Zorlu ve özel koşullarda baş ağrısına yaklaşım: Gebelik ve laktasyon

Gebelik ve doğum sonrası dönemdeki baş ağrıları özel bir önem taşımaktadır. Bu dönemdeki baş ağrısı yönetimi sağlık çalışanları ve hastalar tarafından zorlayıcı olarak bildirilmektedir. Başağrısına doğru yaklaşım hem anne hem de fetal/yenidoğan risklerinin önlenmesi açısından önemlidir. İlk trimesterdeki baş ağrılarının büyük çoğunluğu primer baş ağrıları grubundadır. Gebeliğin son trimesteri ve doğum sonrası dönemlerde, sekonder baş ağrılarının sıklığı ise artmaktadır. Baş ağrısı hastalarında kırmızı bayrak belirti ve bulgularına dikkat edilmelidir. Baş ağrısı hastasının değerlendirilmesinde detaylı anamnez alınması; doğru ve eksiksiz olarak fizik ve nörolojik muayene yapılması yanında gerekirse ileri tetiklerin yapılması da önemlidir. Bu derlemede gebelik ve laktasyon dönemindeki baş ağrılarına yaklaşım ve en iyi medikal uygulama stratejileri gözden geçirilmektedir.

Headache in challenging and special circumstances: Pregnancy and lactation

Headache has special importance during pregnancy and postpartum period. The health-care professionals and patients report headache management as challenging during pregnancy and lactation period. Cautions are recommended in preganancy and lactation due to maternal and fetal/newborn risks. Most headaches in the first trimester are due primary headaches.Nevertheless, the incidence of secondary headaches increase in the last trimester and post-partum period. Red flags promptearly evaluation in a patient with headache. Assessment of headache patient requires a detailed history of the headachecharacteristics and performing appropriate examinations. Approach to headache and strategies to promote best practice inpreganancy and lactation will be reviewed.

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  • GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388(10053):1545–602.
  • Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd ed. Cephalalgia 2013;33(9):629–808.
  • Calhoun AH. Migraine Treatment in Pregnancy and Lactation. Curr Pain Headache Rep 2017;21(11):46.
  • Wilkins LW. Clinical Obstetrics and gynecology. Vol 2. 2013. p. 317–29.
  • Negro A, Delaruelle Z, Ivanova TA, Khan S, Ornello R, Raffaelli B, et al. Headache and pregnancy: a systematic review. J Headache Pain 2017;18(1):106.
  • O’Neal MA. Headaches complicating pregnancy and the postpartum period. Pract Neurol 2017;17(3):191–202.
  • Semere LG, McElrath TF, Klein AM. Neuroimaging in pregnancy: a review of clinical indications and obstetric outcomes. J Matern Fetal Neonatal Med 2013;26(14):1371–9.
  • Patel SJ, Reede DL, Katz DS, Subramaniam R, Amorosa JK. Imaging the pregnant patient for nonobstetric conditions: algorithms and radiation dose considerations. Radiographics 2007;27(6):1705–22.
  • Wall BF, Hart D. Revised radiation doses for typical Xray examinations. Report on a recent review of doses to patients from medical X-ray examinations in the UK by NRPB. National Radiological Protection Board. Br J Radiol 1997;70(833):437–9.
  • McCollough CH, Schueler BA, Atwell TD, Braun NN, Regner DM, Brown DL, et al. Radiation exposure and pregnancy: when should we be concerned? Radiographics 2007;27(4):909–17.
  • Cupini LM, Matteis M, Troisi E, Calabresi P, Bernardi G, Silvestrini M. Sex-hormone-related events in migrainous females. A clinical comparative study between migraine with aura and migraine without aura. Cephalalgia 1995;15(2):140–4.
  • Amundsen S, Øvrebø TG, Amble NM, Poole AC, Nordeng H. Use of antimigraine medications and information needs during pregnancy and breastfeeding: a crosssectional study among 401 Norwegian women. Eur J Clin Pharmacol 2016;72(12):1525–35.
  • Granella F, Sances G, Pucci E, Nappi RE, Ghiotto N, Napp G. Migraine with aura and reproductive life events: a case control study. Cephalalgia 2000;20(8):701–7.
  • Olesen J, Goadsby PJ, Ramadan NM, Hansen PT, Welch KM. The Headaches. 3rd ed. Philadelphia: Williams & Wilkins; 2006.
  • Macgregor EA. Headache in pregnancy. Continuum (Minneap Minn) 2014;20(1 Neurology of Pregnancy):128–47.
  • Rasmussen BK. Migraine and tension-type headache in a general population: precipitating factors, femalehormones, sleep pattern and relation to lifestyle. Pain 1993;53(1):65–72.
  • Marcus DA, Scharff L, Turk DC. Nonpharmacological management of headaches during pregnancy. Psychosom Med 1995;57(6):527–35.
  • Nezvalová-Henriksen K, Spigset O, Nordeng H. Maternal characteristics and migraine pharmacotherapy during pregnancy: cross-sectionalanalysis of data from a large cohort study. Cephalalgia 2009;29(12):1267–76.
  • Brandlistuen RE, Ystrom E, Nulman I, Koren G, Nordeng H. Prenatal paracetamol exposure and child neurodevelopment: a sibling-controlled cohortstudy. Int J Epidemiol 2013;42(6):1702–13.
  • Liew Z, Ritz B, Rebordosa C, Lee PC, Olsen J. Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatr 2014;168(4):313–20.
  • Thompson JM, Waldie KE, Wall CR, Murphy R, Mitchell EA; ABC study group. Associations between acetaminophen use during pregnancy and ADHD symptoms measuredat ages 7 and 11 years. PLoS One 2014;9(9):e108210.
  • Amundsen S, Nordeng H, Nezvalová-Henriksen K, Stovner LJ, Spigset O. Pharmacological treatment of migraine during pregnancy and breastfeeding. Nat Rev Neurol 2015;11(4):209–19.
  • Bitzén PO, Gustafsson B, Jostell KG, Melander A, WåhlinBoll E. Excretion of paracetamol in human breast milk. Eur J Clin Pharmacol 1981;20(2):123–5.
  • Davanzo R, Bua J, Paloni G, Facchina G. Breastfeeding and migraine drugs. Eur J Clin Pharmacol 2014;70(11):1313–24.
  • Worthington I, Pringsheim T, Gawel MJ, Gladstone J, Cooper P, Dilli E, et al; Canadian Headache Society Acute Migraine Treatment Guideline Development Group. Canadian Headache Society Guideline: acute drug therapy for migraine headache. Can J Neurol Sci 2013;40(5 Suppl 3):S1–S80.
  • Koren G, Florescu A, Costei AM, Boskovic R, Moretti ME. Nonsteroidal antiinflammatory drugs during third trimester and the risk of premature closureof the ductus arteriosus: a meta-analysis. Ann Pharmacother 2006;40(5):824–9.
  • Reese J, Paria BC, Brown N, Zhao X, Morrow JD, Dey SK. Coordinated regulation of fetal and maternal prostaglandins directs successful birth and postnatal adaptation in the mouse. Proc Natl Acad Sci U S A 2000;97(17):9759–64.
  • Hernandez RK, Werler MM, Romitti P, Sun L, Anderka M; National Birth Defects Prevention Study. Nonsteroidal antiinflammatory drug use among women and the risk of birth defects. Am J Obstet Gynecol 2012;206(3):228.e1–8.
  • Nakhai-Pour HR, Broy P, Sheehy O, Bérard A. Use of nonaspirin nonsteroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion. CMAJ 2011;183(15):1713–20.
  • Norton ME, Merrill J, Cooper BA, Kuller JA, Clyman RI. Neonatal complications after the administration of indomethacin for preterm labor. N Engl J Med 1993;329(22):1602–7.
  • Tyler CP, Paneth N, Allred EN, Hirtz D, Kuban K, McElrath T, et al; ELGAN Study Investigators. Brain damage in preterm newborns and maternal medication: the ELGAN Study. Am J Obstet Gynecol 2012;207(3):192.e1–9.
  • Benini D, Fanos V, Cuzzolin L, Tatò L. In utero exposure to nonsteroidal anti-inflammatory drugs: neonatal renal failure. Pediatr Nephrol 2004;19(2):232–4.
  • Alano MA, Ngougmna E, Ostrea EM Jr, Konduri GG. Analysis of nonsteroidal antiinflammatory drugs in meconium and its relation to persistentpulmonary hypertension of the newborn. Pediatrics 2001;107(3):519–23.
  • Cassina M, Di Gianantonio E, Toldo I, Battistella PA, Clementi M. Migraine therapy during pregnancy and lactation. Expert Opin Drug Saf 2010;9(6):937–48.
  • Gupta S, Hanff LM, Visser W, Steegers EA, Saxena PR, Vulto AG, et al. Functional reactivity of 5-HT receptors in human umbilical cord and maternal subcutaneous fat arteries after normotensive or pre-eclamptic pregnancy. J Hypertens 2006;24(7):1345–53.
  • Soldin OP, Dahlin J, O’Mara DM. Triptans in pregnancy. Ther Drug Monit 2008;30(1):5–9.
  • Hale TW. Medications and Mothers’ Milk. 12th ed. Hale Publishing; 2006.
  • Pasternak B, Svanström H, Mølgaard-Nielsen D, Melbye M, Hviid A. Metoclopramide in pregnancy and risk of major congenital malformations and fetal death. JAMA 2013;310(15):1601–11.
  • Domperidone: QT prolongation in infants. Prescrire Int 2011;20(112):14.
  • Kauppila A, Arvela P, Koivisto M, Kivinen S, Ylikorkala O, Pelkonen O. Metoclopramide and breast feeding: transfer into milk and the newborn. Eur J Clin Pharmacol 1983;25(6):819–23.
  • Shannon ME, Malecha SE, Cha AJ. Beta blockers and lactation: an update. J Hum Lact 2000;16(3):240–5.
  • Evers S, Afra J, Frese A, Goadsby PJ, Linde M, May A, et al; European Federation of Neurological Societies. EFNS guideline on the drug treatment of migraine-revised report of an EFNS task force. Eur J Neurol 2009;16(9):968–81.
  • Mines D, Tennis P, Curkendall SM, Li DK, Peterson C, Andrews EB, et al. Topiramate use in pregnancy and the birth prevalence of oral clefts. Pharmacoepidemiol Drug Saf 201;23(10):1017–25.
  • Banach R, Boskovic R, Einarson T, Koren G. Long-term developmental outcome of children of women with epilepsy, unexposed or exposed prenatally to antiepileptic drugs: a meta-analysis of cohort studies. Drug Saf 2010;33(1):73–9.
  • Hägg S, Spigset O. Anticonvulsant use during lactation. Drug Saf 2000;22(6):425–40.
  • Pringsheim T, Davenport W, Mackie G, Worthington I, Aubé M, Christie SN, et al; Canadian Headache Society Prophylactic Guidelines Development Group. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci 2012;39(2 Suppl 2):S1–59.
  • Drugs and Lactation Database (LactMed). Bethesda (MD): National Library of Medicine (US); 2006. Available at: https://www.ncbi.nlm.nih.gov/books/NBK501922/. Accessed Oct 30, 2018.
  • Bullo M, Tschumi S, Bucher BS, Bianchetti MG, Simonetti GD. Pregnancy outcome following exposure to angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists: a systematic review. Hypertension 2012;60(2):444–50.
  • ACE inhibitors, angiotensin II receptor blockers and pregnancy: fetal renal impairment. Prescrire Int 2013;22(142):243.
  • Tan M, Kim E, Koren G, Bozzo P. Botulinum toxin type A in pregnancy. Can Fam Physician 2013;59(11):1183–4.
  • Yamasaki M. Magnesium and pregnancy. [Article in Japanese]. Clin Calcium 2012;22(8):1205–10.
  • Demirkaya S, Vural O, Dora B, Topçuoğlu MA. Efficacy of intravenous magnesium sulfate in the treatment of acute migraine attacks. Headache 2001;41(2):171–7.
  • Boehnke C, Reuter U, Flach U, Schuh-Hofer S, Einhäupl KM, Arnold G. High-dose riboflavin treatment is efficacious in migraine prophylaxis: an open study in a tertiary care centre. Eur J Neurol 2004;11(7):475–7.
  • Cruikshank DP, Varner MW, Pitkin RM. Breast milk magnesium and calcium concentrations following magnesium sulfate treatment. Am J Obstet Gynecol 1982;143(6):685–8.
  • Blumenfeld A, Ashkenazi A, Grosberg B, Napchan U, Narouze S, Nett B, et al. Patterns of use of peripheral nerve blocks and trigger point injections among headachepractitioners in the USA: Results of the American Headache Society Interventional Procedure Survey (AHSIPS). Headache 2010;50(6):937–42.
  • Blumenfeld A, Ashkenazi A, Napchan U, Bender SD, Klein BC, Berliner R, et al. Expert consensus recommendations for the performance of peripheral nerve blocks for headaches--a narrative review. Headache 2013;53(3):437–46.
  • Nau H. Clinical pharmacokinetics in pregnancy and perinatology. I. Placental transfer and fetal side effects of local anaesthetic agents. Dev Pharmacol Ther 1985;8(3):149–81.
  • Govindappagari S, Grossman TB, Dayal AK, Grosberg BM, Vollbracht S, Robbins MS. Peripheral nerve blocks in the treatment of migraine in pregnancy. Obstet Gynecol 2014;124(6):1169–74.
  • Rossini PM, Rossi S. Transcranial magnetic stimulation: diagnostic, therapeutic, and research potential. Neurology 2007;68(7):484–8.
  • Clarke BM, Upton AR, Kamath MV, Al-Harbi T, Castellanos CM. Transcranial magnetic stimulation for migraine: clinical effects. J Headache Pain 2006;7(5):341–6.
  • Dodick DW, Schembri CT, Helmuth M, Aurora SK. Transcranial magnetic stimulation for migraine: a safety review. Headache 2010;50(7):1153–63.
  • National Research Council (US) Committee on the Possible Effects of Electromagnetic Fields on Biologic Systems. Possible Health Effects of Exposure to Residential Electric And Magnetic Fields. Washington: National Academies Press; 1997. p. 73.
  • Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD001218. doi: 10.1002/14651858.CD001218.pub2.
  • Airola G, Allais G, Castagnoli Gabellari I, Rolando S, Mana O, Benedetto C. Non-pharmacological management of migraine during pregnancy. Neurol Sci 2010;31 Suppl 1:S63–5.
  • Posadzki P, Ernst E, Terry R, Lee MS. Is yoga effective for pain? A systematic review of randomized clinical trials. Complement Ther Med 2011;19(5):281–7.
  • Jiang Q, Wu Z, Zhou L, Dunlop J, Chen P. Effects of yoga intervention during pregnancy: a review for current status. Am J Perinatol 2015;32(6):503–14.
  • Wells RE, Turner DP, Lee M, Bishop L, Strauss L. Managing Migraine During Pregnancy and Lactation. Curr Neurol Neurosci Rep 2016;16(4):40.
  • Gong H, Ni C, Shen X, Wu T, Jiang C. Yoga for prenatal depression: a systematic review and meta-analysis. BMC Psychiatry 2015;15:14.
  • Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G, Schoenen J; EFNS. EFNS guideline on the treatment of tension-type headache - report of an EFNS task force. Eur J Neurol 2010;17(11):1318–25.
  • Jürgens TP, Schaefer C, May A. Treatment of cluster headache in pregnancy and lactation. Cephalalgia 2009;29(4):391–400.
  • Radhakrishnan K, Ahlskog JE, Cross SA, Kurland LT, O’Fallon WM. Idiopathic intracranial hypertension (pseudotumor cerebri). Descriptive epidemiology in Rochester, Minn, 1976 to 1990. Arch Neurol 1993;50(1):78–80.
  • Digre KB, Varner MW, Corbett JJ. Pseudotumor cerebri and pregnancy. Neurology 1984;34(6):721–9.
  • Huna-Baron R, Kupersmith MJ. Idiopathic intracranial hypertension in pregnancy. J Neurol 2002;249(8):1078–81.
  • Acheson JF. Idiopathic intracranial hypertension and visual function. Br Med Bull 2006;79-80:233–44.
  • Mollan SP, Markey KA, Benzimra JD, Jacks A, Matthews TD, Burdon MA, et al. A practical approach to, diagnosis, assessment and management of idiopathic intracranial hypertension. Pract Neurol 2014;14(6):380–90.
  • Digre KB. Headaches during pregnancy. Clin Obstet Gynecol 2013;56(2):317–29.
  • Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol 2009;33(3):130–7.
  • Report of the National High Blood Pressure Education ProgramWorking Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000;183(1):1–22.
  • Hobson EV, Craven I, Blank SC. Posterior reversible encephalopathy syndrome: a truly treatableneurologic illness. Perit Dial Int 2012;32(6):590–4.
  • Roth C, Ferbert A. The posterior reversible encephalopathy syndrome: what’s certain, what’s new? Pract Neurol 2011;11(3):136–44.
  • Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334(8):494–500.
  • Podymow T, August P. Antihypertensive drugs in pregnancy. Semin Nephrol 2011;31(1):70–85.
  • Berzan E, Doyle R, Brown CM. Treatment of preeclampsia: current approach and futureperspectives. Curr Hypertens Rep 2014;16(9):473.
  • Janghorbani M, Zare M, Saadatnia M, Mousavi SA, Mojarrad M, Asgari E. Cerebral vein and dural sinus thrombosis in adults in Isfahan, Iran: frequency and seasonal variation. Acta Neurol Scand 2008;117(2):117–21.
  • Kamel H, Navi BB, Sriram N, Hovsepian DA, Devereux RB, Elkind MS. Risk of a thrombotic event after the 6-week postpartum period. N Engl J Med 2014;370(14):1307–15.
  • James AH, Bushnell CD, Jamison MG, Myers ER. Incidence and risk factors for stroke in pregnancy and the puerperium. Obstet Gynecol 2005;106(3):509–16.
  • Saposnik G, Barinagarrementeria F, Brown RD Jr, Bushnell CD, Cucchiara B, Cushman M, et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011;42(4):1158–92.
  • Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F; ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis(ISCVT). Stroke 2004;35(3):664–70.
  • Feske SK, Singhal AB. Cerebrovascular disorders complicating pregnancy. Continuum (Minneap Minn) 2014;20(1 Neurology of Pregnancy):80–99.
  • Bousser MG, Ferro JM. Cerebral venous thrombosis: an update. Lancet Neurol 2007;6(2):162–70.
  • Werring DJ. Reversible cerebral vasoconstriction syndrome and intracranialhemorrhage: some answers, many questions. Stroke 2010;41(11):2455–6.
  • Calabrese LH, Dodick DW, Schwedt TJ, Singhal AB. Narrative review: reversible cerebral vasoconstriction syndromes. Ann Intern Med 2007;146(1):34–44.
  • Shainker SA, Edlow JA, O’Brien K. Cerebrovascular emergencies in pregnancy. Best Pract Res Clin Obstet Gynaecol 2015;29(5):721–31.
  • Singhal AB, Hajj-Ali RA, Topcuoglu MA, Fok J, Bena J, Yang D, Reversible cerebral vasoconstriction syndromes: analysis of 139 cases. Arch Neurol 2011;68(8):1005–12.
  • Capatina C, Inder W, Karavitaki N, Wass JA. Management of endocrine disease: pituitary tumour apoplexy. Eur J Endocrinol 2015;172(5):R179–90.
  • Lawton MT, Vates GE. Subarachnoid Hemorrhage. N Engl J Med 2017;377(3):257–66.
  • Bateman BT, Olbrecht VA, Berman MF, Minehart RD, Schwamm LH, Leffert LR. Peripartum subarachnoid hemorrhage: nationwide data and institutional experience. Anesthesiology 2012;116(2):324–33.
  • Edlow AG, Edlow BL, Edlow JA. Diagnosis of Acute Neurologic Emergencies in Pregnant and Postpartum Women. Emerg Med Clin North Am 2016;34(4):943–65.
  • Feske SK. Stroke in pregnancy. Semin Neurol 2007;27(5):442–52.
  • Nyquist P. Management of acute intracranial and intraventricularhemorrhage. Crit Care Med 2010;38(3):946–53.
  • Lybecker H, Møller JT, May O, Nielsen HK. Incidence and prediction of postdural puncture headache. A prospective study of 1021 spinal anesthesias. Anesth Analg 1990;70(4):389–94.
  • Bezov D, Lipton RB, Ashina S. Post-dural puncture headache: part I diagnosis, epidemiology, etiology, and pathophysiology. Headache 2010;50(7):1144–52.
  • Basurto Ona X, Osorio D, Bonfill Cosp X. Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev 2015;(7):CD007887.
  • Katz D, Beilin Y. Review of the Alternatives to Epidural Blood Patch for Treatmentof Postdural Puncture Headache in the Parturient. Anesth Analg 2017;124(4):1219–28.
  • Niraj G, Kelkar A, Girotra V. Greater occipital nerve block for postdural puncture headache(PDPH): a prospective audit of a modified guideline for the management of PDPH and review of the literature. J Clin Anesth 2014;26(7):539–44.
  • Ashkenazi A, Levin M. Greater occipital nerve block for migraine and other headaches: is it useful? Curr Pain Headache Rep 2007;11(3):231–5.
  • Kent S, Mehaffey G. Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in obstetric patients. J Clin Anesth 2016;34:194–6.
  • Edvinsson L. Innervation and effects of dilatory neuropeptides on cerebral vessels. New aspects. Blood Vessels 1991;28(1-3):35–45.
Ağrı-Cover
  • ISSN: 1300-0012
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2018
  • Yayıncı: Ali Cangül
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