The Use of Behavioral Modalities for Headache During Pregnancy and Breastfeeding

Abstract

Purpose of Review Migraine is primary headache which commonly affects women of childbearing age. Migraine and other primary headache disorders are also common during pregnancy. Understanding which treatments are effective and can be safely given to patients with primary headache during pregnancy and lactation is essential in supporting these patients before, during, and after childbirth. Behavioral modalities have the potential to improve the health of both mother and baby, while empowering patients to make informed decisions in family planning and creating future treatment plans. Recent Findings Research shows that behavioral therapies can be powerful tools to treat pain conditions with minimal side effects. Recent literature prioritizes behavioral therapies in preparation for pregnancy, during pregnancy, and during lactation due to the superior safety profile of such therapies. Digital resources for behavioral therapy are another well-received recent direction supported by growing evidence of both efficacy and safety. Popular with patients and headache specialists, digital behavioral therapy has taken various forms during the pandemic, such as telemedicine, online psychology support groups, and smartphone applications that patients can interact with on their own time. Summary In summary, the purpose of this review is to equip providers with important information and updates on the use of behavioral modalities for the treatment of primary headache during pregnancy and lactation.

Management of headache in pregnancy and during lactation

“…Mindfulness-based interventions such as mindful breathing, yoga postures, and meditation as part of relaxation training can reduce stress and have potential as a nonpharmacologic modality for prevention and management of acute headache. 16 Nevertheless, undermanaged headaches can lead to stress, sleep deprivation, depression, and poor nutritional intake, which in turn can have negative consequences for the pregnant patient, fetus, lactating person, or newborn. 6…”

“…These comple-mentary measures include dietary changes and behavioral modification. 16 Referral to a registered dietitian can be considered to explore dietary habits, with emphasis on the importance of appropriate hydration and avoiding fasting states, and to provide support for healthy diet in pregnancy and lactation. Additionally, a referral to a behavioral health specialist can support the patient with headache by focusing on techniques for stress reduction and mindfulness practices to increase self-efficacy.…”

Prevention of Migraine

“…A small post-marketing study in Europe with sTMS included three pregnant patients who had good success with rescue treatment without any reported adverse events. 91 95…”

“…A small post-marketing study in Europe with sTMS included three pregnant patients who had good success with rescue treatment without any reported adverse events. 91,95 Alternative Therapy Patients can employ several alternative strategies to augment pharmacologic therapy for migraine prevention. Encouraging patients to optimize lifestyle choices, such as increasing physical activity, staying well-hydrated, getting adequate sleep, and avoiding triggers like alcohol or caffeine can help patients reclaim a sense of control in their treatment.…”

“…Behavioral therapies should also be prioritized in preparation to and during pregnancy, as they have a superior safety profile. 90 91 Known teratogenic medications such as topiramate, divalproex sodium, lisinopril, and candesartan should be stopped prior to conception. Propranolol (best evidence for safety in pregnancy) among other β-blockers is commonly utilized for hypertension management as well as migraine prevention during pregnancy but may be linked to intrauterine growth retardation.…”