Headache in Pregnancy, the Puerperium, and menopause

Abstract

Headache is a neurologic disorder that displays gender dichotomy. It is well established that there is a strong link between migraine headache and sex hormones, specifically estrogen, which influences the severity of migraines during the menstrual cycle, pregnancy, and menopause. Furthermore, the epidemiology of headaches during pregnancy and the postpartum period is very distinct from that in males or nonpregnant females, in part due to the hemodynamic and hematologic changes that occur during pregnancy. These changes put women at higher risk for cerebral venous thrombosis, hemorrhagic stroke, and hypertensive disorders of pregnancy like preeclampsia, eclampsia, posterior reversible encephalopathy syndrome, and reversible cerebral vasoconstriction syndrome. Headache in pregnancy and the puerperium can be a cause of heightened anxiety in most women, who are concerned not only about the effect of the headache itself on the pregnancy but also about the effect of the treatment options on the pregnancy and the fetus. In this review, we discuss the latest literature on type and distribution of headaches during pregnancy and the postpartum period, and provide a digestible overview of the safety profile of commonly used abortive and prophylactic medications. We also discuss important considerations when treating migraine during menopause.

Keywords

headache - migraine - estrogen - pregnancy - menopause

• References

• 1 Broner SW, Bobker S, Klebanoff L. Migraine in women. Semin Neurol 2017; 37 (06) 601-610
• 2 MacClellan LR, Giles W, Cole J. , et al. Probable migraine with visual aura and risk of ischemic stroke: the stroke prevention in young women study. Stroke 2007; 38 (09) 2438-2445
• 3 Abanoz Y, Gülen Abanoz Y, Gündüz A. , et al. Migraine as a risk factor for young patients with ischemic stroke: a case-control study. Neurol Sci 2017; 38 (04) 611-617
• 4 Kurth T, Winter AC, Eliassen AH. , et al. Migraine and risk of cardiovascular disease in women: prospective cohort study. BMJ 2016; 353: i2610
• 5 Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders. 3rd edition. Cephalalgia 2018; 38 (01) 1-211
• 6 Serrano D, Manack AN, Reed ML, Buse DC, Varon SF, Lipton RB. Cost and predictors of lost productive time in chronic migraine and episodic migraine: results from the American Migraine Prevalence and Prevention (AMPP) Study. Value Health 2013; 16 (01) 31-38
• 7 Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 386 (9995): 743-800
• 8 Steiner TJ, Birbeck GL, Jensen RH, Katsarava Z, Stovner LJ, Martelletti P. Headache disorders are third cause of disability worldwide. J Headache Pain 2015; 16: 58
• 9 Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache 2001; 41 (07) 646-657
• 10 MacGregor EA, Victor TW, Hu X. , et al. Characteristics of menstrual vs nonmenstrual migraine: a post hoc, within-woman analysis of the usual-care phase of a nonrandomized menstrual migraine clinical trial. Headache 2010; 50 (04) 528-538
• 11 Dennerstein L, Morse C, Burrows G, Oats J, Brown J, Smith M. Menstrual migraine: a double-blind trial of percutaneous estradiol. Gynecol Endocrinol 1988; 2 (02) 113-120
• 12 Sulak P, Willis S, Kuehl T, Coffee A, Clark J. Headaches and oral contraceptives: impact of eliminating the standard 7-day placebo interval. Headache 2007; 47 (01) 27-37
• 13 Warhurst S, Rofe CJ, Brew BJ. , et al. Effectiveness of the progestin-only pill for migraine treatment in women: a systematic review and meta-analysis. Cephalalgia 2018; 38 (04) 754-764
• 14 Burch RC, Rayhill ML. Migraine and vascular disease. BMJ 2016; 353: i2806
• 15 Sacco S, Ornello R, Ripa P. , et al. Migraine and risk of ischaemic heart disease: a systematic review and meta-analysis of observational studies. Eur J Neurol 2015; 22 (06) 1001-1011
• 16 Schürks M, Rist PM, Bigal ME, Buring JE, Lipton RB, Kurth T. Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ 2009; 339: b3914
• 17 Adelborg K, Szépligeti SK, Holland-Bill L. , et al. Migraine and risk of cardiovascular diseases: Danish population based matched cohort study. BMJ 2018; 360: k96
• 18 Tietjen GE, Herial NA, Utley C, White L, Yerga-Woolwine S, Joe B. Association of von Willebrand factor activity with ACE I/D and MTHFR C677T polymorphisms in migraine. Cephalalgia 2009; 29 (09) 960-968
• 19 Bigal ME, Kurth T, Hu H, Santanello N, Lipton RB. Migraine and cardiovascular disease: possible mechanisms of interaction. Neurology 2009; 72 (21) 1864-1871
• 20 World Health Organization. Medical Eligibility Criteria for Contraceptive Use. 3rd ed. Geneva: World Health Organization; 2004
• 21 Sheikh HU, Pavlovic J, Loder E, Burch R. Risk of stroke associated with use of estrogen containing contraceptives in women with migraine: a systematic review. Headache 2018; 58 (01) 5-21
• 22 Xu S, Zhong A, Bu X. , et al. Salvianolic acid B inhibits platelets-mediated inflammatory response in vascular endothelial cells. Thromb Res 2015; 135 (01) 137-145
• 23 Robbins MS, Farmakidis C, Dayal AK, Lipton RB. Acute headache diagnosis in pregnant women: a hospital-based study. Neurology 2015; 85 (12) 1024-1030
• 24 Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL. Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA 2016; 316 (09) 952-961
• 25 Goldberg-Stein SA, Liu B, Hahn PF, Lee SI. Radiation dose management: part 2, estimating fetal radiation risk from CT during pregnancy. AJR Am J Roentgenol 2012; 198 (04) W352-6
• 26 Karlı N, Baykan B, Ertaş M. , et al; Turkish Headache Prevalence Study Group. Impact of sex hormonal changes on tension-type headache and migraine: a cross-sectional population-based survey in 2,600 women. J Headache Pain 2012; 13 (07) 557-565
• 27 Fischera M, Marziniak M, Gralow I, Evers S. The incidence and prevalence of cluster headache: a meta-analysis of population-based studies. Cephalalgia 2008; 28 (06) 614-618
• 28 MacGregor EA. Headache in pregnancy. Neurol Clin 2012; 30 (03) 835-866
• 29 Aubé M. Migraine in pregnancy. Neurology 1999; 53 (04) (Suppl. 01) S26-S28
• 30 Ferro JM. Prognosis and treatment of cerebral vein and dural sinus thrombosis. Clin Adv Hematol Oncol 2005; 3 (09) 680-681
• 31 Singhal AB. Postpartum angiopathy with reversible posterior leukoencephalopathy. Arch Neurol 2004; 61 (03) 411-416
• 32 Roberts JM, Cooper DW. Pathogenesis and genetics of pre-eclampsia. Lancet 2001; 357 (9249): 53-56
• 33 Sells CM, Feske SK. Stroke in pregnancy. Semin Neurol 2017; 37 (06) 669-678
• 34 Edvinsson L, Owman C, Sjöberg NO. Autonomic nerves, mast cells, and amine receptors in human brain vessels. A histochemical and pharmacological study. Brain Res 1976; 115 (03) 377-393
• 35 Singhal AB, Hajj-Ali RA, Topcuoglu MA. , et al. Reversible cerebral vasoconstriction syndromes: analysis of 139 cases. Arch Neurol 2011; 68 (08) 1005-1012
• 36 Kittner SJ, Stern BJ, Feeser BR. , et al. Pregnancy and the risk of stroke. N Engl J Med 1996; 335 (11) 768-774
• 37 Sharshar T, Lamy C, Mas JL. ; Stroke in Pregnancy Study Group. Incidence and causes of strokes associated with pregnancy and puerperium. A study in public hospitals of Ile de France. Stroke 1995; 26 (06) 930-936
• 38 Vgontzas A, Robbins MS. A hospital based retrospective study of acute postpartum headache. Headache 2018; 58 (06) 845-851
• 39 Sándor PS, Di Clemente L, Coppola G. , et al. Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial. Neurology 2005; 64 (04) 713-715
• 40 Altman D, Carroli G, Duley L. , et al; Magpie Trial Collaboration Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet 2002; 359 (9321): 1877-1890
• 41 Committee Opinion No. 652 Summary: magnesium sulfate use in obstetrics. Obstet Gynecol 2016; 127 (01) 195
• 42 Marchenko A, Etwel F, Olutunfese O, Nickel C, Koren G, Nulman I. Pregnancy outcome following prenatal exposure to triptan medications: a meta-analysis. Headache 2015; 55 (04) 490-501
• 43 MacGregor EA. Migraine management during menstruation and menopause. Continuum (Minneap Minn) 2015; 21 (4 Headache): 990-1003
• 44 Liew Z, Ritz B, Olsen J. Characteristics of acetaminophen users compared with nonusers during pregnancy, behavioral problems, and hyperkinetic disorders--reply. JAMA Pediatr 2014; 168 (09) 865-866
• 45 Avella-Garcia CB, Julvez J, Fortuny J. , et al. Acetaminophen use in pregnancy and neurodevelopment: attention function and autism spectrum symptoms. Int J Epidemiol 2016; 45 (06) 1987-1996
• 46 Nezvalová-Henriksen K, Spigset O, Nordeng HM. Errata in “Triptan exposure during pregnancy and the risk of major congenital malformations and adverse pregnancy outcomes: results from the Norwegian mother and child cohort study”. Headache 2012; 52 (08) 1319-1320
• 47 Hale TW. . Medications and Mother's Milk. New York, NY: Springer; 2016:324
• 48 Solomon GD, Cady RK, Klapper JA, Ryan Jr RE. ; National Headache Foundation. Standards of care for treating headache in primary care practice. Cleve Clin J Med 1997; 64 (07) 373-383
• 49 Diav-Citrin O, Shechtman S, Tahover E. , et al. Pregnancy outcome following in utero exposure to lithium: a prospective, comparative, observational study. Am J Psychiatry 2014; 171 (07) 785-794
• 50 van der Lugt NM, van de Maat JS, van Kamp IL, Knoppert-van der Klein EA, Hovens JG, Walther FJ. Fetal, neonatal and developmental outcomes of lithium-exposed pregnancies. Early Hum Dev 2012; 88 (06) 375-378
• 51 Govindappagari S, Grossman TB, Dayal AK, Grosberg BM, Vollbracht S, Robbins MS. Peripheral nerve blocks in the treatment of migraine in pregnancy. Obstet Gynecol 2014; 124 (06) 1169-1174
• 52 Aegidius KL, Zwart JA, Hagen K, Schei B, Stovner LJ. Hormone replacement therapy and headache prevalence in postmenopausal women. The Head-HUNT study. Eur J Neurol 2007; 14 (01) 73-78
• 53 Misakian AL, Langer RD, Bensenor IM. , et al. Postmenopausal hormone therapy and migraine headache. J Womens Health (Larchmt) 2003; 12 (10) 1027-1036
• 54 Joffe H, Guthrie KA, LaCroix AZ. , et al. Low-dose estradiol and the serotonin-norepinephrine reuptake inhibitor venlafaxine for vasomotor symptoms: a randomized clinical trial. JAMA Intern Med 2014; 174 (07) 1058-1066
• 55 Tarlaci S. Escitalopram and venlafaxine for the prophylaxis of migraine headache without mood disorders. Clin Neuropharmacol 2009; 32 (05) 254-258