Patterns and predictors of analgesic use in pregnancy: a longitudinal drug utilization study with special focus on women with migraine

DOI: https://doi.org/10.1186/s12884-017-1399-0

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Abstract-Summary Few studies have investigated the drug utilization patterns and factors predicting drug use in pregnant women with migraine.

This longitudinal drug utilization study aimed to describe patterns of analgesic use in a sample of Norwegian pregnant women according to their migraine history, and to identify predictors for analgesic use among these women.

Out of 1981 women, 5.0% reported having migraine in pregnancy, 13.2% had a recent history of migraine, 11.5% had a previous history of migraine, and 68.8% reported no history of migraine.

Many women switched from triptans and non-steroidal anti-inflammatory drugs

to paracetamol, which constituted most of the analgesic use.

Factors associated with analgesic use included recent migraine history (OR 1.6, 95% CI 1.2–2.2), more severe headache intensity (OR 1.3, 95% CI 1.3–1.4), smok- ing (OR 1.9, 95% CI 1.1–3.3) and multiparity (OR 1.4, 95% CI 1.1–1.7).

Analgesic use in pregnancy is affected by migraine characteristics and intensity,

and also by socio-demographic factors.

Clinicians should bear this in mind when giving advice on adequate management

of migraine in pregnancy and safe analgesic use.

Extended: Few studies have investigated the patterns of use of headache and

migraine medications in pregnancy.

Background Few studies have investigated drug utilization patterns and factors predicting drug use in pregnant women with migraine.

One population-based study found that 73% of pregnant women with migraine used anti-migraine drugs, mostly non-narcotic drugs (54%) and triptans (25%) [423]. In another registry-based study, pregnant women using anti-migraine drugs (mainly sumatriptan) were older and more often primiparous than women not using such drugs [424].

This study aims to describe patterns of analgesic use in a sample of Norwegian pregnant women according to their migraine history, and to identify predictors for analgesic use among these women.

Based on previous studies, we hypothesized that the drug utilization patterns would decrease in pregnancy and that severity of migraine would be more important than socio-demographic, lifestyle and other medical factors for use of analgesics among pregnant women.

Methods For the current study, the final study sample consisted of 1981 women who com- pleted all three questionnaires, representing 42.9% of those included.

Women were specifically asked about use of drugs within seven categories  – drugs for headache, migraine, non- headache pain, insomnia, anxiety, depression and other psychotropic medications.

The three questionnaires cover different periods of use  – four months before pregnancy and beginning of pregnancy until week 17 (Q1), week 18 to 32 (Q2), and the last part of pregnancy from week 33 forward (Q3).

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A variable for somatic symptoms was also created, based on a somatic symptom scale in Q2 derived from the Primary care Evaluation on Mental Disorders (PRIME-MD) [425], which included (yes/no): stomach pain, back pain, pain in arms/legs/joints, menstrual pain or problems, pain or problems during sexual inter- course, headache, chest pain, dizziness, fainting spells, feeling your heart pound or race, shortness of breath, constipation/diarrhea/indigestion, feeling tired or having low energy, and having trouble sleeping.

Results Age, parity, marital status, education, alcohol use, chronic diseases, and pregnancy related diseases were equally distributed across these migraine-related subgroups of women.

Use of analgesics for headache or migraine was reported by a total of 977 women

(49.3%) in pregnancy, compared to 1107 (55.9%) before pregnancy.

Among women who reported migraine in pregnancy, 72.0% used analgesics dur-

ing pregnancy.

Analgesic use declined for all groups of women, both at the beginning of preg-

nancy and during pregnancy.

Paracetamol constituted most of the analgesic use in pregnancy in all groups

of women.

It was also the most common medication before pregnancy, followed by NSAIDs,

triptans (for women with migraine) and opioids.

Almost half of the women with migraine in pregnancy had high headache inten-

sity (48.0%).

Discussion For the subgroup of women with active migraine, an increase in use of paracetamol was seen in pregnancy, suggesting that women on strong pain medications switched to paracetamol during pregnancy.

This is particularity relevant for paracetamol, as it is widely used for all types of headache and is the recommended analgesic during pregnancy; therefore its use for migraine could be overestimated in our study [426].

Migraine is often improved in pregnancy [427, 428], and many pregnant women may therefore not require migraine therapy, which could explain the decrease in analgesic use for the group with recent migraine prior to pregnancy.

For women with active migraine in pregnancy, the pattern was different; overall analgesic use decreased slightly and paracetamol increased in the beginning of pregnancy.

Few studies have investigated the patterns of use of headache and migraine medi-

cations in pregnancy.

Conclusions Many women using analgesics for headache or migraine stop or switch to paracetamol when they become pregnant.

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Acknowledgement A machine generated summary based on the work of Harris, Gerd-Marie Eskerud; Wood, Mollie; Eberhard-Gran, Malin; Lundqvist, Christofer; Nordeng, Hedvig. 2017 in BMC Pregnancy and Childbirth.

Medicines for headache before and during pregnancy: a retrospective cohort study (ATENA study)