Headache During Gestation: Evaluation of 1101 Women

Melhado, Eliana Meire; Maciel, Jayme Antunes; Guerreiro, Carlos A. M.

doi:10.1017/s0317167100006028

Cited by 81 publications

(74 citation statements)

References 17 publications

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“…The majority of epidemiological studies demonstrate that pregnant women suffering from headaches prior to pregnancy report an improvement ranging from 55 to 90 % of cases [5]; in our study, we found an improvement in 60 % of cases (375/620) and the total disappearance of attacks in 195 cases (31 %). With regard to the total disappearance of headache in pregnancy, if we consider only those women classified as Definite migraine (n = 303), 27 % of them (n = 81) show complete disappearance of the attacks.…”

Section: Discussionsupporting

confidence: 62%

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Migraine and pregnancy: an internet survey

et al. 2013

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Data in the literature show that migraine tends to improve during pregnancy in most migrainous women. The aim of this Internet survey was to obtain the most likely cross section of the situation in the general population with respect to the presence and course of migraine in pregnancy. All women who participated were asked to answer questions pertaining to their history of pregnancy and headache. One thousand and eighteen women participated in the survey; only 775 met the eligibility criteria for inclusion. One hundred and ninety-five women (25.2 %) reported having had a headache only before pregnancy, 425 (54.8 %) before and during pregnancy, and 155 (20.0 %) only during pregnancy. Women suffering from headache before and/or during pregnancy were much more likely to have headaches with more migrainous features at the ID Migraine Screener test when compared to women whose headache began during pregnancy. ''Definite migraines'' were 277/620 (44.7 %) and 26/155 (16.8 %), respectively, in the two groups (p \ 0.0001). Among the 620 females that suffered from headache before pregnancy, 375 (60.5 %) improved, 195 (31.5 %) showed complete resolution of the disorder, and 180 (29.0 %) had a reduction in headache frequency. Moreover, the multinomial logistic model (with headache pattern as dependent variable) proved fetal presentation as significant (p = 0.0042). Women with ''new headache'' (No/Yes pattern) had an OR (95 % CI) of 1.9 (1.2-3.0) of breech presentation at delivery versus those with a stable pattern of headache (Yes/Yes). Finally, women with not recent pregnancy stated they suffered from headache less than the women with recent pregnancy.

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Section: Discussionsupporting

confidence: 62%

“…However, some of these cases may have been caused by secondary headaches, in particular those linked to hypertensive disorders [5,8]. In fact, our data did not allow us to investigate this aspect.…”

Section: Discussionmentioning

confidence: 71%

Migraine and pregnancy: an internet survey

et al. 2013

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“…Melhado et al 3 conducted a large prospective study of 1,029 pregnant women in a variety of obstetrical settings, also utilizing International Headache Society classification. 21 Although they did not focus on acute severe headache, a subgroup of 76 women experienced new-onset or a new type of headache in pregnancy, of whom 52.6% had secondary headache.…”

Section: Discussionmentioning

confidence: 99%

“…2 Migraine is the most common disabling primary headache disorder, and, in pregnancy, retrospective and prospective studies consistently demonstrate that by the second trimester, migraine frequency typically improves, although attacks of migraine with aura and aura without headache may not reflect this pattern. [3][4][5][6][7][8][9][10] Acute, severe headache in pregnancy is generally regarded as a "red flag" and a cause for further investigation, particularly when new onset. [11][12][13] Various secondary headache disorders are more likely to occur during this time period, 12 possibly related to hypercoagulability, hormonal factors, anesthesia for labor, and other mechanisms.…”

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confidence: 99%

Acute headache diagnosis in pregnant women

et al. 2015

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Objective: To characterize demographic and clinical features in pregnant women presenting with acute headache, and to identify clinical features associated with secondary headache. Methods:We conducted a 5-year, single-center, retrospective study of consecutive pregnant women presenting to acute care with headache receiving neurologic consultation.Results: The 140 women had a mean age of 29 6 6.4 years and often presented in the third trimester (56.4%). Diagnoses were divided into primary (65.0%) and secondary (35.0%) disorders. The most common primary headache disorder was migraine (91.2%) and secondary headache disorders were hypertensive disorders (51.0%). The groups were similar in demographics, gestational ages, and most headache features. In univariate analysis, secondary headaches were associated with a lack of headache history (36.7% vs 13.2%, p 5 0.0012), seizures (12.2% vs 0.0%, p 5 0.0015), elevated blood pressure (55.1% vs 8.8%, p , 0.0001), fever (8.2% vs 0.0%, p 5 0.014), and an abnormal neurologic examination (34.7% vs 16.5%, p 5 0.014). In multivariate logistic regression, elevated blood pressure (odds ratio [OR] 17.0, 95% confidence interval [CI] 4.2-56.0) and a lack of headache history (OR 4.9, 95% CI 1.7-14.5) had an increased association with secondary headache, while psychiatric comorbidity (OR 0.13, 95% CI 0.021-0.78) and phonophobia (OR 0.29, 95% CI 0.09-0.91) had a reduced association with secondary headache.Conclusions: Among pregnant women receiving inpatient neurologic consultation, more than onethird have secondary headache. Diagnostic vigilance should be heightened in the absence of a headache history and if seizures, hypertension, or fever are present. Attack features may not adequately distinguish primary vs secondary disorders, and low thresholds for neuroimaging and monitoring for preeclampsia are justified. Neurology ® 2015;85:1024-1030 GLOSSARY CI 5 confidence interval; HELLP 5 hemolysis, elevated liver enzymes, and low platelet count; ICHD-3 beta 5 International Classification of Headache Disorders, 3rd edition (beta version); OR 5 odds ratio; PRES 5 posterior reversible encephalopathy syndrome.The most common primary headache disorders have a peak prevalence and incidence at a younger age and affect women disproportionately, particularly during childbearing years.1 The female predilection may be explained by the relationship of headache and sex hormones, particularly estrogen.2 Migraine is the most common disabling primary headache disorder, and, in pregnancy, retrospective and prospective studies consistently demonstrate that by the second trimester, migraine frequency typically improves, although attacks of migraine with aura and aura without headache may not reflect this pattern. [3][4][5][6][7][8][9][10] Acute, severe headache in pregnancy is generally regarded as a "red flag" and a cause for further investigation, particularly when new onset. [11][12][13] Various secondary headache disorders are more likely to occur during this time period, 12 possibly related t...

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“…The improvement we found is as previously observed with migraine headaches. [15][16][17] While it is agreed that there is a wide migraine improvement rate of 18-80% in different studies, 14 our finding of migraine improvement rate of 100% is most likely due to the relatively small sample size of our survey. We equally noted a high improvement rate of 82.5% for TTH.…”

Section: Discussionmentioning

confidence: 97%