Planning pregnancy in patients with migraine

Headache associated with pregnancy

The main cause of headaches during pregnancy is hormonal changes in the body that affect the tone of blood vessels.

A common problem for pregnant women is migraine. This is the name for unilateral throbbing headaches that get worse with movement. At the same time, other symptoms may occur: nausea, vomiting, nasal congestion, lacrimation, photophobia. Before the onset of a headache, an “aura” often appears - flashes and flickering before the eyes, tingling or numbness of the face.

Migraine is most severe in the first semester, and usually disappears after childbirth. At the same time, women who suffered from migraines before pregnancy usually stop having headaches after conception.

Against the background of a migraine, a tension headache (TTH) can occur - a dull pain of a pulling or squeezing nature in the back of the head, forehead and temples, often accompanied by nausea. Typically, TTH is provoked by physical or mental fatigue, emotional distress, and insomnia. To get rid of pain, it is enough to fully rest and get enough sleep.

Other factors that can cause headaches in a pregnant woman include:

• increased blood flow due to the formation of uteroplacental circulation;
• decrease (in the first trimester) or increase (in the second and third trimesters) of blood pressure;
• lack or excess of sleep;
• eye strain when working at a computer for long periods of time;
• frequent stressful situations;
• anemia;
• staying in rooms with poor ventilation;
• constant inhalation of tobacco smoke;
• tendency to develop hypoglycemia (low blood sugar concentration);
• visual disturbances;
• lack of fluid in the body;
• giving up coffee.

What drugs are dangerous for pregnant women?

The group of non-steroidal anti-inflammatory drugs is not recommended for use during gestation. However, if your headache is very severe and other medications do not help, then you should adhere to the following rules:

1. Avoid the use of analgin-based products as the most toxic of all drugs in this group.
2. It is not recommended to take combined analgesics that contain several components that relieve pain. These include: “Pentalgin”, “Caffetin”, “Solpadeine”.
3. It is better to give preference to medications with one active ingredient (preferably paracetamol-based).
4. Try not to take two or more tablets in one day, and also avoid long-term use.
5. If possible, avoid taking pills in the first trimester, when the formation of fetal organs and systems occurs.

Pathological causes of headaches

In some cases, headache is a symptom of various diseases:

• preeclampsia – blood pressure additionally increases, vomiting is possible;
• diabetes in pregnant women - accompanied by headache, itching of the genitals, increased urination;
• cervical osteochondrosis;
• intracranial hypertension;
• arteriovenous malformation;
• subarachnoid hemorrhage;
• stroke;
• meningitis;
• benign or malignant tumors.

Diagnostic methods

Doctors at the Clinical Institute of the Brain say that if you have a headache in the first trimester of pregnancy, you should undergo an examination to determine the cause of this condition. Effective treatment with minimal medications requires an accurate history of injuries and chronic illnesses, an accurate description of symptoms, and test results. It is important to tell the doctor what factors provoked the headache, what areas it affects and with what intensity it manifests itself. If it is constant, accompanied by disruption of the cardiovascular system and other dangerous symptoms, the following examination methods are prescribed:

• blood tests - they will help determine the presence of inflammatory processes, features of hormonal balance, glucose and vitamin levels, as well as other important indicators;
• Frequent blood pressure measurements and recording of results;
• Dopplerography - examination of blood vessels using ultrasound;
• Ultrasound of the abdominal cavity and heart to exclude acute and chronic diseases.

Diagnosis of headaches during pregnancy is difficult due to the unavailability of some techniques that can negatively affect the formation of the fetus. Thus, in the first trimester, x-ray radiation is dangerous to health, so x-rays are prescribed only by the decision of the attending physician. It is also undesirable to conduct magnetic resonance imaging in the first 12 weeks of pregnancy, since it is during this period that the formation of the main tissues and organs of the fetus occurs. Unless symptoms pose a threat to the mother's life, diagnosis of headaches is delayed until after delivery.

When is it necessary to consult a doctor?

It is necessary to consult a specialist and undergo diagnostic examinations if:

• sudden onset of severe headaches, their intensification and frequency;
• the appearance or intensification of pain during physical activity;
• the occurrence of additional symptoms - nausea, vomiting, difficulty swallowing, high temperature, increased blood pressure, pulsating tinnitus, increased urination, swelling, numbness of the limbs or face, visual or speech disturbances, lethargy, confusion.

Headache treatment

You should not take medications on your own, as they have a negative effect on the development of the fetus.

The best choice is non-drug medications:

• compresses (cold - on the back of the head or warm - on the face);
• herbal (mint, lemon balm, rosehip, chamomile) teas;
• sweet black tea;
• cold and hot shower;
• washing your hair with warm water;
• relaxing massage of the collar area and feet;
• rest in a dark, quiet room.

As an “first aid”, you can rub the “Golden Star” balm into the temples or wings of the nose, or take paracetamol once. But in any case, you need to consult a doctor. He will determine the cause of the pain and select a medication.

Medicines containing acetylsalicylic acid - aspirin, analgin, citramon, baralgin, spazgan - are strictly contraindicated.

Stopping attacks

The selection of drug therapy for patients with migraine during pregnancy poses significant difficulties. The severity of migraines can be especially high during the first trimester. Full-blown, unrelieved migraine attacks are often accompanied by nausea, vomiting and lead to unnecessary suffering and dehydration, especially in patients suffering from early toxicosis. Despite the desire to avoid taking medications (especially in early pregnancy) to minimize the risk of fetal developmental disorders, many patients with hypertension begin to take analgesics uncontrollably. Therefore, the importance of preliminary counseling and education of patients on the proper control of hypertension cannot be overemphasized.

Non-pregnant women are recommended to take medications to relieve migraine attacks as early as possible, no later than 1 hour after the onset of the attack. This approach allows you to speed up relief and completely stop a migraine attack in a short time. Pregnancy is the only period in a woman’s life when this recommendation can be temporarily ignored. For patients seeking to minimize drug use, a stepwise approach may be recommended, in which treatment of mild to moderate attacks begins with non-drug methods.

If the patient decides not to use analgesics, control of nausea becomes a priority to avoid dehydration. Patients should avoid strong odors and drink more fluids, such as juices diluted 1:1 with water. Feelings of nausea can also be reduced by eating easily digestible foods, such as crackers, applesauce, bananas, rice, and pasta. Metoclopramide or ondansetron can also be used [6].

Neurostimulation methods play a major role in non-drug approaches to the treatment of migraine. The only device registered in Russia for non-invasive transcutaneous stimulation of the supraorbital nerve - Cefaly (Cefaly®) - is specially designed for the treatment of migraines and can be a good alternative to medications for relieving migraine attacks. Using the Cefaly device at the very beginning of an attack allows you to reduce the intensity of headaches and in some cases completely stop the attack. Thus, the intensity of migraine pain decreases by 4.3 points after 1 hour [7]. Cefaly can also be used in conjunction with pain medications to increase their effectiveness.

Despite the fact that, in general, paracetamol is less effective for relieving an acute attack of migraine than acetylsalicylic acid and nonsteroidal anti-inflammatory drugs (NSAIDs), its safety during pregnancy is higher [6]. Caffeine, which has the ability to enhance the analgesic effect, is an important addition to painkillers. Adding 100 mg of caffeine to the analgesic increases its effect by 1.5 times.

The safety of NSAIDs is controversial [6]. Prescribing NSAIDs in the first trimester may be associated with an increased risk of miscarriage and the development of congenital anomalies. Taking NSAIDs and aspirin in the third trimester can lead to premature closure of the ductus arteriosus

. For these reasons, the use of NSAIDs should be limited to the second trimester. It is especially important to stop taking them after the 32nd week. Taking high doses of aspirin may also increase the risk of bleeding.

Triptans are the most effective analgesics for the relief of migraine attacks. The safety of triptans during pregnancy is assessed through pregnancy registries, where a huge amount of data has now been accumulated for sumatriptan, for example. Despite the prohibition of its use during pregnancy indicated in the official instructions for the use of sumatriptan, there is no evidence of an increased risk of congenital malformations when taken by pregnant women [8]. Patients who took triptans in early pregnancy (without knowing they were pregnant) should be advised that the likelihood of adverse effects of this drug on the fetus is extremely low. Women who experience severe, disabling migraine attacks that cause vomiting may be advised to use triptans during pregnancy. To date, this information has not been included in official recommendations for the treatment of migraine, but the safety of sumatriptan is confirmed by the analysis of a huge number of observations and expert recommendations.

It should be borne in mind that the safety of triptans varies. Sumatriptan, as the most hydrophilic of the triptans, has difficulty penetrating the placental barrier, while other triptans (including eletriptan) are lipophilic.

Prednisolone can only be used as an “ambulance” remedy in the event of a prolonged and severe migraine attack [9]. The use of prednisolone is preferable to dexamethasone, since the latter penetrates the placenta better. Nuchal nerve blocks with lidocaine, bipuvacaine and/or a corticosteroid can be used as an ambulance to relieve severe attacks.

Prevention

Help prevent headaches:

• walks in the open air;
• swimming;
• frequent change of activities throughout the day;
• breaks when working on the computer every half hour;
• maintaining a daily routine that includes proper rest;
• balanced diet;
• consumption of a sufficient volume of fluid (1.5-2 liters per day);
• avoiding stress, overwork, noisy, smoky and poorly ventilated rooms;
• quitting smoking and alcoholic beverages;
• exclusion from the diet of chocolate, grapes, hard cheeses, Chinese dishes, and flavor enhancers.

It is impossible to find out the cause of the pain on your own. Therefore, if you experience any discomfort in the abdominal area, you should consult a gynecologist to avoid dangerous complications.

Take care of your health and contact a qualified physician if you experience any symptoms.

Non-drug methods

Given the small choice of medications for relieving headaches during pregnancy, it is worth giving preference to alternative methods.

Massage

It has been proven that running your fingers from the frontal part of the head to the back of the head (in one direction only) helps eliminate stagnation of venous blood in the sinuses of the brain. This is explained by the presence of perforating veins on the surface of the head, which are connected to the venous sinuses.

Such a massage for 15 minutes can significantly reduce pain, even eliminating it completely.

For more information on how to get rid of headaches with massage, watch the video:

Neck massage

It is especially effective if your head hurts due to osteochondrosis of the cervical spine. After all, the vertebral arteries pass through the cervical region, compression of which can cause excruciating pain in the head.

Reflexology

Impact on certain points of our body leads to the activation of certain physiological processes. So, for headaches, light pressure on the temporal areas on both sides is effective; you can use light massaging movements in a clockwise direction.

Doctor's advice

Neck massage can only be done in the form of light pressure on the muscles, stroking, and in no case too much. Firstly, movements with intense pressure will cause muscle pain. Secondly, there is always the possibility of a hernia, massage in which is done very carefully.

Victoria Druzhikina Neurologist, Therapist

Pressing on the following points will help relieve headaches: at the base of the inner edge of both eyebrows, the center of the superciliary arches (the exit point of the supraorbital nerve), the middle of the bridge of the nose, the point between the base of the 1st and 2nd fingers of both hands. You need to gently press on each point for 2-3 minutes.

Drinking strong tea with sugar

It is effective to drink a cup of strong tea for headaches associated with low blood pressure. Coffee drinks should not be consumed during pregnancy, as caffeine can cause increased heart rate. Use caution in case of diabetes mellitus and gestational diabetes mellitus, which is common among pregnant women.

Normalization of the daily routine

If a pregnant woman often has headaches, she needs to adjust her daily routine. Normalizing sleep and rest is very important. For example, walking for 15 minutes before bed is very beneficial. Pain will become much less of a problem if you pay due attention to rest.

Taking a warm shower

Promotes relaxation and improves blood circulation in the body.

You should not get carried away with aromatherapy, as some essential oils can cause an allergic reaction.

There are currently at least 50 known reasons why a headache may occur. During pregnancy, the most common are tension headaches, as well as headaches that occur when pressure rises (for example, with severe gestosis).

Despite such a wide range of drugs available on the pharmacological market, during pregnancy their choice is extremely limited. Therefore, during the period of bearing a child, before taking this or that medicine, it is necessary to find out the cause of the headache.

Unsystematic use of pills can negatively affect the baby's development. We must not forget about the serious causes of headaches (vascular aneurysm, pathological tortuosity, space-occupying brain formations). A consultation with a gynecologist and therapist will help you understand the mechanisms of pain, as well as prescribe the necessary medication.

This article has been verified by a current qualified physician, Victoria Druzhikina, and can be considered a reliable source of information for site users.

Bibliography

1. https://www.mediasphera.ru/issues/zhurnal-nevrologii-i-psikhiatrii-im-ss-korsakova/2015/11/downloads/ru/591997-729820151118 2. https://journals.eco-vector .com/RFD/article/viewFile/1431/1051
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