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June 26, 2013

Data Detail Birth Outcomes in Difficult-to-Treat Population  

NEW YORK (June 26, 2013) – Most pregnant women hospitalized and treated for acute severe migraines were able to successfully deliver full-term babies vaginally, according to a new study by researchers at Montefiore Headache Center. Common pharmacologic treatments used were oral acetaminophen and intravenous metoclopramide. These data will be presented at the International Headache Congress (IHC) on June 28 in Boston.

In this retrospective study of 29 patients with acute migraine during pregnancy without secondary headache, 75.9 percent of patients had full-term vaginal deliveries. Pre-term deliveries occurred in 17.2 percent of patients, which is slightly higher than 11.4 percent seen in the general public. Follow up was not possible for the remaining 6.9 percent.

“Acute migraine during pregnancy is a challenging condition for physicians to treat due to fears of harming the fetus and limited clinical research in the area,” said Matthew Robbins, M.D., director of Inpatient Services, Montefiore Headache Center, chief of Neurology, Einstein Division, Montefiore, and assistant professor of Neurology, Albert Einstein College of Medicine of Yeshiva University. “While these data show a positive result for most women treated for acute severe migraine, more research is needed to better understand the relationship between migraine, available treatments during pregnancy and birth outcomes.”

Researchers analyzed patient charts from July 2009 through January 2012. The average patient age was 29 years and gestational age was 27.5 weeks. Patients were mostly Hispanic (44.8%) or African American (37.9%). In addition to acetaminophen (79.3%) and IV metoclopramide (58.6%), patients were treated with a combination of both of those treatments (55.2%); oral or IV opiate (34.5%); acetaminophen, butalbital, and caffeine (24.1%); and IV magnesium sulfate (6.9%). In 10.3% of patients, insufficient pain relief led to treatment with peripheral nerve blocks.

In addition to Dr. Robbins, other researchers involved in the study are Tracy Grossman, M.D., M.S., resident, Obstetrics and Gynecology & Women’s Health, and Ashlesha Dayal, M.D., medical director, Labor and Delivery, associate professor, Obstetrics and Gynecology & Women's Health, Einstein.

“We always use caution when managing pregnant patients with headache. Several treatment options were captured in this study and we were pleased to take the first step in describing the array of treatments available, and to begin to document pre-term birth rates and compare them to the general population,” said Dr. Robbins. “Our comprehensive team of headache, obstetric and gynecology experts are committed to further exploration and have already doubled our patient population for the next analysis.”