Resumen
INTRODUCCIÓNLa migraña es una condición médica prevalente y altamente discapacitante. Por lo general, durante el embarazo hay una reducción de los síntomas migrañosos, sin embargo, en ocasiones la sintomatología puede no mostrar mejoría, y en algunos casos empeorar. Por tanto, es necesario que el médico del servicio de urgencias realice un correcto diagnóstico de esta enfermedad, que descarte otros tipos de cefaleas y brinde el mejor y el más seguro tratamiento analgésico de acuerdo con la edad gestacional y perfil clínico de cada paciente. En esta revisión se abordará la relación entre la migraña y el embarazo, el papel de los estrógenos en la génesis de la migraña, así como también los datos más actuales en cuanto al tratamiento del manejo agudo de esta patología durante la gestación.
MATERIALES Y METODOS:Se realizó una revisión sistemática de la literatura mundial sobre la relación entre la migraña y el embarazo y el manejo agudo en esta población, obteniéndose un total de 83 referencia bibliográficas.
RESULTADOS:Como manejo inicial, se recomienda el uso de Acetaminofén más metoclopramida en cualquier etapa de la gestación. El uso de AINE debe evitarse a partir de la semana 20 de gestación. El Sumatriptán puede ser utilizado como segunda línea en cualquier trimestre.
A todas las pacientes se les debe brindar manejo no farmacológico.
CONCLUSIONES:Actualmente se cuenta con varios medicamentos y procedimientos seguros para el manejo agudo de la migraña en gestantes, sin embargo, debe tenerse en cuenta la edad gestacional ante su administración.
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Pearce CF, Hansen WF. Headache and neurological disease in pregnancy. Clin Obstet Gynecol. 2012;55(3):810-28, https://doi.org/10.1097/GRF.0b013e31825d7b68.
Loreto Cid JM. Cefaleas, evaluación y manejo inicial. Rev Med Clin Las Condes. 2014;25(4):651-7, https://doi.org/10.1016/S0716-8640(14)70086-0.
Negro A, Delaruelle Z, Ivanova T, Khan S, Ornello R, Raffaelli B, et al. Headache and pregnancy: a systematic review J Headache Pain. 2017;18(1):106, https://doi.org/10.1186/s10194-017-0816-0.
Gelfand AA, Goadsby PJ. A neurologist's guide to acute migraine therapy in the emergency room. Neurohospitalist. 2012;2(2):51-9, https://doi.org/10.1177/1941874412439583.
Steiner TJ, Stovner LJ, Jensen R, Uluduz D, Katsarava Z. Migraine remains second among the world's causes of disability, and first among young women: Findings from GBD2019. J Headache Pain. 2020;21(1):137, https://doi.org/10.1186/s10194-020-01208-0.
Dodick DW Migraine. Lancet. 2018;391(10127):1315-30, https://doi.org/10.1016/S0140-6736(18)30478-1.
Afridi S. Current concepts in migraine and their relevance to pregnancy. Obstet Med. 2018;11(4):154-9, https://doi.org/10.1177/1753495X18769170.
Burch R. Headache in pregnancy and the puerperium. Neurol Clin. 2019;37(1):31-51, https://doi.org/10.1016/j.ncl.2018.09.004.
Wells R, Turner D, Lee M, Bishop L, Strauss L. Managing migraine during pregnancy and lactation. Curr Neurol Neurosci Rep. 2016;16(4):40, https://doi.org/10.1007/s11910-016-0634-9.
Robbins M. Headache in pregnancy. Continuum. 2018;24(4):1092-107, https://doi.org/10.1212/CON.0000000000000642.
Dixit A, Bhardwaj M, Sharma B. Headache in pregnancy: A nuisance or a new sense? Obstet Gynecol Int. 2012;2012:1-11, https://doi.org/doi:10.1155/2012/697697.
Robbins M, Farmakidis C, Dayal A, Lipton R. Acute headache diagnosis in pregnant women. Neurology. 2015;85(12):1024-30, https://doi.org/10.1212/WNL.0000000000001954.
Rizzoli P, Mullally WJ. Headache. Am J Med. 2018;131(1):17-24, https://doi.org/10.1016/j.amjmed.2017.09.005.
Muñoz-Cerón J, Restrepo A, Vega E. Headache during pregnancy: Etiologies and applicability of the ICHD-3 criteria. Neurol Perspectives. 2021, https://doi.org/10.1016/j.neurop.2021.03.015.
McDermott M, Miller EC, Rundek T, Hurn PD, Bushnell CD. Preeclampsia. Stroke. 2018;49(3):524-30, https://doi.org/10.1161/STROKEAHA.117.018416.
Siong KH, Chan OL, Yip CS, Lau HY. Cerebral venous sinus thrombosis in pregnancy: A case report. Hong Kong J Gynaecol, Obstet Mid. 2020;20(2):88-91, https://doi.org/10.12809/hkjgom.20.2.06.
Grand'Maison S, Weber F, Bédard M-J, Mahone M, God- bout A. Pituitary apoplexy in pregnancy: A case series and literature review. Obstet Med. 2015;8(4):177-83, https://doi.org/10.1177/1753495X15598917.
Chai N, Peterlin B, Calhoun A. Migraine and estrogen. Curr Opin Neurol. 2014;27(3):315-24, https://doi.org/10.1097/WCO.0000000000000091.
Puri V, Puri S, Svojanovsky S, Mathur S, Macgregor R, Klein R, et al. Effects of oestrogen on trigeminal ganglia in culture: implications for hormonal effects on migraine. Cephalalgia. 2006;26(1):33-42, https://doi.org/10.1111/j.1468-2982.2005.00987.x.
Krause DN, Warfvinge K, Haanes KA, Edvinsson L. Hormonal influences in migraine - interactions of oestrogen, oxytocin and CGRP. Nat Rev Neurol. 2021;17(10):621-33, https://doi.org/10.1038/s41582-021-00544-2.
Headache classification committee of the International Headache Society (IHS) the International Classification of Headache Disorders, 3rd Edition. Cephalalgia. 2018;38(1):1-211, https://doi.org/10.1177/0333102417738202.
Yamagata K, Sugimura M, Yoshida M, Sekine S, Kawano A, Oyamaguchi A, et al. Estrogens exacerbate nociceptive pain via up-regulation of TRPV1 and ANO1 in trigeminal primary neurons of female rats. Endocrinology. 2016;157:4309-17, https://doi.org/10.1210/en.2016-1218.
Ceruti S, Villa G, Fumagalli M, Colombo L, Magni G, Zanardelli M, et al. Calcitonin gene-related peptide-mediated enhancement of purinergic neuron/glia communication by the algogenic factor bradykinin in mouse trigeminal ganglia from wild-type and R192Q cav2.1 knock-in mice: Implications for basic mechanisms of migraine pain. J Neurosci. 2011;31(10):3638-49, https://doi.org/10.1523/JNEURO-SCI.6440-10.2011.
Ramos Romero M, Sobrino Mejía F. Péptido relacionado con el gen de la calcitonina: un neuropéptido clave en la migraña. Rev Neurol. 2016;63(10):460, https://doi.org/10.33588/rn.6310.2016091.
Iyengar S, Ossipov MH, Johnson KW. The role of calcitonin gene-related peptide in peripheral and central pain mechanisms including migraine. Pain. 2017;158(4):543-59, http://dx.doi.org/10.1097/j.pain.0000000000000831.
MacGregor EA. Headache in pregnancy. Neurol Clin. 2012;30(3):835-66, https://doi.org/10.1016/j.ncl.2012.04.001.
Frederick IO, Qiu C, Enquobahrie DA, Aurora SK, Peterlin BL, Gelaye B, et al. Lifetime prevalence and correlates of migraine among women in a Pacific Northwest pregnancy cohort study. Headache. 2013;54(4):675-85, https://doi.org/10.1111/head.12206.
Qiu C, Frederick IO, Sorensen T, Aurora SK, Gelaye B, Enquobahrie DA, et al. Sleep disturbances among pregnant women with history of migraines: A cross-sectional study. Cephalalgia. 2015;35(12):1092-102, https://doi.org/10.1177/0333102415570493.
Fraser CL, Hepschke JL, Jenkins B, Prasad S. Migraine aura: Pathophysiology, mimics, and treatment options. Semin Neurol. 2019;39(06):739-48, https://doi.org/10.1055/s-0039-1700525.
Buonanotte CF, Buonanotte MC. Migraña. Neurol Argentina. 2013;5(2):94-100, https://dx.doi.org/10.1016/j.neuarg.2012.12.002.
Malfreyt E, Coudoré MA. Migraine ophtalmique: Physiopathologie et conseils à L' officine [tesis]. Clermont-Ferrand: HAL; 2021, https://dumas.ccsd.cnrs.fr/dumas-03658098/document.
Hoffmann J, Charles A. Glutamate and its receptors as therapeutic targets for Migraine. Neurotherapeutics. 2018;15(2):361-70, https://doi.org/10.1007/s13311-018-0616-5.
González de la Aleja J, Ramos A, Mato-Abad V, Martínez-Salio A, Hernández-Tamames JA, Molina JA, et al. Higher glutamate to glutamine ratios in occipital regions in women with migraine during the interictal state. Headache. 2012;53(2):365-75, https://doi.org/10.1111/head.12030.
Revell K, Morrish P. Headaches in pregnancy. Obstet Gynaecol. 2014;16(3):179-84, https://doi.org/10.1111/tog.12101.
Sandweiss AJ, Cottier KE, McIntosh MI, Dussor G, Davis TP, Vanderah TW, et al. 17-[3-estradiol induces spreading depression and pain behavior in alert female rats. Oncotarget. 2017;8(69):114109-22, https://doi.org/10.18632/oncotar-get.23141.
Schwedt TJ. Chronic migraine. BMJ. 2014;348, https://doi.org/10.1136/bmj.g1416.
Singh T, Cutrer F, Smith J. Episodic status migrainosus: A novel migraine subtype. Cephalalgia. 2017;38(2):304-11, https://doi.org/10.1177/0333102416686341.
Fiat F, Merghes PE, Scurtu AD, Almajan Guta B, Dehelean CA, Varan N, et al. The main changes in pregnancy-therapeutic approach to musculoskeletal pain. Medicina. 2022;58(8):1115, https://doi.org/10.3390/medicina58081115.
Migliore E, Zugna D, Galassi C, Merletti F, Gagliardi L, Rasero L, et al. Prenatal paracetamol exposure and wheezing in childhood: causation or confounding? Plos One. 2015;10(8):e0135775, https://doi.org/10.1371/journal.pone.0135775.
USFDA. Drug safety and availability - FDA drug safety communication: FDA has reviewed possible risks of pain medicine use during pregnancy. Cent Drug Eval Res [Internet]. 2015, https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-has-reviewed-possible-risks-pain-medicine-use-during-pregnancy
Nakhai-Pour H, Broy P, Sheehy O, Bérard A. Use of nonaspirin nonsteroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion. Can Med Assoc J. 2011;183(15):1713-20, https://doi.org/10.1503/cmaj.110454.
Li D. Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: population based cohort study. BMJ. 2003;327(7411):368-70, https://doi.org/10.1136/bmj.327.7411.368.
FDA. NSAIDs may cause rare kidney problems in unborn babies [Internet]. U.S. Food and Drug Administration. 2020, https://www.fda.gov/media/142967/download
FDA. Dyloject™ (diclofenac sodium) injection - FDA [Internet]. 2014, https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/022396lbl.pdf
van Gelder MM, Roeleveld N, Nordeng H. Exposure to non-steroidal anti-inflammatory drugs during pregnancy and the risk of selected birth defects: A prospective cohort study. Plos One. 2011;6(7), https://doi.org/10.1371/journal.pone.0022174.
Marchenko A, Etwel F, Olutunfese O, Nickel C, Koren G, Nulman I. Pregnancy outcome following prenatal exposure to triptan medications: a meta-analysis. Headache. 2015;55(4):490-501, https://doi.org/10.1111/head.12500.
Devall A, Coomarasamy A. Sporadic pregnancy loss and recurrent miscarriage. Best Pract Res Clin Obstet Gyn aecol. 2020;69:30-9, https://doi.org/10.1016/j.bpob-gyn.2020.09.002.
Spielmann K, Kayser A, Beck E, Meister R, Schaefer C. Pregnancy outcome after anti-migraine triptan use: A prospective observational cohort study. Cephalalgia. 2017;38:1081-92, https://doi.org/10.1177/0333102417724152.
Duong S, Bozzo P, Nordeng H, Eirnarson A. Safety of triptans for migraine headaches during pregnancy and breastfeeding. Can Fam Phy. 2010;56(6):537-9, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902939/.
Wood M, Lapane K, Frazier J, Ystrom E, Mick E, Nordeng H. Prenatal triptan exposure and internalising and externalising behaviour problems in 3-year-old children: results from the Norwegian mother and child cohort study. Paediatr Perinat Epidemiol. 2015;30(2):190-200, https://doi.org/10.1111/ppe.12253.
Harris G, Wood M, Ystrom E, Nordeng H. Prenatal triptan exposure and neurodevelopmental outcomes in 5-year-old children: Follow-up from the Norwegian Mother and Child Cohort Study. Paediatr Perinat Epidemiol. 2018;32(3):247-55, https://doi.org/10.1111/ppe.12461.
Viard D, Gérard A, Tahiri J, Tieulié N, Van Obberghen E, Drici M. Triptan overuse during pregnancy: a possible cause of placental hypoperfusion. Eur J Clin Pharmacol. 2020;77(2):269-70, https://doi.org/10.1007/s00228-020-02991-0.
Amundsen S, Nordeng H, Nezvalová-Henriksen K, Stovner L, Spigset O. Pharmacological treatment of migraine during pregnancy and breastfeeding. Nat Rev Neurol. 2015;11(4):209- 19, https://doi.org/10.1038/nrneurol.2015.29.
Levin M. Opioids in headache. Headache. 2014;54(1):12-21, https://doi.org/10.1111/head.12266.
Yazdy M, Mitchell A, Tinker S, Parker S, Werler M. Periconceptional use of opioids and the risk of neural tube defects. Obstet Gynecol. 2013;122(4):838-44, https://doi.org/10.1097/AOG.0b013e3182a6643c.
Broussard C, Rasmussen S, Reefhuis J, Friedman J, Jann M, Riehle-Colarusso T, et al. Maternal treatment with opioid analgesics and risk for birth defects. Am J Obstet Gynecol. 2011;204(4):314. e1-11, https://doi.org/10.1016/j.ajog.2010.12.039.
Muñoz J, Volcy M, Sobrino F, Ramirez S, Uribe B, Pradilla G, et al. Consenso de expertos de la Asociación Colombiana de Neurología para el tratamiento preventivo y agudo de la migraña. Acta Neurol Colomb. 2014;30(3):175-85, http://www.scielo.org.co/pdf/anco/v30n3/v30n3a08.pdf.
Klotz JL, Britt JL, Miller MF, Snider MA, Aiken GE, Long NM, et al. Ergot alkaloid exposure during gestation alters: II. uterine and umbilical artery vasoactivity1. J Anim Sci. 2019;97(4):1891-902, https://doi.org/10.1093/jas/skz069.
Jahanfar S, Jaafar S. Effects of restricted caffeine intake by mother on fetal, neonatal and pregnancy outcomes. Cochrane Database Syst Rev. 2015(6):CD006965, https://doi.org/10.1002/14651858.CD006965.pub4.
James JE. Maternal caffeine consumption and pregnancy outcomes: A narrative review with implications for advice to mothers and mothers-to-be. BMJ Evid Based Med. 2020;26(3):114-5, https://doi.org/10.1136/bmjebm-2020-111432.
Gleason JL, Sundaram R, Mitro SD, Hinkle SN, Gilman SE, Zhang C, et al. Association of maternal caffeine consumption during pregnancy with child growth. JAMA Netw Open. 2022;5(10), https://doi.org/10.1001/jamanet-workopen.2022.39609.
Headaches in pregnancy and postpartum. Obstet Gynecol. 2022;139(5):944-72, https://doi.org/10.1097/AOG.0000000000004766.
Chua AL, Grosberg BM, Evans RW. Status migrainosus in children and adults. Headache. 2019;59(9):1611-23, https://doi.org/10.1111/head.13676.
Carmichael S, Shaw G, Ma C, Werler M, Rasmussen S, Lammer E. Maternal corticosteroid use and orofacial clefts. Am J Obstet Gynecol. 2007;197(6):585.e1-7, https://doi.org/10.1016/j.ajog.2007.05.046.
Bandoli G, Palmsten K, Forbess Smith C, Chambers C. A review of systemic corticosteroid use in pregnancy and the risk of select pregnancy and birth outcomes. Rheum Dis Clin North Am. 2017;43(3):489-502, https://doi.org/10.1016/j.rdc.2017.04.013.
Sillero Sánchez M, Rodriguez Fernandez N, Sánchez Vera L, Gómez González B, Asencio Marchante JJ. Trombosis venosa cerebral tras punción lumbar y tratamiento corticoideo a dosis elevada. Neurología. 2014;29(5):315-6, https://doi.org/10.1016/j.nrl.2012.11.003.
Nascimento FA, Sória MG, Rizelio V, Kowacs PA. Cerebral venous thrombosis with migraine-like headache and the trigeminovascular system. Case Rep Neurol Med. 2016;2016:1-3, https://dx.doi.org/10.1155/2016/2059749.
Miller AC, Pfeffer B, Lawson MR, Sewell KA, King AR, Zehtabchi S. Intravenous magnesium sulfate to treat acute headaches in the emergency department: A systematic review. Headache, 2019;59(10):1674-86, https://doi.org/10.1111/head.13648.
Vink R, Nechifor M. Magnesium in the central nervous system. Cambridge: Cambridge University Press; 2012, https://doi.org/10.1017/UPO9780987073051.
Benavides D, Rodríguez LC, Restrepo J, Vargas D. Fisiopatología de la migraña: Teoría vascular, ¿cierta o no? Acta Neurol Colomb. 2015;31(1):84-91, https://doi. org/10.22379/2422402213.
Choi H, Parmar N. The use of intravenous magnesium sulphate for acute migraine. Eur J Emerg Med. 2014;21:2-9, https://doi.org/10.1097/MEJ.0b013e3283646e1b.
Shahrami A, Assarzadegan F, Hatamabadi H, Asgarzadeh M, Sarehbandi B, Asgarzadeh S. Comparison of therapeutic effects of magnesium sulfate vs. dexamethasone/ metoclopramide on alleviating acute migraine headache. J Emerg Med. 2015;48(1):69-76, https://doi.org/10.1016/j.jemermed.2014.06.055.
Meller C, Izbizky G, Otaño L. Actualización sobre el uso de sulfato de magnesio como neuroprotector en el parto prematuro. Arch Argent Pediatr. 2015;113(04):1-7, http://dx.doi.org/10.5546/aap.2015.345.
FDA. Magnesium sulfate in water for injection. 2013. p. 5-9, https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/020309s028lbl.pdf
FDA. FDA recommends against prolonged use of magnesium sulfate to stop pre-term labor due to bone changes in exposed babies. 2013. p. 5-8, https://www.fda.gov/media/85971/download.
Anaya G. Lidocaína: aspectos generales y nuevas implicaciones en la inflamación. Rev Mex Anestesiol. 2017;40:220-5, https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=74695
Ruiz Piñero M, Mulero Carrillo P, Pedraza Hueso M, de la Cruz Rodríguez C, López Mesonero L, Guerrero Peral A. Bloqueo anestésico de nervios pericraneales como tratamiento preventivo de migraña: experiencia en una serie de 60 pacientes. Neurología. 2016;31(7):445-51, https://doi.org/10.1016/j.nrl.2014.10.001.
Levin M. Nerve blocks in the treatment of headache. Neurotherapeutics. 2010;7(2):197-203, https://doi.org/10.1016/j.nurt.2010.03.001.
Pasternak B, Svanstrõm H, Melgaard-Nielsen D, Melbye M, Hviid A. Metoclopramide in pregnancy and risk of major congenital malformations and fetal death. JAMA. 2013;310(15):1601-11, https://doi.org/10.1001/jama.2013.278343.
FDA. Diphenhydramine hydrochloride injection [Internet]. U.S. Food and Drug Administration. 2013, https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/091526lbl.pdf
Friedman B, Garber L, Yoon A, Solorzano C, Wollowitz A, Esses D, et al. Randomized trial of IV valproate vs metoclopramide vs ketorolac for acute migraine. Neurology. 2014;82(11):976-83, https://doi.org/10.1212/WNL.0000000000000223.
Doganay Aydin H, Vuralli D, Akçali DT, Bolay H. Metoclo-pramide inhibits trigeminovascular activation:evidence for effective acute attack treatment in migraine. Turk J Med Sci. 2017;47:343-7, https://doi.org/10.3906/sag-1601-195.
Alstadhaug KB. Histamine in migraine and brain. Headache. 2014;54(2):246-59, https://doi.org/10.1111/head.12293.
Friedman B, Cabral L, Adewunmi V, Solorzano C, Esses D, Bijur P, et al. Diphenhydramine as adjuvant therapy for acute migraine: an emergency department-based randomized clinical trial. Ann Emerg Med. 2016;67(1):32-9.e3, https://doi.org/10.1016/j.annemergmed.2015.07.495.
Sprouse-Blum AS, Gabriel AK, Brown JP, Yee MHC. Randomized controlled trial: targeted neck cooling in the treatment of the migraine patient. Hawaii J Med Public Health. 2013;72(7):237-41, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3727573/
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