The article that I chose was based on my last H&P that I had presented. This was a systematic review with meta-analysis that focused on the topic of headaches and its association with pregnancy. The top differential diagnosis that I believed my patient had in my third H&P was a migraine. It was learned that migraines are the second most common primary headache disorder after tension-type headache and it’s estimated to affect about one in seven people worldwide.

Migraines are two to three times more prevalent in women of childbearing age, with almost 30% experiencing migraine by the age of 45 years. Patients that have migraines are more likely to report a negative impact on their education, employment, family relationships and leisure activities. If there is a presence of aura (focal neurological symptoms), which occurs 30% of the time, there is an increased risk of ischemic heart disease and stroke than migraine alone. Recommended treatment options during pregnancy include Acetaminophen (first line), non-steroidal anti-inflammatory drugs (NSAIDs – prior to 20 weeks) or triptans (third line) for symptom relief. However, there is little evidence regarding their safety in pregnancy, which means that it is advised they are used with caution with acetaminophen being the safest option for the mother and fetus.

It was concluded that women with migraine had a higher odds of preeclampsia, low birth weight and peripartum mental illness. It was also shown that women exposed to triptans had higher odds of miscarriage compared to healthy controls, which is why it’s used as a third line agent in severe cases.