[Migraine during pregnancy and lactation: treatment of the acute attack and non-pharmacological prophylactic strategies].
Migraine is a typical "women's disease": the fluctuations of sex hormones, in particular estrogens, during woman's reproductive life show a direct and major influence on migraine course. Even if during pregnancy a high percentage of migraineurs report an improvement of symptomatology, it is still controversial how to manage migraine crises occurring during pregnancy, considering that almost all drugs are partially or totally contraindicated during gestation. The most important drugs employed in acute attack management (triptans, non steroidal anti-inflammatory drugs, analgesics, antiemetics, ergot derivatives and combination products) are reviewed and the indications and contraindications of their use during the 3 trimesters of pregnancy and during lactation, taking into consideration the indications of the Food and Drug Administration and of the American Academy of Pediatrics, are analysed. Furthermore, the therapeutic effects of the 2 most important non pharmacological therapies used for migraine prophylaxis, biofeedback and acupuncture, are discussed. For this latter therapy, the personal preliminary positive experience using a predetermined formula of acupoints for the combined treatment of migraine and hyperemesis gravidarum is reported.
Allais
G
G
Centro Cefalee della Donna, III Clinica Ostetrico-Ginecologica, Dipartimento di Discipline Ginecologiche e Ostetriche, Università degli Studi di Torino, CSTNF-Centro Studi Terapie Naturali e Fisiche, Torino. gb.allais@tiscali.it
Bosio
A
A
Mana
O
O
Airola
G
G
Ciochetto
D
D
Terzi
M G
MG
De Lorenzo
C
C
Quirico
P E
PE
Benedetto
C
C
D000014:Abnormalities, Drug-Induced / Q000209:etiology; D000082:Acetaminophen / Q000009:adverse effects / Q000627:therapeutic use; D015669:Acupuncture Points; D015670:Acupuncture Therapy; D000328:Adult; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D000932:Antiemetics / Q000009:adverse effects / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D001676:Biofeedback, Psychology; D018849:Controlled Clinical Trials as Topic; D004294:Domperidone / Q000009:adverse effects / Q000627:therapeutic use; D004878:Ergotamine / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005333:Fetus / Q000187:drug effects; D006801:Humans; D006939:Hyperemesis Gravidarum / Q000628:therapy; D007231:Infant, Newborn; D007774:Lactation; D008881:Migraine Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000628:therapy*; D011263:Pregnancy Trimester, Third; D011379:Prognosis; D012064:Relaxation Therapy; D012307:Risk Factors; D014481:United States; D014486:United States Food and Drug Administration; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use
D000700:Analgesics; D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000932:Antiemetics; D014662:Vasoconstrictor Agents; D000082:Acetaminophen; D004294:Domperidone; D004878:Ergotamine; D001241:Aspirin