Department of Neurology, Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Headache. 2019 Feb;59(2):173-179. doi: 10.1111/head.13434. Epub 2018 Nov 7.
To assess the acute treatment of pregnant women presenting to a hospital with migraine.
Migraine is a common problem in pregnancy; however, migraine treatment is challenging in pregnant women for fears of medication teratogenicity and lack of data in this population. To date, no study has directly explored physician practices for treatment of acute migraine in pregnant women.
We conducted a retrospective chart review of medication administration for pregnant women who presented to an acute care setting with a migraine attack and received neurology consultation between 2009 and 2014.
We identified 72 pregnant women with migraine who were treated with pain medications. Fifty-one percent (37/72) were in the third trimester of pregnancy, 39% (28/72) in the second trimester, and 10% (7/72) in the first trimester. Thirty-two percent (23/72) had not tried any acute medications at home before coming to the hospital, and 47% (34/72) presented in status migrainosus. Patients received treatment in the hospital for a median of 23 hours (interquartile range = 5-45 hours). The most common medications prescribed were metoclopramide in 74% (53/72) of patients (95% confidence interval [CI] 62-82%) and acetaminophen in 69% (50/72) of patients (95% CI 58-79%). Metoclopramide was administered along with diphenhydramine in 81% (44/53) of patients (95% CI 71-91%). Acetaminophen was the most frequent medicine administered first (53%, 38/72). Patients were often treated with butalbital (35%, 25/72) or opioids (30%, 22/72), which were used as second- or third-line treatments in 29% of patients (20/72). Thirty-eight percent (27/72) received an intravenous (IV) fluid bolus, 24% received IV magnesium (17/72), and 6% (4/72) had peripheral nerve blocks performed.
While the majority of pregnant women with acute migraine received medications considered relatively safe in pregnancy, there was variation in treatment choice and sequence. Some acute medications considered potentially hazardous for fetal health and less effective for migraine (opioids and butalbital) were used frequently, whereas other treatments that may have low teratogenic risk (nerve blocks, IV fluid boluses, and triptans) were used less or not at all. These results indicate a need for developing guidelines and protocols to standardize acute treatment of migraine in pregnancy.
评估因偏头痛而到医院就诊的孕妇的急性治疗效果。
偏头痛在妊娠期间较为常见；然而，由于担心药物的致畸性以及该人群缺乏相关数据，孕妇偏头痛的治疗颇具挑战。迄今为止，尚无研究直接探讨医生在治疗孕妇急性偏头痛时的治疗方法。
我们对 2009 年至 2014 年间因偏头痛发作到急症就诊并接受神经病学咨询的孕妇的用药情况进行了回顾性图表审查。
我们确定了 72 名患有偏头痛的孕妇，她们接受了止痛药物治疗。51%（37/72）的孕妇处于妊娠晚期，39%（28/72）处于妊娠中期，10%（7/72）处于妊娠早期。32%（23/72）在来医院前没有在家中尝试过任何急性药物治疗，47%（34/72）处于偏头痛持续状态。患者在医院接受治疗的中位时间为 23 小时（四分位距=5-45 小时）。最常开的药物是甲氧氯普胺，占 74%（53/72）（95%置信区间[CI] 62-82%），其次是对乙酰氨基酚，占 69%（50/72）（95% CI 58-79%）。甲氧氯普胺与苯海拉明联合使用，占 81%（44/53）（95% CI 71-91%）。对乙酰氨基酚是最常首先使用的药物（53%，38/72）。患者经常接受可待因（35%，25/72）或阿片类药物（30%，22/72）治疗，这两种药物在 29%的患者（20/72）中作为二线或三线治疗药物。38%（27/72）的患者接受了静脉输液（IV）补液，24%（17/72）接受了静脉注射镁，6%（4/72）接受了周围神经阻滞。
虽然大多数患有急性偏头痛的孕妇接受了被认为在妊娠期间相对安全的药物治疗，但治疗选择和顺序存在差异。一些被认为对胎儿健康有潜在危害且对偏头痛效果较差的急性药物（阿片类药物和可待因）经常使用，而其他可能具有较低致畸风险的治疗方法（神经阻滞、IV 补液和曲坦类药物）则使用较少或根本不使用。这些结果表明，需要制定指南和方案来规范妊娠期间偏头痛的急性治疗。
