Special populations

• Published in: Migraine and Headache
• Main Author: Mauskop, Alexander
• Format: Book Chapter
• Language: English
• Published: New York, NY Oxford University Press 26.06.2009; Oxford University Press, Incorporated
• Subjects: Pain Medicine; analgesic; approach; Metoclopramide; considered; pregnancy
• ISBN: 9780195368208; 0195368207
• DOI: 10.1093/oso/9780195368208.003.0008

Migraine headaches stop in two-thirds of pregnant women, especially in the second and third trimester. They also stop after menopause, and at around the same age in men. In pregnancy, all attempts are made to avoid medications by using nonpharmacological therapies, such as biofeedback, massage, application of ice, and aromatherapy. Nausea can be treated with motion sickness bands (Sea-Band, BioBands, Psi-Bands), which are wrist bands with a pressure point placed 2 inches above the wrist crease. This is an acupuncture point and has been proved to relieve nausea induced by motion, pregnancy, chemotherapy, and post surgery. Pyridoxine (vitamin B), 30 mg a day and 25 mg three times a day was shown to be effective for nausea or pregnancy in two double-blind trials. Metoclopramide is in Category B and is safe in pregnancy. When necessary, acetaminophen alone or with an opioid analgesic is tried first. Ibuprofen and naproxen can be used only in the first two trimesters of pregnancy. Triptans are considered to be a safer approach than allowing a woman to have uncontrolled migraine attack with nausea, vomiting, and dehydration. For prophylactic therapy in pregnancy, the author uses magnesium, intravenously or orally, before any other intervention. Propranolol, which is in Category C, is considered safe and is often used as the first-line drug, but atenolol is in Category D and is contraindicated. Amitriptyline is generally considered safe, although it is also in Category C, as is topiramate. Divalproex sodium is in Category D and is strictly contraindicated.