Treatment of Migraine and Headache Disorders during pregnancy is incredibly challenging for both physicians and patients. Many standard preventive and abortive treatments are known to be unsafe for the developing fetus or inadequate information exists to make a confident decision about the safety of available treatments.
Researchers from New York’s Montefiore Headache Clinic presented research information about the use of peripheral nerve blocks for Headache Disorders in pregnant women at the 66th Annual Meeting of the American Academy of Neurology (AAN) in May 2014.
Peripheral nerve blocks are injections to the nerves that block them from sending pain signals to the brain. They are often used for chronic conditions that involve pain, such as Migraine. For patients with Migraine it is common for the occipital nerves to be the target of nerve blocks.
Peripheral nerve blocks, including occipital nerve blocks, are generally considered quite safe. A small number of patients who receive them will experience numbness or tingling following administration. But little has been known about whether nerve blocks are also safe for a pregnant woman and/or a developing fetus.
The data presented at the AAN meeting suggests peripheral nerve blocks are both effective and safe for pregnant women and their unborn children.
The researchers conducted a retrospective review of all peripheral nerve blocks administered to pregnant women for Headache Disorders between the dates of July 2009 and April 2013.
- The procedure was performed a total of 24 times in 11 pregnant women during this time period.
- All 11 patients had failed standard acute and/or preventive therapies prior to receiving the injections.
- The mean gestational age at the time the injections were given was 24 weeks.
- Nine of the 11 patients had a history of Migraine.
- Some patients received the injections just once while others received them on multiple occasions.
- The procedure was used both for status migrainosus and high attack frequency.
- Among status migrainosus patients, the average pain score before the procedure was 8.3 and the average pain score was 4.7 after the procedure.
- Among high frequency attack patients, the average pain score before the procedure was 3.5 and the average pain score was 0.8 after the procedure.
- More than 90% of the patients treated reported no obstetrical complaints following the procedure.
- Two patients who did not respond to the treatment were diagnosed with preeclampsia (high blood pressure) and delivered.
- 36.3% of patients (4 people) delivered after 37 weeks (full term).
- 27.2% of patients (3 people) delivered between 35 and 37 weeks. These patients had either poorly controlled diabetes or Preterm Premature Rupture of Membranes (PPROM).
- 18.1% of patients (2 people) delivered preterm at 29 weeks. One of these patients had preeclampsia and the other placental abruption.
- The final two patients of the 11 delivered at different hospitals and were lost to follow up.
Although prospective research (rather than review of existing use) is still needed to further assess the safety and efficacy of peripheral nerve blocks for pregnant Migraine and Headache Disorders patients, the procedure is worth discussing with your treatment team to determine if it might be a good option for you during pregnancy.