Pfaffenrath V, Rehm M
Drug Saf. 1998 Nov;19(5):383-8. doi: 10.2165/00002018-199819050-00005.
The occurrence of migraine in women is influenced by hormonal changes throughout the lifecycle. A beneficial effect of pregnancy on migraine, mainly during the last 2 trimesters, has been observed in 55 to 90% of women who are pregnant, irrespective of the type of migraine. A higher percentage of women with menstrual migraine find that their condition improves when they are pregnant. However, in rare cases migraine may appear for the first time during pregnancy. The positive effects of pregnancy on migraine and the possible worsening post partum are probably related to the uniformly high and stable estrogen levels during pregnancy and the rapid fall-off thereafter. Nondrug therapies (relaxation, sleep, massage, ice packs, biofeedback) should be tried first to treat migraine in women who are pregnant. For treatment of acute migraine attacks 1000 mg of paracetamol (acetaminophen) preferably as a suppository is considered the first choice drug treatment. The risks associated with use of aspirin (acetylsalicylic acid) and ibuprofen are considered to be small when the agents are taken episodically and if they are avoided during the last trimester of pregnancy. The 'triptans' (sumatriptan, zolmitriptan, naratriptan), dihydroergotamine and ergotamine tartrate are contraindicated in women who are pregnant. Prochlorperazine for treatment of nausea is unlikely to be harmful during pregnancy. Metoclopramide is probably acceptable to use during the second and third trimester. Prophylactic treatment is rarely indicated and the only agents that can be given during pregnancy are the beta-blockers metoprolol and propranolol.
女性偏头痛的发作在整个生命周期中受到激素变化的影响。在55%至90%的孕妇中观察到怀孕对偏头痛有有益影响，主要发生在妊娠晚期的最后两个月，无论偏头痛的类型如何。患有月经性偏头痛的女性中，有更高比例的人发现怀孕时病情会改善。然而，在极少数情况下，偏头痛可能在孕期首次出现。怀孕对偏头痛的积极影响以及产后可能出现的病情恶化可能与孕期雌激素水平持续居高且稳定以及之后的迅速下降有关。对于孕期偏头痛的治疗，应首先尝试非药物疗法（放松、睡眠、按摩、冰袋、生物反馈）。对于急性偏头痛发作，1000毫克对乙酰氨基酚（扑热息痛），最好制成栓剂，被认为是首选药物治疗。当偶尔使用阿司匹林（乙酰水杨酸）和布洛芬且在妊娠晚期避免使用时，其相关风险被认为较小。“曲坦类药物”（舒马曲坦、佐米曲坦、那拉曲坦）、二氢麦角胺和酒石酸麦角胺在孕妇中禁用。用于治疗恶心的丙氯拉嗪在孕期不太可能有害。甲氧氯普胺在妊娠中期和晚期使用可能是可以接受的。预防性治疗很少需要，孕期唯一可使用的药物是β受体阻滞剂美托洛尔和普萘洛尔。
