Study of the Mechanisms and Therapeutic Approaches of Migraine in Women and Pregnancy: A Literature Review

Abstract

Headache is a significant and debilitating health problem, affecting more than half of the population worldwide. Migraine is a type of headache that is strongly associated with women and accounts for the high number of years lived with disability among women. The pathophysiology of migraine attacks may begin with a premonitory phase, followed by an aura phase and migraine headache. In women, many factors influence the prevalence of migraine, and sex hormone fluctuations around the menstruation cycle were believed to impact the pathogenesis of migraine. The International Classification of Headache Disorders, 3rd edition identifies menstrual migraine as pure menstrual migraine without aura and menstrually related migraine without aura. While migraine without aura (MwoA) was clearly associated with menstruation, migraine with aura (MwA) was generally unrelated to menstruation. Studies suggested that estrogen withdrawal is a trigger for MwoA, but high estrogen states are a trigger for MwA. During pregnancy, the increase in estrogen hypothetically prevents migraine attacks. There are several strategies for managing menstrual migraine, from acute/abortive, mini-preventive, and continuous preventive treatment. Managing migraine during pregnancy follows a similar strategy, but the drugs' safety profile should be considered.

How migraine and its associated treatment impact on pregnancy outcomes: Umbrella review with updated systematic review and meta-analysis

“…Overlap was quantified using corrected covered area (CCA). Overlap was rated as slight (0-5), moderate (6)(7)(8)(9)(10), high (11)(12)(13)(14)(15) and very high (>15) (18). In the case of high or very high overlap, one review was selected for inclusion.…”

“…Recommended treatment options during pregnancy include paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) (prior to the third trimester) or triptans for symptom relief and aspirin, beta blockers and amitriptyline for migraine prophylaxis (9). However, even for these medications, there is a paucity of evidence regarding their safety in pregnancy, meaning that it is advised they are used with caution (10,11). Despite this, medication use and polypharmacy are prevalent in pregnant women with migraine.…”

Exploring the Connection between Migraines and Pregnancy: The Impact of Physical Activity on Symptom Management

“…Most of these categories can be subcategorized, but from the clinical aspect of view, MWAs appear to be the most relevant. MWAs are primarily associated with hormone level changes and are accountable for approximately 80% of all cases of migraines [11].…”

Prevalence of Menstrual Migraine and the Efficacy of Sumatriptan Administration

“…The estrogen withdrawal mechanism is the most accepted theory in explaining the pathophysiology of menstrual migraine. Estrogen withdrawal is when somewhat stable estrogen levels are replaced by a more fluctuating pattern (10).…”