Neurológia pre prax 5/2010
Treatment of migraine during pregnancy and breastfeeding
Primary headache disorders, particularly migraine and tension headaches, are very frequent in women in the childbearing age. The article deals with the specific situation of women during the periods of pregnancy and lactation when the development and progression of various types of headache disorders is affected by the hormonal situation of the organism. Most studies and the clinical practice confirm that in about 70 % of female migraine sufferers their migraine improves, particularly during the second and third trimesters. This statement applies to migraine without aura. Women with migraine with aura more frequently suffer from attacks in pregnancy as well. If the first migraine attack occurs no sooner than during pregnancy, it is mostly migraine with aura. In that case, it is necessary to rule out some of the secondary headache disorders, such as cerebral venous thrombosis, other cerebrovascular accidents or incipient eclampsia. There is no evidence that migraine with aura or without aura would have any negative impact on the fetus. The article also mentions the therapeutic options for the treatment of an acute migraine attack that are limited substantially during pregnancy. Individual drugs or drug groups and risks related to the use of these drugs during individual trimesters are discussed (acetylsalicylic acid, nonsteroidal anti-inflammatory drugs, paracetamol, codeine, tramadol, dihydroergotamine, ergot preparations, triptans). The administration of ergot preparations is absolutely contraindicated during the whole pregnancy. The administration of sumatriptan during the first trimester is not considered harmful in terms of congenital malformations (Sumatriptan and naratriptan pregnancy registry); however, in patient information leaflets in this country caution is recommended during treatment in pregnancy. In the third trimester, triptans should not be used. During pregnancy, it is advisable to discontinue prophylactic treatment of migraine. If the treatment is necessary, drugs from the group of beta blockers are best used. The phase of breastfeeding is also significant in terms of migraine because, after a period of rest in pregnancy, migraine attacks begin to recur. The treatment is once again problematic. The use of drugs in pregnancy and breastfeeding means balancing between benefit and risk; the administration of each drug should always be carefully considered and the risk assessed. Paracetamol and magnesium are considered safe during both pregnancy and breastfeeding.
Keywords: migraine, pregnancy, lactation, medications in pregnancy, medications in a breastfeeding woman.
