Chronic Daily Headache during Pregnancy*

Migraine affects 25% of the female population during childbearing years (aged 18–49 years). Managing chronic headache during pregnancy poses many challenges for the pregnant patient, her family, and treating clinicians. Although for many women, higher estrogen levels during pregnancy may result in less frequent or less severe headache episodes, for others headache may not improve, and may indeed worsen, particularly in the first trimester. There are few trials and little evidence-based data for many medications during pregnancy because of the obvious risks inherent in exposing the fetus to these drugs. This article will address what is currently known about the clinical and pathophysiologic evidence for headaches (predominantly migraine) associated with pregnancy, the epidemiology of the condition, in addition to the pharmacologic and nonpharmacologic treatment options available. The relative risks and recommendations for the most common pharmacologic therapies prescribed for acute and preventive treatment of headache will be discussed within the context of conception, pregnancy, and lactation. T here are few comprehensive studies regarding the issue of headache during pregnancy, yet it can pose great treatment challenges, and perhaps the foremost challenge is how to manage pregnant women who are experiencing serious headache on a daily or near daily basis. In the climate of the developing fetus, the concern about any risk to the fetus is paramount for the mother, the father, the obstetrician, the family in general, and for the treating neurologist or headache specialist who is helping to care for the pregnant woman. The treatment options are poorly studied because there are few trials and little evidence-based data for many medications during pregnancy because of the obvious risks inherent in exposing the fetus to these drugs. This article will address what is currently known about the clinical and pathophysiologic evidence for headaches (predominantly migraine) associated with pregnancy, the epidemiology of the condition, and the treatment options available.