Lack of consensus on best way to treat pregnant women with migraine

PHILADELPHIA — Headache specialists do not agree on the best approach to treat pregnant women with migraine, survey findings presented at the American Headache Society Annual Scientific Meeting suggested.

“Treatment of migraine in women who are pregnant can be difficult due to lack of medication trials and guidelines,” Katherine Hamilton, MD, assistant professor of neurology at the University of Pennsylvania Perelman School of Medicine, told Healio Primary Care.

Researchers reviewed online survey responses from headache specialists and found that 173 of 185 were "somewhat" or "very uncomfortable" prescribing butalbital-containing analgesics. In addition, 136 of 187 were "somewhat" or "very uncomfortable" about prescribing opioids, 108 of 193 were "somewhat" or "very uncomfortable" about pregnant women using triptans and 131 of 196 were "somewhat" or "very uncomfortable" about these women using onabotulinumtoxinA.

Nerve blocks with lidocaine or neuromodulation devices may be used to treat pregnant women with migraine, Hamilton said.

 

Headache specialists showed various levels of support behind certain approaches that can treat pregnant women with migraine, survey findings presented at the American Headache Society Annual Scientific Meeting suggested..

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“These are sometimes harder for patients to access, but in those patients with severe migraine, they can be a nice, safer option than others,” she said in the interview.

The survey also showed that 180 of 197 headache specialists were somewhat or very comfortable with nerve blocks for acute treatment, while 178 of 194 were somewhat or very uncomfortable using nerve blocks as a preventive treatment. In addition, 87 of 197 responders said they usually or always discussed the option of neuromodulation for acute or preventive treatment of migraine. – by Janel Miller

Reference: Hamilton K, et al. A survey of American Headache Society members on treatment of migraine in pregnancy. Presented at: American Headache Society Annual Scientific Meeting; July 11-14, 2019; Philadelphia.

Disclosures: Healio Primary Care was unable to determine the authors’ relevant financial disclosures prior to publication.