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González-García N, Díaz de Terán J, López-Veloso AC, Mas-Sala N, Mínguez-Olaondo A, Ruiz-Piñero M, Gago-Veiga AB, Santos-Lasaosa S, Viguera-Romero J, Pozo-Rosich P. Headache: pregnancy and breastfeeding Recommendations of the Spanish Society of Neurology's Headache Study Group. Neurologia 2022; 37:1-12. [PMID: 31047730 DOI: 10.1016/j.nrl.2018.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/22/2018] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Headache is one of the most common neurological complaints, and is most frequent during reproductive age. As a result, we are routinely faced with pregnant or breastfeeding women with this symptom in clinical practice. It is important to know which pharmacological choices are the safest, which should not be used, and when we should suspect secondary headache. To this end, the Spanish Society of Neurology's Headache Study Grouphas prepared a series of consensus recommendations on the diagnostic and therapeutic algorithms that should be followed during pregnancy and breastfeeding. DEVELOPMENT This guide was prepared by a group of young neurologists with special interest and experience in headache, in collaboration with the Group's Executive Committee. Recommendations focus on which drugs should be used for the most frequent primary headaches, both during the acute phase and for prevention. The second part addresses when secondary headache should be suspected and which diagnostic tests should be performed in the event of possible secondary headache during pregnancy and breastfeeding. CONCLUSIONS We hope this guide will be practical and useful in daily clinical practice and that it will help update and improve understanding of headache management during pregnancy and breastfeeding, enabling physicians to more confidently treat these patients.
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Affiliation(s)
| | - J Díaz de Terán
- Unidad de Cefaleas, Servicio de Neurología, Hospital Universitario La Paz, IdiPAZ, Instituto de Investigación Sanitaria, Madrid, España
| | - A C López-Veloso
- Servicio de Neurología, Hospital Universitario de Gran Canaria Dr. Negrín, Gran Canaria, España
| | - N Mas-Sala
- Servicio de Neurología, Hospital Universitario Sant Joan de Déu, Fundación Althaia, Manresa, Barcelona, España
| | - A Mínguez-Olaondo
- Servicio de Neurología, Hospital Universitario Donostia, Donostia, España; Servicio de Neurología, Clínica Universidad de Navarra, Pamplona, España
| | - M Ruiz-Piñero
- Servicio de Neurología, Hospital Universitario San Juan de Alicante, Alicante, España
| | - A B Gago-Veiga
- Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de la Princesa, Madrid, España
| | - S Santos-Lasaosa
- Unidad de Cefaleas, Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J Viguera-Romero
- Unidad Gestión Clínica de Neurología, Hospital Virgen Macarena, Sevilla, España
| | - P Pozo-Rosich
- Unidad de Cefalea, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España, Grupo de Investigación en Cefalea, VHIR, Universitat Autònoma Barcelona, España
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Headache: pregnancy and breastfeeding. Recommendations of the Spanish Society of Neurology's Headache Study Group. NEUROLOGÍA (ENGLISH EDITION) 2021; 37:1-12. [PMID: 34535428 DOI: 10.1016/j.nrleng.2018.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/22/2018] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Headache is one of the most common neurological complaints, and is most frequent during reproductive age. As a result, we are routinely faced with pregnant or breastfeeding women with this symptom in clinical practice. It is important to know which pharmacological choices are the safest, which should not be used, and when we should suspect secondary headache. To this end, the Spanish Society of Neurology's Headache Study Group has prepared a series of consensus recommendations on the diagnostic and therapeutic algorithms that should be followed during pregnancy and breastfeeding. DEVELOPMENT This guide was prepared by a group of young neurologists with special interest and experience in headache, in collaboration with the Group's Executive Committee. Recommendations focus on which drugs should be used for the most frequent primary headaches, both during the acute phase and for prevention. The second part addresses when secondary headache should be suspected and which diagnostic tests should be performed in the event of possible secondary headache during pregnancy and breastfeeding. CONCLUSIONS We hope this guide will be practical and useful in daily clinical practice and that it will help update and improve understanding of headache management during pregnancy and breastfeeding, enabling physicians to more confidently treat these patients.
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Vélez-Jiménez MK, Chiquete-Anaya E, Orta DSJ, Villarreal-Careaga J, Amaya-Sánchez LE, Collado-Ortiz MÁ, Diaz-García ML, Gudiño-Castelazo M, Hernández-Aguilar J, Juárez-Jiménez H, León-Jiménez C, Loy-Gerala MDC, Marfil-Rivera A, Antonio Martínez-Gurrola M, Martínez-Mayorga AP, Munive-Báez L, Nuñez-Orozo L, Ojeda-Chavarría MH, Partida-Medina LR, Pérez-García JC, Quiñones-Aguilar S, Reyes-Álvarez MT, Rivera-Nava SC, Torres-Oliva B, Vargas-García RD, Vargas-Méndez R, Vega-Boada F, Vega-Gaxiola SB, Villegas-Peña H, Rodriguez-Leyva I. Comprehensive management of adults with chronic migraine: Clinical practice guidelines in Mexico. CEPHALALGIA REPORTS 2021. [DOI: 10.1177/25158163211033969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
| | - Erwin Chiquete-Anaya
- Department of Neurology and Psychiatry, National Institute of Medical Science and Nutrition “Salvador Zubirán”, Mexico City, México
| | - Daniel San Juan Orta
- Department of Clinical Research of the National Institute of Neurology and Neurosurgery “Dr. Manuel Velazco Suárez”, Mexico City, Mexico
| | | | - Luis Enrique Amaya-Sánchez
- Department of Neurology, Hospital de Especialidades del Centro Médico Nacional SXXI Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Miguel Ángel Collado-Ortiz
- Staff physician of the hospital and the Neurological Center ABC (The American British Cowdray Hospital IAP, Mexico City, Mexico
| | | | | | - Juan Hernández-Aguilar
- Department of Neurology, Hospital Infantil de México. Federico Gómez, Mexico City, Mexico
| | | | - Carolina León-Jiménez
- Department of Neurology, ISSSTE Regional Hospital, “Dr. Valentin Gomez Farías”, Zapopan, Jalisco, Mexico
| | | | - Alejandro Marfil-Rivera
- Headache and Chronic Pain Clinic, Neurology Service, Hospital Univrsitario Autónoma de Nuevo Leon, Mexico City, Mexico
| | | | - Adriana Patricia Martínez-Mayorga
- Department of Neurology, Central Hospital “Dr. Ignacio Morones Prieto”, Faculty of Medicine, Universidad Autónoma de San Luis Potosi, SLP, Mexico City, Mexico
| | | | - Lilia Nuñez-Orozo
- Department of Neurology, National Medical Center 20 de Noviembre, ISSSTE, Mexico City, Mexico
| | | | - Luis Roberto Partida-Medina
- Department of Neurology, Hospital de Especialidades, Centro Medico Nacional de Occidente, IMSS, Guadalajara, Jalisco, Mexico
| | | | | | | | | | | | | | | | - Felipe Vega-Boada
- Department of Neurology and Psychiatry, National Institute of Medical Science and Nutrition “Salvador Zubirán”, Mexico City, México
| | | | - Hilda Villegas-Peña
- Department of Pediatric Neurology, Clínica de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Ildefonso Rodriguez-Leyva
- Department of Neurology, Central Hospital “Dr. Ignacio Morones Prieto”, Faculty of Medicine, Universidad Autónoma de San Luis Potosi, SLP, Mexico City, Mexico
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Pavlović JM. The impact of midlife on migraine in women: summary of current views. Womens Midlife Health 2020; 6:11. [PMID: 33042563 PMCID: PMC7542111 DOI: 10.1186/s40695-020-00059-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 09/06/2020] [Indexed: 12/20/2022] Open
Abstract
Migraine is three times more common in women than in men and is the 4th leading cause of disability in women. Onset of migraine increases at menarche, with peaks in prevalence in the late 30s, and a rapid decline after menopause. While the prevalence is highest among women of childbearing age the frequency of headache and burden of migraine frequently worsens during midlife. Abundant population data suggest that hormonal factors may trigger headache attacks and influence onset and remission. The midlife worsening of migraine is attributed to hormonal fluctuations characteristic of the menopausal transition. Drops in estrogen presumably lead to increased migraine attacks at the time of menses as well as during the menopausal transition. During the menopausal transition, recommended approaches include both acute and preventive non-hormonal and hormonal options as well as behavioral approaches. Herein, is a brief review on the presentation of migraine in women across the lifespan, with special emphasis on midlife and the menopausal transition and implications for treatment.
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Affiliation(s)
- Jelena M Pavlović
- Albert Einstein College of Medicine, Department of Neurology, 1225 Morris Park Avenue, Van Etten 3C9B, Bronx, NY 10461 USA.,Montefiore Medical Center/Montefiore Headache Center, 1250 Waters place, 8th floor, Bronx, NY 10461 USA
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