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

DOI: https://doi.org/10.1007/s10072-020-04702-0

Abstract-Summary To investigate headache treatment before and during pregnancy.

Most headache medications should be avoided during pregnancy because of

potential fetal risks.

Only scarce evidence on headache drug consumption during pregnancy is

available.

ATENA was a retrospective, self-administered questionnaire-based, cohort study on women in either pregnancy or who have just delivered and reporting headache before and/or during pregnancy.

Out of 271 women in either pregnancy or who have just delivered, 100 (37%) reported headache before and/or during pregnancy and constituted our study sample.

Pregnancy changes how women self-treat their headache, and leads to search for information regarding drug safety, mostly due to the perception of fetal risk of drugs. Extended: This study was conducted in one institution and, consequently, the

findings cannot be generalized to all Italian regions.

Background Notwithstanding the high prevalence of headache in women with childbearing potential [429], hence candidate to drug consumption during pregnancy, evidence about the safety of headache medication use during gestation is still limited.

In a Norwegian cross-sectional Internet-based survey [419], the majority of pregnant women and new mothers with migraine reported the intake of symptom- atic medications during pregnancy, with a decreased use of triptans and nonsteroi- dal anti- inflammatory drugs (NSAIDs) in favor of paracetamol compared to the pregestational age, yet less than a third considered their headache to be optimally treated.

We aimed to investigate headache before and/or during pregnancy in a cohort of women, focusing on its pharmacological treatment, in terms of attitude on drug use, need of information on medications, and perception of the possible risks to the fetus deriving from drug consumption.

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Methods We performed a retrospective cohort study with cross-sectional collection of data by convenience sampling of treatment-seeking individuals.

From July 12, 2017, to September 2, 2017, women (≥18 years old) either in the last period of pregnancy (i.e., while they were admitted for planned delivery) or who have delivered in the previous 7 days were screened at the Maternal and Child Department, Careggi University Hospital, for enrolment in the study.

Women who reported a diagnosis of secondary headaches, according to the International Classification of Headache Disorders 3rd edition (ICHD-3) [430], were not considered eligible to the study.

Patients who reported having experienced headache before and/or during preg- nancy were asked for filling a self-administered questionnaire, translated and adapted from Amundsen et al. [419].

According to the descriptive aim of the study, no formal sample size calculation

has been performed.

Results In the 87 women who referred headaches in the year before pregnancy, the median monthly frequency of headache attacks was 2 (IQR, ± 2.25); 4 women (4%) referred no headaches, while 9 (9%) did not report this information.

71 women referred headache attacks in at least one trimester of their pregnancy. Among the 71 women who referred headache attacks in at least one trimester of pregnancy, 37 (52%) used drugs to treat the attacks, 32 (45%) did not use symptom- atic medications, and 2 (3%) did not remember this information.

Thirty-one women (36%) of the 87 suffering from headache before pregnancy reported to have searched information about headache medications prior to the pregnancy and the information sources were represented by physicians (n = 20), the Internet (n = 17), pharmacy (n = 9), friends/family (n = 4), and leaflet (n = 1).

Discussion A general, initial comment to our results is that according to the high rate (51%) of women suffering from headache among those attending the Maternal and Child Department, this setting should be considered optimal to enroll patients in future studies collecting data about headache and migraine.

Before pregnancy, almost all patients (88%) used to treat headache attacks with drugs, but this percentage decreases significantly during pregnancy when almost half of women (45%) did not take symptomatic drugs.

From the analysis of the data regarding the attitude of the patients toward the use of symptomatic drugs before the pregnancy, it emerges a concern about the safety of drugs and, more importantly, the willingness to avoid a possible dependence from them.

Both women who have discontinued the use of symptomatic drugs and those who have used them have shown that they have obtained adequate information about their safety during pregnancy.

4.5 Pregnancy

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Conclusions One pregnant woman out of two reported to have suffered from headache, suggest- ing that maternal departments may be taken into consideration to enroll patients in studies collecting data about headache and migraine.

In our cohort, the large majority of patients reporting headache have never received a diagnosis, suggesting the need to both increase the patients’ awareness for searching medical attention and ameliorate the diagnostic process.

Healthcare providers, in order to optimize headache treatment during pregnancy, should be aware they have to face particular needs of pregnant women with head- ache, namely pregnancy-oriented education and prescription changes.

Acknowledgement A machine generated summary based on the work of Lupi, Chiara; Negro, Andrea; Gambassi, Elisabetta; Susini, Tommaso; Geppetti, Pierangelo; Benemei, Silvia. 2020 in Neurological Sciences.

The impact of pregnancy on headache evaluation in the emergency department, a retrospective cohort study