The Use of Behavioral Modalities for Headache During Pregnancy and Breastfeeding

DOI: https://doi.org/10.1007/s11916-021-00980-1

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4 Treatment

Abstract-Summary Migraine and other primary headache disorders are also common during pregnancy. Understanding which treatments are effective and can be safely given to patients with primary headache during pregnancy and lactation is essential in supporting these patients before, during, and after childbirth.

Recent literature prioritizes behavioral therapies in preparation for pregnancy, during pregnancy, and during lactation due to the superior safety profile of such therapies.

Popular with patients and headache specialists, digital behavioral therapy has taken various forms during the pandemic, such as telemedicine, online psychology support groups, and smartphone applications that patients can interact with on their own time.

The purpose of this review is to equip providers with important information and updates on the use of behavioral modalities for the treatment of primary headache during pregnancy and lactation.

Extended: Migraine and other primary headache disorders (such as trigeminal autonomic cephalalgias) are common during pregnancy affecting 10–17% of preg- nancies [451].

Understanding which treatments are effective and can be safely offered during pregnancy and lactation to patients with primary headache is essential in supporting these patients.

Future research with emphasis on this population would be very beneficial.

Introduction We consulted with a research librarian affiliated with our institution, who assisted with our PubMed search regarding any published articles with the following key- words/phrases: (pregnancy[ti] OR pregnant[ti] OR lactation[ti] OR lactating[ti] OR breast feeding[ti] OR breastfeeding[ti] OR pregnancy[ot] OR pregnant[ot] OR lactation[ot] OR lactating[ot] OR breast feeding[ot] OR breastfeeding[ot] OR pregnancy[mh] OR lactation[mh] OR breast feeding[mh) AND (primary headache OR “headache disorders, primary” [mh] OR migraine OR cluster headache) AND (behavioral therapy OR exercise OR yoga OR meditation OR mindfulness OR stress reduction) With these specific search terms, 150 articles were found with no time limitations.

There is evidence emerging that exercise has proven physical and mental health

benefits in the treatment of chronic pain such as migraine and headache.

Groundbreaking research in this area clearly indicates that regular, individual- ized exercise-based treatments are likely to result in improvements in pain and func- tion, including for headache and migraine [452–456].

Conclusions Recent findings show that behavioral therapies can be powerful tools to treat pain conditions such as headache and migraine with minimal side effects.

Due to the excellent safety profile of behavioral therapies, recent literature priori- tizes behavioral therapies for women preparing to get pregnant, during pregnancy, and during lactation.

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An exciting and democratizing recent trend is digital resources for behavioral therapy, which are well received and have growing evidence for efficacy and safety.

Behavioral modalities may be an excellent first choice and also an option to aug- ment other treatments for patients with headache during preparation for pregnancy, during pregnancy and lactation.

Understanding which treatments are effective and can be safely offered during pregnancy and lactation to patients with primary headache is essential in supporting these patients.

Acknowledgement A machine generated summary based on the work of Riggins, Nina; Ehrlich, Annika. 2021 in Current Pain and Headache Reports.

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Neuromodulation

Machine generated keywords: stimulation, magnetic stimulation, nerve stimulation, magnetic, sham, occipital, session, transcranial, transcranial magnetic, cortex, elec- trical, nerve, repetitive, device, occipital nerve

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