Severe migraines are vexing for the patient and her caregivers. Multitargeted drug therapy is necessary in most cases for migraine relief (Gonzalez-Hernandez, 2014). Headaches are treated aggressively with intravenous hydration and parenteral antiemetics and opioids for immediate pain relie. Although a 2-g infusion of magnesium sulfate has gained favor in the past few years, a metaanalysis reported no beneits (Choi, 2014). Ergotamine derivatives are potent vasoconstrictors and are avoided in pregnancy because of their uterotonic efects (Briggs, 2015).
Triptans are serotonin 5-HT I Bl20-receptor agonists that efectively relieve headaches by causing intracranial vasoconstriction (Contag, 2010). They also relieve nausea and vomiting and greatly reduce the need for analgesics. Triptans can be given as an oral tablet, injection, rectal suppository, or intranasal spray. hey are best used in combination with NSAIDs (Goadsby, 2015). The greatest experience is with sumatriptan (Imitrex), and although not studied extensively in pregnancy, it appears to be safe (Briggs, 2015; Nezvalova-Henriksen, 2010). However, in one follow-up study at 36 months of children exposed to triptans in pregnancy, Wood and colleagues (2016) found neurodevelopment diferences, including emotionality and activity problems.
Some women will beneit from peripheral nerve blocks, and Govindappagari and coworkers (2014) described their experiences with 13 pregnant women. For women with frequent migraine headaches, oral prophylactic therapy is warranted. Amitriptyline (Elavil), 10 to 175 mg daily; propranolol (Inderal), 40 to 120 mg daily; or metoprolol (Lopressor, Toprol), 25 to 100 mg daily, have been used with success (Contag, 2010; Goadsby, 2015; Lucas, 2009).
This rare primary headache disorder is characterized by severe unilateral lancinating pain radiating to the face and orbit, lasting 15 to 180 minutes, and occurring with autonomic symptoms and agitation. Pregnancy does not afect symptom severity. Afected women should avoid tobacco and lcohol. Acute mnagement includes 100-percent oxygen therapy and sumatriptan given as a 6-mg dose subcutaneously (VanderPluym, 2016). If recurrent, prophylaxis is administered using a calcium-channel blocking agent.
The Centers for Disease Control and Prevention reported that the prevalence of epilepsy in adults in 2005 was 1.65 percentthus over 1 million American women of childbearing age are afected (Kobau, 2008). After headaches, seizures are the next most prevalent neurological condition encountered in pregnancy, and they complicate 1 in 200 births (Brodie, 1996; Yerby, 1994). Importantly, epilepsy accounted for 5 percent of maternal deaths in the United Kingdom for the 2011 to 2013 triennium (Knight, 2015).