Effective Migraine Treatment in Pregnant and Lactating Women: A Practical Guide (eBook)

Effective Migraine Treatment in Pregnant and Lactating Women: A Practical Guide 2
Foreword 6
Preface 7
Contents 9
Understanding Migraine and Pregnancy 13
Typical Concerns Your Patient May Have 17
Summary 37
References 37
Safety Rating Systems for Drugs Used in Pregnancy and Lactation 41
Pregnancy 42
Medication Use During Pregnancy 42
Understanding Reproductive Risk 45
Tools for Assessing Reproductive Risk 45
Lactation 48
Trends in Breastfeeding 49
Maternal Drug Effects on the Baby 50
Helpful Online and Print Resources 53
Summary 56
References 56
Non-Pharmacological Headache Treatments 58
Trigger Identification and Avoidance 61
Cause or Coincidence? 61
Dietary Recommendations During Pregnancy and Lactation 63
Trigger Avoidance or Desensitization? 63
Psychological Pain Management Skills 64
Relaxation and Biofeedback 64
Relaxation During Pregnancy and Lactation 65
Stress Management 66
Cognitive Restructuring 67
Distraction 68
Effective Psychological Pain Management Technique Delivery Systems 69
Healthy Lifestyle Habits 70
Diet 70
Sleep 71
Physiology of Sleep and Headache 71
Effect of Sleep Disturbance on Headache 72
Sleep and Pregnancy 73
Smoking 74
Smoking and pregnancy 74
Exercise and Physical Therapy 75
Aerobic Exercise 75
Stretching Exercises 76
Intraoral Appliances 76
Massage and Other Manual Therapies 77
Summary 77
References 78
Acute Treatment Options for the Pregnant Headache Patient 82
Design Safer Treatment Plans Before Conception 85
Develop a Safer and Effective Acute Treatment Plan 86
Don’t Medicate Mild Headaches 87
Treat Nausea Aggressively 88
Non-drug Treatments 88
Anti-emetic Medications 89
Herbs and Supplements 89
Determining First-Line Treatment of Migraine-Related Nausea During Pregnancy 91
Maximize Non-drug Treatments 93
Treat Co-existing Temporomandibular Dysfunction 94
Effectively Implementing Non-drug Treatments 94
Select the Safest Effective Medications 95
OTC Medications 96
Prescription Medications 98
Herbal Remedies 102
Determining First-Line Migraine Medication Treatment 102
Effectively Communicating Medication Advice 103
Regularly Assess Treatment Efficacy 105
Scheduling Follow-Up Visits 107
Summary 108
References 109
Acute Treatment Options for the Lactating Headache Patient 112
Consider Important Secondary Causes of Headache 113
Anticipate Headache Recurrence After Delivery 117
Utilize Good Principles of Acute Headache Treatment 119
Select the Safest Medications 119
Time Maternal Medication Dosing 120
Specific Medication Recommendations 121
Analgesics 121
Triptans 124
Rescue Therapy 124
Anti-emetics 125
Herbal Remedies 125
Summary 125
References 126
Preventive Treatment Options for the Pregnant Headache Patient 128
Identify Patients Needing Preventive Therapy 130
Provide Safe and Effective Prevention Recommendations 131
Consider Possible Future Pregnancy When Using Prevention in Non-pregnant Patients 132
Maximize Safe and Effective Non-medication Treatments 132
Utilize Medications in Select, Difficult-to-treat Patients 133
Don’t Permit Analgesic Overuse in Patients Needing Prevention 135
Limit Preventive Medication Exposure 137
Antihypertensives 138
Antiepileptics 139
Antidepressants 140
Injections and Alternative Therapies 141
Vitamins, Herbs, and Supplements 143
Summarizing Medication Recommendations 144
Summary 145
References 145
Preventive Treatment Options for the Lactating Headache Patient 148
Plan for Headache Recurrence After Delivery 150
Include Plans for Contraception 150
Develop a Safe and Effective Preventive Treatment Plan 151
Maximize Effective Non-medication Treatments 151
Select Safe Medications 151
Antihypertensives 152
Antiepileptics 153
Antidepressants 153
Muscle Relaxants 154
Vitamins and Minerals 154
Summarizing Preventive Medication Recommendations 155
Time Drug Administration to Minimize Effects 155
Summary 156
References 156
Urgent Care/Emergency Treatment of the Acute, Severe Headache in Pregnant and Lactating Patients 158
Utilize a Consistent Evaluation and Treatment Plan 162
Rule Out Secondary Causes of Headache 162
Treat Dehydration 163
Treat Nausea Aggressively 164
Always Consider Non-medication Treatments 166
Treat Pain Appropriately 167
Consider Trigger Point Injections or Occipital Blocks 169
Arrange Post-ED Follow-up 170
Summary 173
References 174
Work-up for Headache During Pregnancy and Lactation 177
Headache History 178
Red Flags/Alarm Symptoms 180
Physical Examination 181
Spinal Fluid Examination 183
Neuroimaging 184
Computed Tomography 186
Magnetic Resonance Imaging 187
Contrast Agents During Pregnancy 187
Contrast Agents During Lactation 188
Summary 188
References 189
Patient Headache Resources 191
References 193
General Information 194
When you’re ready to get pregnant hellip 194
Now that you’re pregnant hellip 195
After you’ve delivered hellip 196
Headache Treatment 198
Now that I’m trying to get pregnant, what can I do when I get a headache? 198
What non-drug treatments are effective for treating headaches? 200
Practicing relaxation techniques 203
Tips for performing relaxation techniques 203
Stress management 205
Headache-reducing exercises 207
Nausea Treatment 209
What can I do if I’m feeling nauseated during my pregnancy? 209
Additional Headache Resources 210
Where can I find reliable online information about migraine and other headaches? 210
Where can I learn more about managing headaches? 211
Index 213