The very first paper I would like to present was on headache in pregnancy, which was published in 2017 by a group of European researchers on the behalf of the European Headache Federation. The topic is Headache and Pregnancy: a systematic review. As indicated in the topic, this is a systematic review, which is generally the best form of evidence.


This review included clinical trials between 1997-2017, and it covered both primary and secondary headaches. Primary headaches are headaches without serious underlying diseases. On the hand, headaches are the manifestation of other diseases, some of which are life threatening.


Before further discussion on primary and secondary headaches in pregnancy, I noticed a very interesting point of this article, which I think it very important to share with you. There are three possible scenarios:


  1. She suffers from a primary headache, and now she presents with her usual headache;
  2. She dose not suffer from a primary headache and she presents with her first severe headache during pregnancy;
  3. She suffers from a primary headache, but now pain is different in quality, intensity or associated symptoms.


In the second and third scenarios, headache must be considered as a symptoms of an underlying disease until proven otherwise. If your headache fell into the 2nd and 3rd category, please discuss with your GP or obstetrician.


For primary headaches, 4 types of headaches were included, which were migraine with/without aura, tension-type headaches and cluster headaches. Generally speaking, the majority, over 2/3, of patients with migraines experienced improvement, approximately 8% were worse, and the rest were unchanged. Unfortunately, migraines returned soon after delivery, normally within 4 weeks. Another bad news was that migraines can happen to approximate 10% of pregnant women without migraine history.


Another common headache is tension-type headache, which follows the similar pattern of migraines minimal risk of worsening. The last type was cluster headache, which was quite rare, less than 0.3%.


From the treatment point of view, the authors listed over 20 medications, and divided adverse effects into confirmed and suspected groups. There were only 2 medications are free from both groups of side-effects, which were duloxetine, an antidepressant and verapamil, which is only effective in cluster headache. Commonly used headache medications such as Panadol, anti-inflammatories, metoprolol and aspirin are all have confirmed or suspected concerns.


On the other hand, local treatments, including Botox injection and nerve block are safe. Unfortunately, this review did not provide detailed data on the efficacy of each treatment options. However, it made some recommendations. Panadol is considered the safest option for headache at this stage. Beta-blocker, metoprolol, can be used for prevention despited intra-uterine growth retardation. Lastly, but not least, acupuncture is helpful for headaches in pregnancy.


The final part is to reflect on my acupuncture treatment. Headaches are confusing, and pregnancies are complicated. The combination is both confusing and complicated. However, most headaches have a common pathway, the alternation of cerebral blood flow, which is the perfect target for acupuncture treatment. The stimulation of sympathetic and parasympathetic nerve directly regulate the local cerebral blood flow, which relieves the symptoms within minutes in most cases.


I will continue with the secondary headache part of this review next week.

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