Migraine Treatment, Management For Pregnant Women

In this video, Stephanie Bakaysa, MD, discusses her team's research, "Migraine treatment in pregnancy: a survey of comfort and treatment practices of women's healthcare providers." Dr Bakaysa discusses the prevalence of migraine in women who are pregnant, why clinicians should prescribe migraine treatment to women to help with migraine pain, and what is next in research on the topic of migraine and pregnancy.

Additional Resource: 

Verhaak A, Bakaysa S, Johnson A, Veronesi M, Williamson A, Grosberg B. Migraine treatment in pregnancy: a survey of comfort and treatment practices of women's healthcare providers. Headache. Published online January 25, 2023. doi:10.1111/head.14436

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TRANSCRIPTION:

Stephanie Bakaysa, MD: My name is Stephanie Bakaysa. I'm a maternal-fetal medicine specialist. I work for Hartford HealthCare Medical Group. Since I started at Hartford HealthCare, I joined Dr Brian Grosberg's Headache Council as a woman's health representative, and I see a lot of women prior to becoming pregnant and talk about migraine management and medications they can take during pregnancy for their chronic headache conditions.

Consultant360: What was the impetus for the study, “Migraine treatment in pregnancy: A survey of comfort and treatment practices of women's healthcare providers?”

Dr Bakaysa: A significant amount of women of childbearing age are affected by migraines or chronic headache disorders, probably in the 20% to 30% range. And a significant portion of these women still continue to experience migraines or headaches during pregnancy. But unfortunately, there's a huge limit of randomized clinical trials or drug studies that included pregnant women. We really wanted to query women's health providers and see what their practice patterns were in prescribing or continuing both acute and preventative medications for women in the childbearing years or as they're gearing up to become pregnant. And we wanted to see how often they were counseling women. Then with this information, hopefully we could improve the care implementation of chronic headache conditions in pregnancy.

C360: How common is migraine in pregnancy?

Dr Bakaysa: Luckily, a lot of women who experience migraines improve during pregnancy, but probably 50% to 60% of people who have migraines outside of pregnancy continue to have migraines throughout the pregnancy. Sometimes this can vary throughout the trimesters, and probably about 25% of women of reproductive age have migraines outside of pregnancy so that it goes to say that a good number of them are going to continue to have migraines during pregnancy.

C360: What were the major highlights from this study?

Dr Bakaysa: I think this study highlighted that many women's health providers were really uncomfortable both continuing prescriptions or initiating treatment for acute and preventative treatment of migraines for women during pregnancy. This really leads women with migraines have limited options for treatment during pregnancy. Women with migraines were really only encouraged to take acetaminophen or a caffeine, but a lot of the other medications that treat migraines, the women's health providers were really uncomfortable recommending during pregnancy.

C360: Is there a reason a clinician would not offer other medication options to women experiencing migraine during pregnancy?

Dr Bakaysa: Unfortunately, when drug companies are doing trials for the safety of their medications, oftentimes women who are pregnant or lactating are excluded from drug research so we have limited data on the long-term effects of medications that women take during pregnancy on their offspring. Of course, we can always rule out medications that we think have a high traumagenic risk. A lot of those medications we've identified, but of course there's always that risk. But the bigger problem is what are the long-term neural behavioral effects of certain medications that women take during pregnancy? Since we have such limited data, people are really hesitant to continue pregnant women on medications so it's strictly a field where we're not driven by data and we really need data.

C360: How do the results of the study impact clinical practice?

Dr Bakaysa: I do think that it's really helpful when we provide education for the non-obstetricians and the non-woman's healthcare providers so that these are the headache doctors or the neurologists and say, "Hey, there are medications that are safe in pregnancy." If those providers are more comfortable talking about it, they can educate their patients. Also, if we know where the decreased comfort levels are in our women's health providers, hopefully we can provide education for them so that they're more comfortable, reassuring their patients that they can take certain medications. It's working together as a team so that women's health isn't separated from all of the other disciplines that help to treat migraines.

C360: What are the next steps in research on this topic?

Dr Bakaysa: I think it would be great if we actually were able to study women who had their migraines treated during pregnancy and had maybe some long-term studies on not only neonatal outcomes, but on outcomes for these women who have significant diminished quality of life due to their migraines. Then you combine that with childbearing and postpartum depression and postpartum anxiety, and if we can actually treat their migraine condition, can we improve their overall quality of life without having a delay during their childbearing years?

C360: What is the overall take-home message from our conversation today?

Dr Bakaysa: I think the overall take-home message from this conversation is that we just have to be inquisitive and we should look at the data that we have available and talk to the experts when we're trying to figure out how to best treat our pregnant patients, rather than just telling them, "Oh, no. You can't take that. It's dangerous." I think that we have to dig a little bit deeper and realize that this is a chronic condition that we really shouldn't be neglecting.

Thank you so much for having me. I'm really excited about the work that we do with the Headache Council and the Headache Center, in improving migraine treatment for women so thank you so much for including me in this conversation.