TY - JOUR
T1 - Peripheral nerve blocks in the treatment of migraine in pregnancy
AU - Govindappagari, Shravya
AU - Grossman, Tracy B.
AU - Dayal, Ashlesha K.
AU - Grosberg, Brian M.
AU - Vollbracht, Sarah
AU - Robbins, Matthew S.
N1 - Publisher Copyright:
© 2014 by The American College of Obstetricians and Gynecologists.
PY - 2014/12/11
Y1 - 2014/12/11
N2 - OBJECTIVE: To describe the use of peripheral nerve blocks in a case series of pregnant women with migraine.METHODS: A retrospective chart review of all pregnant patients treated with peripheral nerve blocks for migraine over a 5-year period was performed. Injections targeted greater occipital, auriculotemporal, supraorbital, and supratrochlear nerves using local anesthetics.RESULTS: Peripheral nerve blocks were performed 27 times in 13 pregnant women either in a single (n=6) or multiple (n=7) injection series. Mean patient age was 28 years and gestational age was 23.5 weeks, and all women had migraine, including 38.5% who had chronic migraine. Peripheral nerve blocks were performed for status migrainosus (51.8%) or short-term prophylaxis of frequent headache attacks (48.1%). Before peripheral nerve blocks were performed, oral medications failed for all patients and intravenous medications failed for most. In patients with status migrainosus, average pain reduction was 4.0 (±2.6 standard deviation) (P<.001) immediately postprocedure and 4.0 (±4.4 standard deviation) (P=.007) 24 hours postprocedure in comparison to preprocedure pain. For patients receiving peripheral nerve blocks for short-term prophylaxis, immediate mean pain score reduction was 3.0 (±2.1 standard deviation). No patients had any serious immediate, procedurally related adverse events, and the two patients who had no acute pain reduction ultimately developed preeclampsia and had postpartum headache resolution.CONCLUSION: Peripheral nerve blocks for treatmentrefractory migraine may be an effective therapeutic option in pregnancy.
AB - OBJECTIVE: To describe the use of peripheral nerve blocks in a case series of pregnant women with migraine.METHODS: A retrospective chart review of all pregnant patients treated with peripheral nerve blocks for migraine over a 5-year period was performed. Injections targeted greater occipital, auriculotemporal, supraorbital, and supratrochlear nerves using local anesthetics.RESULTS: Peripheral nerve blocks were performed 27 times in 13 pregnant women either in a single (n=6) or multiple (n=7) injection series. Mean patient age was 28 years and gestational age was 23.5 weeks, and all women had migraine, including 38.5% who had chronic migraine. Peripheral nerve blocks were performed for status migrainosus (51.8%) or short-term prophylaxis of frequent headache attacks (48.1%). Before peripheral nerve blocks were performed, oral medications failed for all patients and intravenous medications failed for most. In patients with status migrainosus, average pain reduction was 4.0 (±2.6 standard deviation) (P<.001) immediately postprocedure and 4.0 (±4.4 standard deviation) (P=.007) 24 hours postprocedure in comparison to preprocedure pain. For patients receiving peripheral nerve blocks for short-term prophylaxis, immediate mean pain score reduction was 3.0 (±2.1 standard deviation). No patients had any serious immediate, procedurally related adverse events, and the two patients who had no acute pain reduction ultimately developed preeclampsia and had postpartum headache resolution.CONCLUSION: Peripheral nerve blocks for treatmentrefractory migraine may be an effective therapeutic option in pregnancy.
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U2 - 10.1097/AOG.0000000000000555
DO - 10.1097/AOG.0000000000000555
M3 - Article
C2 - 25415168
AN - SCOPUS:84916898814
SN - 0029-7844
VL - 124
SP - 1169
EP - 1174
JO - Obstetrics and gynecology
JF - Obstetrics and gynecology
IS - 6
ER -