Management of primary headaches in pregnancy / investigators, Ian J. Saldanha [and 12 others] ; prepared by Brown Evidence-based Practice Center

OBJECTIVES: This systematic review (SR) evaluates the literature on pharmacologic and nonpharmacologic interventions to prevent or treat attacks of primary headaches (migraine, tension headache, cluster headache, and other trigeminal autonomic cephalgias) in women who are pregnant (or attempting to become pregnant), postpartum, or breastfeeding. DATA SOURCES: We searched Medline(r), Embase(r), Cochrane CENTRAL, CINAHL(r), and ClinicalTrials.gov to identify primary studies (comparative studies and single-group studies) in women who are pregnant (or attempting to become pregnant), postpartum, or breastfeeding with primary headache (direct evidence). We searched Medline, the Cochrane Database of Systematic Reviews, and Epistemonikos for existing SRs of harms of interventions in pregnant women regardless of indication (indirect evidence). REVIEW METHODS: We extracted study data into the Systematic Review Data Repository. We assessed the risk of bias and evaluated the strength of evidence (SoE) using standard methods. The PROSPERO protocol registration number is CRD42020158310. RESULTS: Our searches for direct and indirect evidence yielded 8,549 citations and 2,788 citations, respectively. Sixteen primary studies comprising 14,185 patients in total and 26 SRs met criteria. Risk of bias was high for most primary studies. We found no evidence addressing effectiveness of any intervention for prevention of primary headaches. We found one single-group study (of topiramate) and 11 SRs reporting potential harms of various interventions used for primary headache prevention during pregnancy. Antiepileptics (except lamotrigine), venlafaxine, tricyclic antidepressants, benzodiazepines, beta blockers, prednisolone, and oral magnesium may be associated with increased risk of fetal/child adverse effects, but calcium channel blockers and antihistamines may have low risk of adverse effects (indirect evidence; low to moderate SoE). For treatment of acute attacks of primary headache, we found three randomized controlled trials (RCTs), eight nonrandomized comparative studies (NRCSs), and four single-group studies. Combination metoclopramide and diphenhydramine may be more effective than codeine in reducing severity of migraine or tension headache; adverse effect profiles were similar (1 RCT; low SoE). Triptans used for migraine during pregnancy were not associated with spontaneous abortions or congenital anomalies (8 NRCSs; low SoE). Acetaminophen, prednisolone, indomethacin, ondansetron, antipsychotics, and intravenous magnesium may be associated with increased risk of fetal/child adverse effects, but low-dose aspirin (either during pregnancy or postpartum) may not be associated with increased risk (indirect evidence; low to moderate SoE). There is insufficient evidence to make conclusions about the benefits or harms of nonpharmacologic treatments used during pregnancy, including acupuncture (1 RCT); biofeedback, relaxation therapy, and physical therapy (1 RCT and 2 single-group studies); nerve blocks (1 single-group study); and transcranial magnetic stimulation (1 single-group study). CONCLUSIONS: Evidence regarding the benefits and harms of all interventions in women who are pregnant (or attempting to become pregnant), postpartum, or breastfeeding is insufficient, or at best of low strength of evidence. Future research is needed to identify the most effective and safe interventions for preventing or treating primary headaches in these populations of women..

Medienart:	E-Book

Erscheinungsjahr:	November 2020
Erschienen:	Rockville, MD: Agency for Healthcare Research and Quality ; November 2020

Reihe:	Comparative effectiveness review - number 234 AHRQ publication - no, 20(21)-EHC026

Sprache:	Englisch

Beteiligte Personen:	Saldanha, Ian J. [VerfasserIn]

Links:	www.ncbi.nlm.nih.gov [teilw. kostenfrei]

Themen:	Complementary Therapies Headache Disorders, Primary Pregnancy Systematic Review

Anmerkungen:	Includes bibliographical references. - Description based on online resource; title from PDF title page (viewed March 18, 2021)

Umfang:	1 online resource (1 PDF file (various pagings)) ; illustrations.

Förderinstitution / Projekttitel:

PPN (Katalog-ID):	1773183117