Acute treatment of migraine during pregnancy

Abstract
Introduction: Migraine is a prevalent and highly disabling condition. Usually during pregnancy there is
relief of symptoms, however, sometimes headache cannot improve, and some cases may get worse. Therefore, it is necessary for physicians who work at the emergency department perform a correct diagnosis
of this pathology, rule-out other types of headaches and give the best and safest treatment according to
gestational age and clinical profile of each patient. This review will address the relationship between migraine and pregnancy, the role of estrogens in the genesis of migraine. Updated information with respect
to acute treatment of migraine during this period will be discussed.
Methods: A systematic review of the world literature on the relationship between migraine and pregnancy
and acute management in this population was carried out, obtaining a total of 83 bibliographic references.
Results: As an initial management, the use of acetaminophen plus metoclopramide is recommended at any
stage of pregnancy. The use of NSAIDs should be avoided from week 20 of gestation. Sumatriptan can be
used as a second line in any trimester.
Non-pharmacological management should be provided to all patients.
Conlcuisons: There are currently safe drugs and procedures for the acute management of migraine in
pregnant women, however, gestational age should be taken into account before administering them.