Treatment of cluster headache in pregnancy and lactation

Authors


  • [Correction added after online publication 6 February 2009: The first author name has been corrected from Jüergens to Jürgens. Additionally, the first author affiliations have been changed from 1,2 to 1,3.]

Arne May MD, Assistant Professor of Neurology, Department of Systems Neuroscience, University Clinic Hamburg Eppendorf (UKE), Martinistr. 52, D-20246 Hamburg. Tel. + 49-40-42803 9189, fax + 49-40-42803 9955, e-mail: a.may@uke.uni-hamburg.de

Abstract

Cluster headache is a rare disorder in women, but has a serious impact on the affected woman's life, especially on family planning. Women with cluster headache who are pregnant need special support, including the expertise of an experienced headache centre, an experienced gynaecologist and possibly a teratology information centre. The patient should be seen through all stages of the pregnancy. A detailed briefing about the risks and safety of various treatment options is mandatory. In general, both the number of medications and the dosage should be kept as low as possible. Preferred treatments include oxygen, subcutaneous or intranasal sumatriptan for acute pain and verapamil and prednisone/prednisolone as preventatives. If there is a compelling reason to treat the patient with another preventative, gabapentin is the drug of choice. While breastfeeding, oxygen, sumatriptan and lidocaine for acute pain and prednisone/prednisolone, verapamil, and lithium as preventatives are the drugs of choice. As the individual pharmacokinetics differ substantially, adverse drug effects should be considered if unexplained symptoms occur in the newborn.

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