Magazine article Clinical Psychiatry News

Severe Migraine in Pregnancy Signals High Risk

Magazine article Clinical Psychiatry News

Severe Migraine in Pregnancy Signals High Risk

Article excerpt

AT IHC 2015

VALENCIA, SPAIN -- Women who present with acute severe migraine during pregnancy are at increased risk for adverse pregnancy outcomes and should be seen in a high-risk pregnancy clinic, Dr. Tracy B. Grossman asserted at the International Headache Congress.

"We should not be seeing these patients in a regular ob.gyn./generalist's office because oftentimes we need input from neurology, and we need extra surveillance for both the fetus and the mother," she said at the meeting sponsored by the International Headache Society and the American Headache Society.

Dr. Grossman presented a retrospective study of 90 consecutive pregnant patients who presented with acute severe migraine and obtained a neurology consult at Montefiore Medical Center, New York, where she is an ob.gyn. resident.

"These patients are different from most migraine patients, because most migraine patients actually see improvement of symptoms during pregnancy. So this is a special group of patients with worsening and refractory migraine," Dr. Grossman noted in an interview.

Most of the patients were in their third trimester and had migraine without aura. Twenty-four presented with status migrainosus, a migraine for 15 or more days a month for more than 3 months.

Forty-nine of the 90 patients (54%) experienced one or more adverse pregnancy outcomes.

Of note, the 28% preterm delivery rate was nearly three times the national average of 11% as reported by the March of Dimes. The pre-eclampsia rate was 20.5%, compared with a national rate of just 3%-4%. The 19.2% low birth weight rate was more than double the 8% national average. The cesarean section rate was 30.8%.

The study hypothesis was that the migraine-with-aura group would have higher preeclampsia, preterm delivery, and low birth weight rates, as has been reported by some other investigators in what is a sparse literature. …

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