International Headache Management in Pregnancy and Lactation

Abstract

Headache is a common complaint in pregnancy and the postpartum period. Fortunately, most headaches seen during pregnancy are primary headache disorders (migraine, tension-type headache, and occasionally cluster headache). Secondary headache disorders (cerebral venous thrombosis, benign intracranial hypertension, posterior reversible encephalopathy syndrome, pituitary apoplexy, and preeclampsia) require a strict differential diagnosis for every case. As many drugs have potential harmful effects on the fetus and breast-fed infant, the management of headaches in these periods is difficult. It is essential for clinicians to make the diagnosis correctly regarding whether there is a primary or secondary headache and to be aware of the possible treatments of headaches during pregnancy without harming the fetus. The number of studies on medication use during pregnancy and lactation is limited, and pharmacological therapy and interventional management should therefore be considered and selected carefully in the absence of a response to non-pharmacological methods. Currently, there is no drug that has been proven to be reliable and efficacious in the treatment of primary and secondary headaches. In this respect, interventional options with less drug side effects such as nerve blocks and trigger point injections can be the method of choice.