and store breast milk for use if you need to take medication to prevent migraines.

Occipital nerve root is a safe treatment option during pregnancy or breastfeeding. The doctor injects an anesthetic into the back of the neck to block the nerve signals that trigger the migraine.

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Transcranial magnetic stimulation (TMS) is a recently approved treatment for migraine. Research shows that it can reduce pain and the frequency of contractions. This is a device that is worn on the head and delivers a magnetic pulse. It has no side effects, so it can be used safely during pregnancy and breastfeeding.

Migraines do not affect your pregnancy or your baby. There is a good chance that your migraine will improve. Before you get pregnant, talk to your doctor about treatment options. If you become pregnant unexpectedly, tell your doctor immediately. You will most likely be able to get pregnant and breastfeed without major problems.

Dr. Chris Iliades is a physician with 20 years of experience in clinical practice and clinical research. Chris has been a staff writer and health reporter since 2004. His columns appear in over 1000 online articles including EverydayHealth, Health Advisor and Healthgrades. He has also written for print media including Cruising World Magazine, MD News and the Johns Hopkins Children’s Center. Chris lives with his wife and is in the Boston area with his three children and four grandchildren. The next patient is a 29-year-old G1P0 female, currently 24+5 weeks pregnant. She had a history of migraines, which had previously been treated with NSAIDs with good effect. She now has “unbearable” headaches and nausea, and is visibly upset on examination. You want to provide adequate pain relief, but be aware that some medications may be contraindicated in pregnancy due to their potential effects on the developing fetus. How do you deal with headaches during pregnancy?

What To Do For Headache While Pregnant

Primary headaches are common during and outside of pregnancy. However, some serious causes of headaches are exaggerated or specific to the region of pregnancy. When examining a pregnant patient with headache, consider the following diagnoses:

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1. Preeclampsia: New onset hypertension or after 20 weeks of gestation, systolic pressure of 140 and/or diastolic pressure of 90 on two separate occasions at least four hours apart. This should be accompanied by signs of end-organ dysfunction (usually proteinuria >0.3 g in 24-hour urine collection).

2. Cerebral vein thrombosis (CVT): the formation of blood clots in the venous sinuses of the brain. Often the third trimester is reinforced by the prothrombotic state of pregnancy. Most patients present with headache (70-90%), central nervous system disorders such as hemiparesis, visual disturbances, impaired level of consciousness, and papilledema.

3. Idiopathic intracranial hypertension: defined as increased intracranial pressure without a natural cause. It is more common in women who are overweight or obese. When using Valsalva, patients experience more severe headache (90%), visual changes (temporary blindness, diplopia) and swelling of the optic nerve head. On lumbar puncture, opening pressure > 25 mmHg. Art.

4. Pituitary apoplexy. An increase in the size of the pituitary gland during pregnancy (due in part to lactotrophic hyperplasia/hypertrophy) causes pituitary ischemia and thrombosis. Symptoms include headache (90%), nausea (80%) and visual field loss (71%). It may be caused by a deficiency of pituitary hormones.

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Historically, the patient is not a red flag for the above diseases. You conclude that the patient has a headache, and the next step is to determine a treatment plan for the headache and associated symptoms, including nausea and vomiting. You have read that some of the drugs commonly used to treat these conditions are contraindicated in pregnancy, including neuroleptics such as Haldol (risk of muscle disorders) and ergotamine (risk of increased uterine contractions and miscarriage).

You can try two consecutive doses of acetaminophen with diphenhydramine. Although the patient’s sleep is improving, at the next examination she complains of constant pain, so you start metoclopramide and intravenous magnesium sulfate. After finishing IV administration, your patient reports that her pain and nausea have improved significantly. You send him home with a doctor and advise him to return if he develops warning symptoms, including headache or neurological problems, including blurred vision, focal weakness, dysarthria, dysphagia, or nausea. and incessant vomiting.

Headache is the usual bread and butter of emergency medicine. We carefully consider the risk assessment and at the same time try to inflict the right pain on the patient. Pregnant patients also often suffer from ED, which often causes pain and discomfort to the doctor. When a woman presents to the emergency room with a headache during pregnancy, it is the doctor’s responsibility to consider other serious headaches that often affect this particular population. Although most emergency room physicians are satisfied with headache management, in pregnant patients the overall drug cocktail should be evaluated, given the potential for harm to the developing fetus. This review by Dr. Tom shows warning signs for headaches during pregnancy, as well as options for using painkillers and antiemetics for severe symptoms in the first, second, and third trimesters.

What To Do For Headache While Pregnant

Emergency Physician at North York General Hospital and Lecturer at Trillium Health Partners, Department of Community and Family Medicine, University of Toronto.

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Vivian Tam is a second year family therapy resident at the University of Toronto with a master’s degree in systems leadership and innovation. His academic interests include EM FOAM, health equity, and contributions to public policy.

Dr. Elisha Trugonsky is an emergency physician at North York General Hospital and Trillium Health Partners, and an educator.

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