Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review
Saldanha IJ, Cao W, Bhuma MR, Konnyu KJ, Adam GP, Mehta S, Zullo AR, Chen KK, Roth JL, Balk EM
Headache · 25 citations
How it was studied
- Design
- Systematic review (indexed by PubMed)
- Studied in
- People
- Main outcome
- Health markers and function
Who paid for it
- Funding
- Independent funding
- Government
- Agency for Healthcare Research and Quality
- Grants
- Agency for Healthcare Research and Quality (HHSA 290-2015-00002-I)
Based on 1 listed funder(s).
Publication
- Published
- 2021-01-01 · Headache · vol. 61 · issue 1 · pp. 11–43
- Publisher
- Wiley
- Cited
- 46 citations · more than 84% of similar papers · 1.7× the field average
- References
- 74 works
- Access
- Paywalled
- Research areas
- Migraine and Headache Studies · Pregnancy-related medical research · Pregnancy and Medication Impact
- Keywords
- Medicine, Migraine, Adverse effect, Randomized controlled trial, Triptans, Headaches, Pregnancy, Pediatrics, Anesthesia, Internal medicine, Surgery
- MeSH
- humans, pregnancy complications, breast feeding, postpartum period, pregnancy, female, headache disorders, primary
10 authors
From US
- Ian Jude SaldanhaBrown University
- Wangnan CaoBrown University
- Monika Reddy BhumaBrown University
- Kristin J. KonnyuBrown University
- Gaelen P. AdamBrown University
- Shivani MehtaBrown University
Abstract
Background
Primary headaches (migraine, tension headache, cluster headache, and other trigeminal autonomic cephalgias) are common in pregnancy and postpartum. It is unclear how to best and most safely manage them.
Objective
We conducted a systematic review (SR) of interventions to prevent or treat primary headaches in women who are pregnant, attempting to become pregnant, postpartum, or breastfeeding.
Methods
We searched Medline, Embase, Cochrane CENTRAL, CINAHL, ClinicalTrials.gov, Cochrane Database of SRs, and Epistemonikos for primary studies of pregnant women with primary headache and existing SRs of harms in pregnant women regardless of indication. No date or language restrictions were applied. We assessed strength of evidence (SoE) using standard methods.
Results
We screened 8549 citations for studies and 2788 citations for SRs. Sixteen studies (mostly high risk of bias) comprising 14,185 patients (total) and 26 SRs met the criteria. For prevention, we found no evidence addressing effectiveness. Antiepileptics, venlafaxine, tricyclic antidepressants, benzodiazepines, β-blockers, prednisolone, and oral magnesium may be associated with fetal/child adverse effects, but calcium channel blockers and antihistamines may not be (1 single-group study and 11 SRs; low-to-moderate SoE). For treatment, combination metoclopramide and diphenhydramine may be more effective than codeine for migraine or tension headache (1 randomized controlled trial; low SoE). Triptans may not be associated with fetal/child adverse effects (8 nonrandomized comparative studies; low SoE). Acetaminophen, prednisolone, indomethacin, ondansetron, antipsychotics, and intravenous magnesium may be associated with fetal/child adverse effects, but low-dose aspirin may not be (indirect evidence; low-to-moderate SoE). We found insufficient evidence regarding non-pharmacologic treatments.
Conclusions
For prevention of primary headache, calcium channel blockers and antihistamines may not be associated with fetal/child adverse effects. For treatment, combination metoclopramide and diphenhydramine may be more effective than codeine. Triptans and low-dose aspirin may not be associated with fetal/child adverse effects. Future research should identify effective and safe interventions in pregnancy and postpartum.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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