Effective Migraine Treatment in Pregnant and Lactating Women

by Marcus, Dawn A.; Bain, Philip A., M.D.; Shoupe, Donna, M.D.

• ISBN13: 9781603274388
• ISBN10: 1603274383
• Edition: 1st
• Format: Paperback
• Copyright: 2009-03-04
• Publisher: Humana Pr Inc

Summary

More than 28 million Americans suffer from migraine headaches, with migraine affecting nearly one in five women in their reproductive years. Effective Migraine Treatment in Pregnant and Lactating Women: A Practical Guide, provides a comprehensive resource to address diagnosis, testing, and treatment of headaches in reproductively fertile women. This important new book offers a wealth of practical, ready-to-use, clinically tested tips and recommendations to treat women with headaches during pregnancy and nursing. Although women may ideally prefer to restrict migraine treatments during pregnancy, up to one in three pregnant women self-medicate for symptoms, especially with analgesics. Fortunately, there are many effective treatment options that can be safely used when pregnant and breastfeeding. Available therapies include medication and nonmedication treatments, traditional and alternative therapies, and nutritional supplements.This book uniquely answers frequently asked questions by patients and offers healthcare providers easy-to-use office tools for patient education and charting documentation. Resources are provided within the text, with printable materials available on the enclosed CD for ready use in the clinic. The authors of this important new work have collaborated to provide a resource that will help clinicians provide women with the tools and knowledge to become empowered and to gain control over their migraines when trying to conceive, during pregnancy, and when nursing.

Table of Contents

Understanding Migraine and Pregnancy	p. 1
Typical Concerns Your Patient May Have	p. 5
Summary	p. 25
References	p. 25
Safety Rating Systems for Drugs Used in Pregnancy and Lactation	p. 29
Pregnancy	p. 30
Medication Use During Pregnancy	p. 30
Understanding Reproductive Risk	p. 33
Tools for Assessing Reproductive Risk	p. 33
Lactation	p. 36
Trends in Breastfeeding	p. 37
Maternal Drug Effects on the Baby	p. 38
Helpful Online and Print Resources	p. 41
Summary	p. 44
References	p. 44
Non-Pharmacological Headache Treatments	p. 47
Trigger Identification and Avoidance	p. 50
Cause or Coincidence?	p. 50
Trigger Avoidance or Desensitization?	p. 52
Psychological Pain Management Skills	p. 53
Relaxation and Biofeedback	p. 53
Stress Management	p. 55
Cognitive Restructuring	p. 56
Distraction	p. 57
Effective Psychological Pain Management Technique Delivery Systems	p. 58
Healthy Lifestyle Habits	p. 59
Diet	p. 59
Sleep	p. 60
Smoking	p. 63
Exercise and Physical Therapy	p. 64
Aerobic Exercise	p. 64
Stretching Exercises	p. 65
Intraoral Appliances	p. 65
Massage and Other Manual Therapies	p. 66
Summary	p. 66
References	p. 67
Acute Treatment Options for the Pregnant Headache Patient	p. 71
Design Safer Treatment Plans Before Conception	p. 74
Develop a Safer and Effective Acute Treatment Plan	p. 75
Don't Medicate Mild Headaches	p. 76
Treat Nausea Aggressively	p. 77
Maximize Non-drug Treatments	p. 82
Select the Safest Effective Medications	p. 84
Effectively Communicating Medication Advice	p. 92
Regularly Assess Treatment Efficacy	p. 94
Scheduling Follow-Up Visits	p. 96
Summary	p. 97
References	p. 98
Acute Treatment Options for the Lactating Headache Patient	p. 101
Consider Important Secondary Causes of Headache	p. 102
Anticipate Headache Recurrence After Delivery	p. 106
Utilize Good Principles of Acute Headache Treatment	p. 108
Select the Safest Medications	p. 108
Time Maternal Medication Dosing	p. 109
Specific Medication Recommendations	p. 110
Summary	p. 114
References	p. 115
Preventive Treatment Options for the Pregnant Headache Patient	p. 117
Identify Patients Needing Preventive Therapy	p. 119
Provide Safe and Effective Prevention Recommendations	p. 120
Consider Possible Future Pregnancy When Using Prevention in Non-pregnant Patients	p. 121
Maximize Safe and Effective Non-medication Treatments	p. 121
Utilize Medications in Select, Difficult-to-treat Patients	p. 122
Summary	p. 134
References	p. 134
Preventive Treatment Options for the Lactating Headache Patient	p. 137
Plan for Headache Recurrence After Delivery	p. 139
Include Plans for Contraception	p. 139
Develop a Safe and Effective Preventive Treatment Plan	p. 140
Maximize Effective Non-medication Treatments	p. 140
Select Safe Medications	p. 140
Time Drug Administration to Minimize Effects	p. 144
Summary	p. 145
References	p. 145
Urgent Care/Emergency Treatment of the Acute, Severe Headache in Pregnant and Lactating Patients	p. 147
Utilize a Consistent Evaluation and Treatment Plan	p. 151
Rule Out Secondary Causes of Headache	p. 151
Treat Dehydration	p. 152
Treat Nausea Aggressively	p. 153
Always Consider Non-medication Treatments	p. 155
Treat Pain Appropriately	p. 156
Consider Trigger Point Injections or Occipital Blocks	p. 158
Arrange Post-ED Follow-up	p. 159
Summary	p. 162
References	p. 163
Work-up for Headache During Pregnancy and Lactation	p. 167
Headache History	p. 168
Red Flags/Alarm Symptoms	p. 170
Physical Examination	p. 171
Spinal Fluid Examination	p. 173
Neuroimaging	p. 174
Summary	p. 178
References	p. 179
Patient Headache Resources	p. 181
References	p. 183
General Information	p. 184
When you're ready to get pregnant	p. 184
Now that you're pregnant	p. 185
After you've delivered	p. 186
Daily Headache Diary	p. 187
Headache Treatment	p. 188
Now that I'm trying to get pregnant, what can I do when I get a headache?	p. 188
What non-drug treatments are effective for treating headaches?	p. 190
Practicing relaxation techniques	p. 193
Tips for performing relaxation techniques	p. 193
Stress management	p. 195
Headache-reducing exercises	p. 197
Nausea Treatment	p. 199
What can I do if I'm feeling nauseated during my pregnancy?	p. 199
Additional Headache Resources	p. 200
Where can I find reliable online information about migraine and other headaches?	p. 201
Where can I learn more about managing headaches?	p. 201
Index	p. 203
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