Author: Hubei Provincial Third People's Hospital Peng Yingxian
Migraine is the most common primary headache. It is clinically manifested as recurrent moderate and severe headaches. It often occurs in the mitolateral head and is often pulsating. It may be accompanied by autonomic dysfunction symptoms such as nausea, vomiting, photophobia and phonophobia.
pregnancy migraine
Research found that at least about 25% of women of childbearing age suffer from migraine, of which 80% to 90% of women will experience headaches during pregnancy. There is growing evidence of the link between migraine and vascular disease during pregnancy.
Hazards
1, Wabnitz A and Jarvis S found that women with migraine have an increased risk of cardiovascular and cerebrovascular complications during pregnancy, including pregnancy hypertension, preeclampsia, ischemic stroke , heart disease and venous thromboembolism. In addition, severe migraine may be a risk factor for adverse pregnancy outcomes. Foreign studies such as
2, Skajaa N, etc. found that compared with non-migraine women, women with migraine have an increased risk of giving birth to low-birth weight babies, and have a higher incidence of miscarriage, premature birth rate, caesarean section rate and placental abruption rate. Therefore, it is necessary to treat migraine during pregnancy in a timely manner.
Treatment plan
Non-drug treatment
1, adjust lifestyle
During pregnancy, you should maintain adequate sleep, avoid hunger or fullness, reduce caffeine intake, and exercise appropriately. Avoid taking wine, chocolate, foods containing tyramine (ripe cheese, pickled products, smoked products, fermented foods, etc.), caffeine-containing diet (coffee, tea, etc.), saccharin (methyl asparagus phenylalanine), foods containing nitrite and nitrate (pickled products, smoked products, pickled vegetables, colorants, preservatives, etc.), citrus fruits, etc. Avoid irritation of noise, strong light and special odors (especially irritating odors such as gasoline, alcohol , paint, etc.).
2, Cognitive Behavioral Therapy
Patients receiving cognitive behavioral therapy need to record a daily headache diary, including the time of the headache, the occurrence of the headache, the medications used, the body's feelings and thoughts during the headache, etc. Understand behavioral therapists understand the patient's psychological migraine state and bad coping behavior through headache diaries, help patients identify and correct negative thoughts, teach patients about psychosocial medicine related to migraine, establish more regular sleep and meal schedules, exercise more regularly, and promote healthy diet (e.g., balanced diet, avoid excessive caffeine and alcohol); encourage patients to actively seek social support, and enhance patients' ability to cope with stress can help reduce the impact of various stressors, and triggers. Let patients learn to cope with negative emotions such as fear caused by migraine attacks, use acute analgesic drugs correctly, and avoid drug abuse. A meta-analysis of found that this method can reduce drug use by 20%-25%.
3, biofeedback
biofeedback is a self-regulation therapy based on behavioral . Its principle is to use modern electronic instruments to convert physiological information that people cannot be perceived under normal circumstances (such as muscle tension, skin temperature, sweating, gastrointestinal motility, heart rate and blood pressure , etc.) into signals that can be felt by people (such as visual or auditory signals), and then let patients conduct conscious "mind" control and psychological training based on these signals, and learn to control their own functions.The most common biofeedback therapy for migraine is the skin temperature biofeedback method. The main method is to let the patient lie in a treatment room with a quiet temperature suitable for use. The temperature feedback device is used to collect the temperature at the end of the patient's fingers. Usually, when a migraine occurs, the sympathetic nerve is excited and the skin temperature drops. The instrument will convert the temperature changes into an image and feed back to the patient. The doctor teaches the patient to relax his or her neuromuscles, control the excitability of sympathetic nerve , increase the skin temperature, thereby reducing the duration and intensity of migraine. After this long period of training, patients can control the onset of migraine without the help of a feedback device.
4, Relaxation Training
Relaxation Training can reduce the tension of the sympathetic nerves (such as slowing heart rate, lowering blood pressure, regulating breathing, etc.) by relaxing the overall tension of the muscles, so as to achieve physiological relaxation and mental calmness, which can reduce the body's impact on stress response. The specific method is to choose a quiet place, empty the urine and defecate, and lie comfortably or sit. Focus on your body's feelings, abandon distractions, perform natural and rhythmic slow abdominal deep breathing, and then gradually practice tension and relaxation of the main muscles. The training process for each part of the muscle group is to focus - muscle tension - keep tense - muscle relaxation (usually, relaxation of the limbs first, then relaxation of the chest and abdomen, and finally relaxation of the head and neck muscle groups).
Drug treatment
Although non-drug therapy is always the first-line treatment during pregnancy, when migraine occurs in acute attacks, non-drug treatment alone is not enough to control the onset of migraine, and drug treatment may be required at this time.
Note: According to the 2022 American Society of Obstetricians and Gynecologists (ACOG) Clinical Practice Guide : Pregnancy and postpartum pain, medium-strength recommended: the benefits are significantly greater than the harm, and most patients should receive intervention. Recommendation intensity is conditional: weigh risks and benefits according to patient characteristics, and choose whether to use them.
Pharmacist reminds
Migraine treatment during pregnancy is mainly focused on optimizing lifestyle and non-drug treatment.
A good lifestyle can reduce the onset of migraine during pregnancy. If you need to choose drug treatment, you should choose under the guidance of a doctor and a pharmacist. When using it, you should pay special attention to the indications and adverse reactions of the drug, and use a safe dose to reduce the degree of headache attacks as much as possible, reduce the frequency of attacks, etc. If drugs are abused, it will increase health risks in all aspects of pregnant women and fetus.
Reviewer: Deputy Director of Pharmacist of Hubei Third People's Hospital Anwei
or above are original works of volunteers of the "Drug Safety Cooperation Alliance". If reprinted, please indicate the author and source!
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