Severe Headache in Pregnancy – What’s the Answer?

There are quite a few excellent treatments for headache in pregnancy. The situation does get a little more difficult, however, when an unexplained headache lands you in emergency, and you want to take something that will help break the pain cycle.

Acetaminophen / paracetamol is a common drug to try first. In the case of migraine, intravenous magnesium may be tried as well.

But after that, the possibilities are a little more controversial. There are narcotic treatments, for example, which are being used less and less because they seem to be less helpful overall and may cause problems in pregnancy. NSAIDs and triptans are sometimes avoided in pregnancy, although it’s a matter of risk, and triptans are being more often accepted today. In that case, a medication such as sumatriptan may be given by injection.

Dr. Katherine Scolari-Childress wanted to know if there was a better option, so she tested a combination treatment against an older standard, codeine.

The women were first treated with 650-1000 mg of paracetamol/acetaminophen, but this treatment did not do enough to relieve the pain.

The combination that was being tested is intravenous metoclopramide (often given for nausea) and diphenhydramine (an antihistamine). Out of 46 pregnant women with normal blood pressure, 100% responded to just one dose (only about 2/3 responded to the codeine). 65% had full headache relief. Women taking the combination also spent slightly less time in the unit.

Almost every woman said she would use the medication combination again.

Doctors in emergency need to take notice of new treatments that may work better for pregnant women. As less effective drugs are phased out, and others are in some cases too high a risk, there are still excellent treatments which can provide relief in a way that is safe for mother and baby.

For more information: IV regimen safely resolved acute headache in pregnant women