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Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review.

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Title: Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review.
Authors: Saldanha, Ian J., Cao, Wangnan, Bhuma, Monika Reddy, Konnyu, Kristin J., Adam, Gaelen P., Mehta, Shivani, Zullo, Andrew R., Chen, Kenneth K., Roth, Julie L., Balk, Ethan M.
Source: Headache: The Journal of Head & Face Pain. Jan2021, Vol. 61 Issue 1, p11-43. 33p.
Subjects: Calcium antagonists, Antihistamines, Aspirin, Combination drug therapy, CINAHL database, Drug side effects, Information storage & retrieval systems, Medical databases, Medical information storage & retrieval systems, MEDLINE, Health outcome assessment, Postnatal care, Tryptamine, Systematic reviews, Diphenhydramine, Breastfeeding techniques, Metoclopramide, Primary headache disorders, Pregnancy
Abstract: Background: Primary headaches (migraine, tension headache, cluster headache, and other trigeminal autonomic cephalgias) are common in pregnancy and postpartum. It is unclear how to best and most safely manage them. Objective: We conducted a systematic review (SR) of interventions to prevent or treat primary headaches in women who are pregnant, attempting to become pregnant, postpartum, or breastfeeding. Methods: We searched Medline, Embase, Cochrane CENTRAL, CINAHL, ClinicalTrials.gov, Cochrane Database of SRs, and Epistemonikos for primary studies of pregnant women with primary headache and existing SRs of harms in pregnant women regardless of indication. No date or language restrictions were applied. We assessed strength of evidence (SoE) using standard methods. Results: We screened 8549 citations for studies and 2788 citations for SRs. Sixteen studies (mostly high risk of bias) comprising 14,185 patients (total) and 26 SRs met the criteria. For prevention, we found no evidence addressing effectiveness. Antiepileptics, venlafaxine, tricyclic antidepressants, benzodiazepines, β‐blockers, prednisolone, and oral magnesium may be associated with fetal/child adverse effects, but calcium channel blockers and antihistamines may not be (1 single‐group study and 11 SRs; low‐to‐moderate SoE). For treatment, combination metoclopramide and diphenhydramine may be more effective than codeine for migraine or tension headache (1 randomized controlled trial; low SoE). Triptans may not be associated with fetal/child adverse effects (8 nonrandomized comparative studies; low SoE). Acetaminophen, prednisolone, indomethacin, ondansetron, antipsychotics, and intravenous magnesium may be associated with fetal/child adverse effects, but low‐dose aspirin may not be (indirect evidence; low‐to‐moderate SoE). We found insufficient evidence regarding non‐pharmacologic treatments. Conclusions: For prevention of primary headache, calcium channel blockers and antihistamines may not be associated with fetal/child adverse effects. For treatment, combination metoclopramide and diphenhydramine may be more effective than codeine. Triptans and low‐dose aspirin may not be associated with fetal/child adverse effects. Future research should identify effective and safe interventions in pregnancy and postpartum. [ABSTRACT FROM AUTHOR]
Copyright of Headache: The Journal of Head & Face Pain is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review.
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  Data: <searchLink fieldCode="AR" term="%22Saldanha%2C+Ian+J%2E%22">Saldanha, Ian J.</searchLink><br /><searchLink fieldCode="AR" term="%22Cao%2C+Wangnan%22">Cao, Wangnan</searchLink><br /><searchLink fieldCode="AR" term="%22Bhuma%2C+Monika+Reddy%22">Bhuma, Monika Reddy</searchLink><br /><searchLink fieldCode="AR" term="%22Konnyu%2C+Kristin+J%2E%22">Konnyu, Kristin J.</searchLink><br /><searchLink fieldCode="AR" term="%22Adam%2C+Gaelen+P%2E%22">Adam, Gaelen P.</searchLink><br /><searchLink fieldCode="AR" term="%22Mehta%2C+Shivani%22">Mehta, Shivani</searchLink><br /><searchLink fieldCode="AR" term="%22Zullo%2C+Andrew+R%2E%22">Zullo, Andrew R.</searchLink><br /><searchLink fieldCode="AR" term="%22Chen%2C+Kenneth+K%2E%22">Chen, Kenneth K.</searchLink><br /><searchLink fieldCode="AR" term="%22Roth%2C+Julie+L%2E%22">Roth, Julie L.</searchLink><br /><searchLink fieldCode="AR" term="%22Balk%2C+Ethan+M%2E%22">Balk, Ethan M.</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Headache%3A+The+Journal+of+Head+%26+Face+Pain%22">Headache: The Journal of Head & Face Pain</searchLink>. Jan2021, Vol. 61 Issue 1, p11-43. 33p.
– Name: Subject
  Label: Subjects
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Calcium+antagonists%22">Calcium antagonists</searchLink><br /><searchLink fieldCode="DE" term="%22Antihistamines%22">Antihistamines</searchLink><br /><searchLink fieldCode="DE" term="%22Aspirin%22">Aspirin</searchLink><br /><searchLink fieldCode="DE" term="%22Combination+drug+therapy%22">Combination drug therapy</searchLink><br /><searchLink fieldCode="DE" term="%22CINAHL+database%22">CINAHL database</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+side+effects%22">Drug side effects</searchLink><br /><searchLink fieldCode="DE" term="%22Information+storage+%26+retrieval+systems%22">Information storage & retrieval systems</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+databases%22">Medical databases</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+information+storage+%26+retrieval+systems%22">Medical information storage & retrieval systems</searchLink><br /><searchLink fieldCode="DE" term="%22MEDLINE%22">MEDLINE</searchLink><br /><searchLink fieldCode="DE" term="%22Health+outcome+assessment%22">Health outcome assessment</searchLink><br /><searchLink fieldCode="DE" term="%22Postnatal+care%22">Postnatal care</searchLink><br /><searchLink fieldCode="DE" term="%22Tryptamine%22">Tryptamine</searchLink><br /><searchLink fieldCode="DE" term="%22Systematic+reviews%22">Systematic reviews</searchLink><br /><searchLink fieldCode="DE" term="%22Diphenhydramine%22">Diphenhydramine</searchLink><br /><searchLink fieldCode="DE" term="%22Breastfeeding+techniques%22">Breastfeeding techniques</searchLink><br /><searchLink fieldCode="DE" term="%22Metoclopramide%22">Metoclopramide</searchLink><br /><searchLink fieldCode="DE" term="%22Primary+headache+disorders%22">Primary headache disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Pregnancy%22">Pregnancy</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Primary headaches (migraine, tension headache, cluster headache, and other trigeminal autonomic cephalgias) are common in pregnancy and postpartum. It is unclear how to best and most safely manage them. Objective: We conducted a systematic review (SR) of interventions to prevent or treat primary headaches in women who are pregnant, attempting to become pregnant, postpartum, or breastfeeding. Methods: We searched Medline, Embase, Cochrane CENTRAL, CINAHL, ClinicalTrials.gov, Cochrane Database of SRs, and Epistemonikos for primary studies of pregnant women with primary headache and existing SRs of harms in pregnant women regardless of indication. No date or language restrictions were applied. We assessed strength of evidence (SoE) using standard methods. Results: We screened 8549 citations for studies and 2788 citations for SRs. Sixteen studies (mostly high risk of bias) comprising 14,185 patients (total) and 26 SRs met the criteria. For prevention, we found no evidence addressing effectiveness. Antiepileptics, venlafaxine, tricyclic antidepressants, benzodiazepines, β‐blockers, prednisolone, and oral magnesium may be associated with fetal/child adverse effects, but calcium channel blockers and antihistamines may not be (1 single‐group study and 11 SRs; low‐to‐moderate SoE). For treatment, combination metoclopramide and diphenhydramine may be more effective than codeine for migraine or tension headache (1 randomized controlled trial; low SoE). Triptans may not be associated with fetal/child adverse effects (8 nonrandomized comparative studies; low SoE). Acetaminophen, prednisolone, indomethacin, ondansetron, antipsychotics, and intravenous magnesium may be associated with fetal/child adverse effects, but low‐dose aspirin may not be (indirect evidence; low‐to‐moderate SoE). We found insufficient evidence regarding non‐pharmacologic treatments. Conclusions: For prevention of primary headache, calcium channel blockers and antihistamines may not be associated with fetal/child adverse effects. For treatment, combination metoclopramide and diphenhydramine may be more effective than codeine. Triptans and low‐dose aspirin may not be associated with fetal/child adverse effects. Future research should identify effective and safe interventions in pregnancy and postpartum. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: <i>Copyright of Headache: The Journal of Head & Face Pain is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=148337303
RecordInfo BibRecord:
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    Identifiers:
      – Type: doi
        Value: 10.1111/head.14041
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        Text: English
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      – SubjectFull: Calcium antagonists
        Type: general
      – SubjectFull: Antihistamines
        Type: general
      – SubjectFull: Aspirin
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      – SubjectFull: Combination drug therapy
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      – SubjectFull: CINAHL database
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      – SubjectFull: Information storage & retrieval systems
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      – SubjectFull: Medical databases
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      – SubjectFull: Medical information storage & retrieval systems
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      – SubjectFull: MEDLINE
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      – SubjectFull: Health outcome assessment
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      – SubjectFull: Postnatal care
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      – SubjectFull: Tryptamine
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      – SubjectFull: Systematic reviews
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      – SubjectFull: Pregnancy
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      – TitleFull: Management of primary headaches during pregnancy, postpartum, and breastfeeding: A systematic review.
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              Text: Jan2021
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