Headache in pregnancy: a nuisance or a new sense?

Exploring the Connection between Migraines and Pregnancy: The Impact of Physical Activity on Symptom Management

Migraine is a prevalent neurological disorder that significantly impacts the quality of life for affected individuals. The pathogenesis behind migraines is not yet fully understood, but hormonal changes, especially fluctuations in, estrogen and progesterone levels, have a significant role in the susceptibility of women to migraines. Pregnancy introduces a unique set of challenges for women who experience migraines, as they must navigate the complexities of managing their condition while safeguarding the health of both them and their unborn child. Pharmacological options for treating migraines during pregnancy are limited, and, therefore, there is a growing interest in exploring alternative approaches to migraine symptom relief and management. Physical activity during pregnancy provides a range of benefits, and it has gained attention as a potentially valuable tool for alleviating migraine symptoms in pregnant patients. This review explores the intricate relationship between migraines and pregnancy, emphasizing how physical activity and other alternative approaches may influence the frequency, severity, and overall experience of migraines during pregnancy. Through collaboration with healthcare providers and the adoption of personalized management strategies, women can strike a balance that supports both their own well-being and the healthy development of their unborn child. By examining existing research and emerging insights, we aim to provide a comprehensive understanding of the potential benefits and considerations of incorporating physical activity and other treatment options into migraine management strategies for pregnant women. Further research is needed to elucidate the specific mechanisms linking migraines, pregnancy, and physical activity, enabling the development of more targeted interventions and guidelines.

Assessing the efficacy of magnesium oxide and riboflavin as preventative treatment of migraines in pregnancy

PURPOSE

The purpose of this study is to assess the efficacy of magnesium oxide (MgO) alone and, secondarily, MgO plus riboflavin as preventive treatment of migraines in pregnancy. We hypothesize that MgO alone will be effective for the majority of patients and, when clinically indicated, the addition of riboflavin will result in further benefit.

METHODS

This was a retrospective cohort study of pregnant patients treated for migraines between 2015 and 2020. We evaluated pre-/post-differences in the following primary outcomes: migraine frequency, severity, and duration. Secondary outcomes included associated migraine symptoms.

RESULTS

Of 203 total patients, 117 received MgO alone and 86 received MgO plus riboflavin. There were no significant differences in baseline demographics between the two groups. There was a statistically significant decrease in migraine frequency, severity, and duration in the groups receiving MgO alone and MgO plus riboflavin (p < 0.01 for all). In total, 154 patients reported migraine-associated symptoms, of which 119 (77%) improved after treatment, 18 (12%) did not improve, and 17 (11%) patients' data were missing. The MgO plus riboflavin group had a lower gestational age at treatment initiation and was more likely to receive treatment prior to pregnancy (p < 0.01). Significant differences were observed for several baseline migraine symptoms, including photophobia, phonophobia, nausea, and vomiting, which were more common in the group receiving MgO plus riboflavin (p < 0.05 for all).

CONCLUSION

Migraine frequency, severity, and duration all decreased with MgO alone and MgO plus riboflavin in this pregnancy cohort. Associated symptoms also significantly decreased for both groups.

Comprehensive management of adults with chronic migraine: Clinical practice guidelines in Mexico

Introduction:

Migraine is a polygenic multifactorial disorder with a neuronal initiation of a cascade of neurochemical processes leading to incapacitating headaches. Headaches are generally unilateral, throbbing, 4–72 h in duration, and associated with nausea, vomiting, photophobia, and sonophobia. Chronic migraine (CM) is the presence of a headache at least 15 days per month for ≥3 months and has a high global impact on health and economy, and therapeutic guidelines are lacking.

Methods:

Using the Grading of Recommendations, Assessment, Development, and Evaluations system, we conducted a search in MEDLINE and Cochrane to investigate the current evidence and generate recommendations of clinical practice on the identification of risk factors and treatment of CM in adults.

Results:

We recommend avoiding overmedication of non-steroidal anti-inflammatory drugs (NSAIDs); ergotamine; caffeine; opioids; barbiturates; and initiating individualized prophylactic treatment with topiramate eptinezumab, galcanezumab, erenumab, fremanezumab, or botulinum toxin. We highlight the necessity of managing comorbidities initially. In the acute management, we recommend NSAIDs, triptans, lasmiditan, and gepants alone or with metoclopramide if nausea or vomiting. Non-pharmacological measures include neurostimulation.

Conclusions:

We have identified the risk factors and treatments available for the management of CM based on a grading system, which facilitates selection for individualized management.

Pilot study on patients with Mal de Debarquement syndrome during pregnancy

Aim:

To evaluate if patients with Mal de Debarquement syndrome (MdDS) demonstrate different symptom levels or symptom type during pregnancy.

Materials & methods:

18 MdDS patients that were or had been pregnant during their condition were recruited to complete a retrospective online questionnaire. Respondents answered questions regarding their basic clinical data, diagnosis, triggers and differences in symptom level and symptom type during pregnancy and before pregnancy.

Results:

A total of 81.3% reported that their symptoms were reduced during pregnancy compared with before pregnancy. Respondents also reported a different perception of motion and experienced less dizziness while being pregnant.

Conclusion:

The physiological changes that occur during pregnancy improve the symptoms of patients with MdDS, and this is potentially attributable to the rise in estrogen and progesterone.

Mal de Debarquement syndrome (MdDS) is a rare neurological disorder characterized by a constant sensation of self-motion. More women are affected than men, and subsequently a hormonal implication has been theorized. This study aimed to evaluate if symptoms change in patients with MdDS during their pregnancy. A total of 18 MdDS patients were recruited to complete a retrospective online questionnaire. Among these, 81.3% of respondents reported that their symptoms were lower during pregnancy compared with before pregnancy. Respondents also reported a different perception of motion and experienced less dizziness while being pregnant. Our results support the hypothesis that pregnancy positively influences MdDS symptoms.

Effectiveness of Manual Treatment on Pregnancy Symptoms: Usefulness of Manual Treatment in Treating Pregnancy Symptoms

Objectives

To determine the usefulness of manual treatment in reducing or eliminating pregnancy symptoms during first and second trimester.

Methods

Manual treatment of the cervical and thoracic spine was performed in a group of 115 pregnant women who developed pregnancy symptoms during normal pregnancy. A rotational traction of the cervical spine was applied. Patients in whom the treatment was unsuccessful underwent second round of treatment after a pause of a minimum 3 days. Patients for whom the treatment was initially successful but later relapsed also repeated whole procedure. Pregnancy symptoms analyzed in this study were heartburn, nausea, vomiting, dizziness, headache, insomnia, neck pain, hyperosmia and hypersalivating.

Results

Manual treatment successfully treated pregnancy symptoms in 91 (79.1%) patients, it was partially successful for 22 (19.1%), and unsuccessful for 2 patients (1.7%) after the first treatment. After the second treatment, out of a total 56 patients, the treatment was completely successful in 40 (71.4%), partially successful in 14 (25%), and unsuccessful in 2 (3.6%) patients. The highest success rate was in eliminating headache (97.3%), vomiting (95.9%), dizziness (94.5%), nausea (92.9%), neck pain (92.9%), insomnia (91.9%), heartburn (88.8%), hyperosmia (78.5%) and hyper salivating (78%).

Conclusion

Manual therapy in pregnancy is a drugless, etiological, usually highly effective therapy. It is a low cost, rapid, safe, and well tolerated treatment for pregnancy symptoms which frequently has an immediate effect, thus making it an optimal treatment for pregnancy symptoms.

Headache and pregnancy: a systematic review

This systematic review summarizes the existing data on headache and pregnancy with a scope on clinical headache phenotypes, treatment of headaches in pregnancy and effects of headache medications on the child during pregnancy and breastfeeding, headache related complications, and diagnostics of headache in pregnancy. Headache during pregnancy can be both primary and secondary, and in the last case can be a symptom of a life-threatening condition. The most common secondary headaches are stroke, cerebral venous thrombosis, subarachnoid hemorrhage, pituitary tumor, choriocarcinoma, eclampsia, preeclampsia, idiopathic intracranial hypertension, and reversible cerebral vasoconstriction syndrome. Migraine is a risk factor for pregnancy complications, particularly vascular events. Data regarding other primary headache conditions are still scarce. Early diagnostics of the disease manifested by headache is important for mother and fetus life. It is especially important to identify “red flag symptoms” suggesting that headache is a symptom of a serious disease. In order to exclude a secondary headache additional studies can be necessary: electroencephalography, ultrasound of the vessels of the head and neck, brain MRI and MR angiography with contrast ophthalmoscopy and lumbar puncture. During pregnancy and breastfeeding the preferred therapeutic strategy for the treatment of primary headaches should always be a non-pharmacological one. Treatment should not be postponed as an undermanaged headache can lead to stress, sleep deprivation, depression and poor nutritional intake that in turn can have negative consequences for both mother and baby. Therefore, if non-pharmacological interventions seem inadequate, a well-considered choice should be made concerning the use of medication, taking into account all the benefits and possible risks.

Discriminative Analysis of Migraine without Aura: Using Functional and Structural MRI with a Multi-Feature Classification Approach

Magnetic resonance imaging (MRI) is by nature a multi-modality technique that provides complementary information about different aspects of diseases. So far no attempts have been reported to assess the potential of multi-modal MRI in discriminating individuals with and without migraine, so in this study, we proposed a classification approach to examine whether or not the integration of multiple MRI features could improve the classification performance between migraine patients without aura (MWoA) and healthy controls. Twenty-one MWoA patients and 28 healthy controls participated in this study. Resting-state functional MRI data was acquired to derive three functional measures: the amplitude of low-frequency fluctuations, regional homogeneity and regional functional correlation strength; and structural MRI data was obtained to measure the regional gray matter volume. For each measure, the values of 116 pre-defined regions of interest were extracted as classification features. Features were first selected and combined by a multi-kernel strategy; then a support vector machine classifier was trained to distinguish the subjects at individual level. The performance of the classifier was evaluated using a leave-one-out cross-validation method, and the final classification accuracy obtained was 83.67% (with a sensitivity of 92.86% and a specificity of 71.43%). The anterior cingulate cortex, prefrontal cortex, orbitofrontal cortex and the insula contributed the most discriminative features. In general, our proposed framework shows a promising classification capability for MWoA by integrating information from multiple MRI features.

Headache in the Emergency Department: Avoiding Misdiagnosis of Dangerous Secondary Causes

There are a number of dangerous secondary causes of headaches that are life, limb, brain, or vision threatening that emergency physicians must consider in patients presenting with acute headache. Careful history and physical examination targeted at these important secondary causes of headache will help to avoid misdiagnosis in these patients. Patients with acute thunderclap headache have a differential diagnosis beyond subarachnoid hemorrhage. Considering the "context" of headache "PLUS" some other symptom or sign is one strategy to help focus the differential diagnosis.

A repeated measures study of changes in health-related quality of life during pregnancy and the relationship with obstetric factors

AIMS

To examine changes in health-related quality of life throughout the course of pregnancy and among three pairs of consecutive periods (pre-pregnancy to early pregnancy, early to middle pregnancy and middle to late pregnancy), as well as to identify associated obstetric factors during the entire period of pregnancy.

BACKGROUND

Only sparse data are available concerning the profiles of health-related quality of life throughout pregnancy.

DESIGN

A within-subject comparison was undertaken.

METHODS

In total, 358 women completed the Taiwanese version of the Medical Outcomes Study Short Form-36 Health Questionnaire and a demographic-obstetric questionnaire at three stages of pregnancy at a medical centre. The participants were recruited between 2009-2010. A generalized estimating equation regression model was employed for the repeated measures.

RESULTS

The scores for physical component summary decreased significantly throughout early, middle and late pregnancy. The scores for mental component summary increased. The scores for physical, mental component summary and the eight domains of health-related quality of life decreased significantly from pre-pregnancy to early pregnancy. After adjusting for demographic and clinical factors, significant factors predicting physical component summary during pregnancy included stage of pregnancy and previous infertility. The factors predicting mental component summary included stage of pregnancy, parity and medical condition.

CONCLUSIONS

The results revealed the dynamic pattern of perceived health status by the Taiwanese pregnant women in their surrounding socio-cultural context and identified the stage of pregnancy and obstetric factors predicting health-related quality of life.