Review article

Special Conditions in Migraine Treatment (Status Migrainosus, Menstrual Migraine, Migraine During Pregnancy and Breastfeeding)

Marijana Bosnar Puretić

Abstract

Status migrainosus is a condition of prolonged and continuous migraine attack lasting longer than 72 hours. Treatment is based on parenteral use of analgesics, antimigraine agents, antiemetics and intravenous rehydration. Corticosteroids reduce the risk of headache recovery. The higher prevalence of migraines in women is a result of estrogen influence on migraine pathophysiology. A pure menstrual migraine is rare, and it occurs exclusively in the days around the beginning of the menstrual cycle. A menstrually-related migraine occurs at the beginning of the cycle, but also on other days of the cycle and is significantly more common. Standard abortive therapy is used for the treatment of acute attacks. A prophylaxis of menstrual migraine and menstrually-related migraine can be short-term, and mini-prophylaxis and NSAID (naproxen), triptans or hormone therapy from two days before and until the third or fourth day of menstruation are used for this purpose. If mini-prophylaxis is not effective, continuous prophylaxis is needed using standard prophylactic medications or hormonal therapy. During pregnancy and lactation, therapeutic options are limited due to safety concerns of the effect of the medication on pregnancy and the child. In acute therapy, paracetamol, sumatriptan and metoclopramide are safe in all conditions. Migraine prophylaxis during pregnancy is rarely indicated and then the use of propranolol is considered safe. During breastfeeding, the majority of medications for acute therapy are safe for the child, except opiates and ergotamine-based medications. Greater range of preventive drugs are compatible with breastfeeding. CGRP antagonists are not indicated for migraine prophylaxis
during pregnancy and breastfeeding.

Keywords

status migrainosus; menstrual migraine; migraine; pregnancy; breastfeeding; pharmacological treatment

Hrčak ID:

257527

URI

https://hrcak.srce.hr/257527

Publication date:

17.5.2021.

Article data in other languages: croatian

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