Management of Primary Headaches in Pregnancy

Saldanha, Ian J.; Roth, Julie; Chen, Kenneth K.; Zullo, Andrew R.; Adam, Gaelen P; Konnyu, Kristin J.; Cao, Wangnan; Bhuma, Monika Reddy; Kimmel, Hannah J.; Mehta, Shivani; Riester, Melissa R.; Sorial, Mark N.; Balk, Ethan M

doi:10.23970/ahrqepccer234

Cited by 8 publications

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“…We conducted a systematic review (SR) under the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) Program to support the American College of Obstetricians and Gynecologists in its effort to develop a new clinical practice guideline on management of primary headaches during pregnancy. 6 We addressed two Key Q uestions: What are the (comparative) benefits and harms of pharmacologic and non-pharmacologic interventions to (a) prevent or (b) treat acute attacks of primary headache in women who are pregnant, attempting to become pregnant, postpartum, or breastfeeding? For each Key Question, we were also interested in whether the (comparative) benefits and harms varied by phase (i.e., preconception, pregnancy trimester, postpartum, and breastfeeding) or by type of primary headache (i.e., migraine, tension headache, cluster headache, and other TACs).…”

Section: Objective and Key Questionsmentioning

confidence: 99%

Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review

et al. 2021

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Background: Primary headaches (migraine, tension headache, cluster headache, and other trigeminal autonomic cephalgias) are common in pregnancy and postpartum. It is unclear how to best and most safely manage them. Objective: We conducted a systematic review (SR) of interventions to prevent or treat primary headaches in women who are pregnant, attempting to become pregnant, postpartum, or breastfeeding. Methods: We searched Medline, Embase, Cochrane CENTRAL, CINAHL, ClinicalTrials. gov, Cochrane Database of SRs, and Epistemonikos for primary studies of pregnant women with primary headache and existing SRs of harms in pregnant women regardless of indication. No date or language restrictions were applied. We assessed strength of evidence (SoE) using standard methods. Results: We screened 8549 citations for studies and 2788 citations for SRs. Sixteen studies (mostly high risk of bias) comprising 14,185 patients (total) and 26 SRs met the criteria. For prevention, we found no evidence addressing effectiveness. Antiepileptics, venlafaxine, tricyclic antidepressants, benzodiazepines, β-blockers, prednisolone, and oral magnesium may be associated with fetal/child adverse effects, but calcium channel blockers and antihistamines may not be (1 single-group study and 11 SRs; lowto-moderate SoE). For treatment, combination metoclopramide and diphenhydramine may be more effective than codeine for migraine or tension headache (1 randomized controlled trial; low SoE). Triptans may not be associated with fetal/child adverse effects (8 nonrandomized comparative studies; low SoE). Acetaminophen, prednisolone, indomethacin, ondansetron, antipsychotics, and intravenous magnesium may be associated with fetal/child adverse effects, but low-dose aspirin may not be (indirect evidence; low-to-moderate SoE). We found insufficient evidence regarding non-pharmacologic treatments.

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Section: Objective and Key Questionsmentioning

confidence: 99%

Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review

et al. 2021

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“…Of these 50 potentially relevant articles, 33 publications were excluded for various reasons and 17 publications met the inclusion criteria and were included in this report. These comprised 3 overviews of reviews 28-30 (i.e., systematic reviews of systematic reviews) and 13 systematic reviews [31][32][33][34][35][36][37][38][39][40][41][42][43][44] (5 with meta-analysis [31][32][33]37,42,44 and1 with network-meta analysis), 38 1 of which was reported in 2 publications. 32,33 Appendix 1 presents the PRISMA 45 flow chart of the study selection.…”

Section: Quantity Of Research Availablementioning

confidence: 99%

“…These comprised 3 overviews of reviews 28-30 (i.e., systematic reviews of systematic reviews) and 13 systematic reviews [31][32][33][34][35][36][37][38][39][40][41][42][43][44] (5 with meta-analysis [31][32][33]37,42,44 and1 with network-meta analysis), 38 1 of which was reported in 2 publications. 32,33 Appendix 1 presents the PRISMA 45 flow chart of the study selection. Additional references of potential interest are provided in Appendix 4.…”

Section: Quantity Of Research Availablementioning

confidence: 99%

“…Three overviews of reviews 28-30 and 13 systematic reviews [31][32][33][34][35][36][37][38][39][40][41][42][43][44] (5 with meta-analysis [31][32][33]37,42,44 and 1 with network-meta analysis) 38 were identified for inclusion in this review. Of these, 3 overviews of reviews 28-30 and 10 systematic reviews [31][32][33][34][35][36][37][38][39][40][41] were specific to pain, 2 systematic reviews 42,43 were specific to cough, and 1 systematic review 44 examined both pain and cough.…”

Section: Summary Of Study Characteristicsmentioning

confidence: 99%

“…All included overviews of reviews [28][29][30] and systematic reviews [31][32][33][34][35][36][37][38][39][40][41][42][43][44] had objectives and inclusion criteria that were broader than the current report (i.e., wider in scope), mostly relating to the eligible interventions and comparators. Of the overviews of reviews and systematic reviews that were specific to pain conditions, the included studies covered any opioid for the treatment of adults with non-cancer pain, 28 adults with cancer-related pain, 29 children with chronic non-cancer pain, 39 and children with cancer-related pain; 40 pharmacological and nonpharmacological interventions for the treatment of adults with chronic tension-type headache and 30 any analgesic medications for adults undergoing surgical dental implant placement; 31 pharmacologic and non-pharmacologic interventions to prevent or treat episodes of primary headaches in women who were pregnant, attempting to become pregnant, postpartum, or breastfeeding; 32,33 any oral medications used for pain control in adults who underwent endodontic treatments, 34 any pain control preparation for people who underwent otologic surgery, 35 low-dose codeine products (defined by the authors as ≤ 30 mg) in adults 36 or people of all ages, 37 systemic pharmaceutical for adults with chronic cancer pain, 38 and oral paracetamol with or without codeine or dihydrocodeine for the treatment of adults with chronic neuropathic pain conditions. 41 As for the 2 systematic reviews 42,43 that were specific to cough conditions, 1 systematic review 42 included studies of any drug or non-drug treatments for people (16 years of age and older) with subacute cough, while 1 systematic review 43 included stud...…”

Section: Summary Of Study Characteristicsmentioning

confidence: 99%

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Medications Containing Low-Dose Codeine for the Treatment of Pain and Coughs

Young¹,

Loshak²

2021

cjht

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Codeine and codeine-containing medicines are used to treat people experiencing pain or cough symptoms. Whereas most products containing codeine require a prescription in Canada, some jurisdictions permit over-the-counter sales of products containing low doses of codeine mixed with other non-narcotic medicinal ingredients. Three overviews of reviews and 13 systematic reviews of variable methodological quality failed to identify studies on the effectiveness of low-dose codeine (i.e., 8 mg of codeine per tablet or 20 mg of codeine per 30 mL in liquid products) for the treatment of pain or coughs. There is a lack of evidence on the clinical effectiveness of oral analgesics and oral antitussives containing low doses of codeine.

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Headaches in Pregnancy and Postpartum

2022

Obstetrics &Amp; Gynecology

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PURPOSE:To provide updated evidence-based recommendations for the evaluation and treatment of primary and secondary headaches in pregnancy and postpartum.TARGET POPULATION:Pregnant and postpartum patients with a history of or experiencing primary or new secondary headaches.METHODS:This guideline was developed using an a priori protocol in conjunction with a writing team consisting of two specialists in obstetrics and gynecology appointed by the ACOG Committee on Clinical Practice Guidelines–Obstetrics and one external subject matter expert. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements.RECOMMENDATIONS:This Clinical Practice Guideline includes recommendations on interventions to prevent primary headache in individuals who are pregnant or attempting to become pregnant, postpartum, or breastfeeding; evaluation for symptomatic patients presenting with primary and secondary headaches during pregnancy; and treatment options for primary and secondary headaches during pregnancy and lactation. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.

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Management of Primary Headaches in Pregnancy

Cited by 8 publications

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Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review

Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review

Medications Containing Low-Dose Codeine for the Treatment of Pain and Coughs

Headaches in Pregnancy and Postpartum

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