title: Peripheral nerve blocks in the treatment of migraine in pregnancy.
abstract: OBJECTIVE
  To describe the use of peripheral nerve blocks in a case series of pregnant women with migraine.
  
  
  METHODS
  A retrospective chart review of all pregnant patients treated with peripheral nerve blocks for migraine over a 5-year period was performed. Injections targeted greater occipital, auriculotemporal, supraorbital, and supratrochlear nerves using local anesthetics.
  
  
  RESULTS
  Peripheral nerve blocks were performed 27 times in 13 pregnant women either in a single (n=6) or multiple (n=7) injection series. Mean patient age was 28 years and gestational age was 23.5 weeks, and all women had migraine, including 38.5% who had chronic migraine. Peripheral nerve blocks were performed for status migrainosus (51.8%) or short-term prophylaxis of frequent headache attacks (48.1%). Before peripheral nerve blocks were performed, oral medications failed for all patients and intravenous medications failed for most. In patients with status migrainosus, average pain reduction was 4.0 (±2.6 standard deviation) (P<.001) immediately postprocedure and 4.0 (±4.4 standard deviation) (P=.007) 24 hours postprocedure in comparison to preprocedure pain. For patients receiving peripheral nerve blocks for short-term prophylaxis, immediate mean pain score reduction was 3.0 (±2.1 standard deviation). No patients had any serious immediate, procedurally related adverse events, and the two patients who had no acute pain reduction ultimately developed preeclampsia and had postpartum headache resolution.
  
  
  CONCLUSIONS
  Peripheral nerve blocks for treatment-refractory migraine may be an effective therapeutic option in pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology & Women's Health, Montefiore Medical Center, and the Department of Neurology, Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Shravya
authors.initials: S
authors.lastname: Govindappagari
authors.forename: Tracy B
authors.initials: TB
authors.lastname: Grossman
authors.forename: Ashlesha K
authors.initials: AK
authors.lastname: Dayal
authors.forename: Brian M
authors.initials: BM
authors.lastname: Grosberg
authors.forename: Sarah
authors.initials: S
authors.lastname: Vollbracht
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Robbins
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008881:Migraine Disorders / Q000628:therapy*; D009407:Nerve Block; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult