Headaches during pregnancy

Overview
Headaches are very common during pregnancy. It is widely believed that headaches are a normal part of pregnancy, however, severe headaches have a significant impact on the quality of life.

There are many types of headaches, such as migraine, cluster headache and tension-type headache. From the treatment point of view, the headaches are divided into two major groups, primary and secondary. Primary headaches mean that there is not any significant underlying illness, and secondary headaches are the presentation of severe diseases such as gestational diabetes and preeclampsia. Fortunately, the majority of headaches during pregnancy are primary headaches and benign in nature.

Treatment options
The pharmacological choices for headaches in pregnancy are very limited. Simple analgesia, such as paracetamol, is safe (Category A) but usually inadequate. Other medications including anti-inflammatories (e.g. ibuprofen), beta-blockers and triptans are not safe (Category C) in pregnancy.

Acupuncture in pregnancy
Acupuncture is proven to be safe and effective in many general medical and obstetric conditions. For example, stimulation over a point over little toes (Bladder 67, Zhi Yin) can safely resolve breech positions, which is routine practice in obstetrics now. Acupuncture has its unique advantages in the management of headaches during pregnancy.

Treatment objective
If a headache is present at the time of treatment, significant relief or complete resolution can be expected within 20 minutes. The severity and frequency of headaches should decrease significantly after the 1st treatment. The aim after the course of treatment is to make the headaches manageable with occasional paracetamol (Category A), though many are headache-free during their pregnancy.

Treatment protocol
Patients normally require 6 sessions to achieve maximum effects, which are 2 weeks of twice per week treatments and 2 weeks of weekly treatments. Another 2 treatments may be needed in a small percentage of patients. The protocol is subject to change according to patient conditions, especially the stage of pregnancy.

Safety
Acupuncture is a well-tolerated safe treatment. Patients experience pain less than intra-muscular injection and blood tests. However, patients may experience acupuncture-specific sensation, De Qi, which might feel like vague tingling and lasts seconds.

The treatment principles for headaches in pregnancy are “minimal stimulation” and “maximum certainty”. To achieve both, only 5 to 9 points will be used for the treatment, patients will be asked to provide feedback frequently during the treatment, and laser is NOT used due to the absence of immediate feedback.

Bleeding and bruising rarely happen. Temporary nerve irritation or damage are theoretical risks, which haven’t been encountered in this treatment.

Fee
1st & 2nd - $300
3rd - 6th - $250

Medicare rebate - $107.25 x 6 = 643.50
Total out-of-pocket cost $956.50

* Patients may be eligible to get higher rebates if the Extended Medicare Safety Net (EMSN) threshold is met. The total out-of-pocket cost may be as low as $194. Please contact Medicare regarding EMSN