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Headache in Pregnancy

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1. Tiny Tips: “SNOOP MEETS Pregnancy” Headache mnemonic

Tiny Tips: “SNOOP MEETS PregnancyHeadache mnemonic Tiny Tips: “SNOOP MEETS PregnancyHeadache mnemonic - CanadiEM Tiny Tips: “SNOOP MEETS PregnancyHeadache mnemonic In , by Sean Patrick September 8, 2017 Many must-not-miss diagnoses manifest as a secondary headache. Though the DDx list is quite large, the pertinent questions that must be asked on history can be remembered using the mnemonic “SNOOP MEETS Pregnancy” 1 , 2 Below you’ll find the cues associated with each letter, the symptoms (...) : Idiopathic intracranial hypertension, Carotid or vertebral artery dissection, SAH Exposure Hx DDx: Illicit drug use, Toxins, CO poisoning Trauma Hx DDx: Trauma Secondary risk factors = HIV, cancer DDx: Meningitis, Brain abscess, Metastases Pregnancy DDx: Pre-eclampsia, Venous sinus thrombosis, Pituitary apoplexy, Carotid dissection This post was copyedited by Sean McIntosh. References 1. Donohoe C. The role of the physical examination in the evaluation of headache. Med Clin North Am . 2013;97(2):197-216

2017 CandiEM

2. Metoclopramide and Diphenhydramine: A Randomized Controlled Trial of a Treatment for Headache in Pregnancy when Acetaminophen Alone Is Ineffective (MAD Headache Study). (PubMed)

Metoclopramide and Diphenhydramine: A Randomized Controlled Trial of a Treatment for Headache in Pregnancy when Acetaminophen Alone Is Ineffective (MAD Headache Study).  We investigated whether metoclopramide administered with diphenhydramine (MAD) relieves headache in pregnant women when acetaminophen alone is ineffective, using codeine for comparison. Normotensive pregnant women in the second or third trimester were randomized to MAD intravenously (10 mg and 25 mg, respectively) or codeine (...) orally (30 mg) for headache after 650 to 1,000 mg of acetaminophen failed to relieve their headaches. Headache severity (pain score 0-10) was noted at intervals over 24 hours. The primary outcome was reduction in pain score 6 hours after medication administration. A sample size calculation of 35 patients per group was based on estimated reduction in headache pain score by at least two points, with an α of 0.05 and a power of 80%. No difference was seen in the primary outcome. MAD pain scores were

2018 American journal of perinatology

3. Systematic review of randomized controlled trials of headache treatment in pregnancy

Systematic review of randomized controlled trials of headache treatment in pregnancy Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites

2019 PROSPERO

4. A headache-free reversible cerebral vasoconstriction syndrome (RCVS) with symptomatic brain stem ischemia at late pregnancy as a rare manifestation of RCVS resolved with termination of pregnancy by semi-urgent cesarean section (PubMed)

A headache-free reversible cerebral vasoconstriction syndrome (RCVS) with symptomatic brain stem ischemia at late pregnancy as a rare manifestation of RCVS resolved with termination of pregnancy by semi-urgent cesarean section A 32-year-old pregnant woman in her 39th week of pregnancy presented at the emergency room complaining of sudden-onset dizziness with gaze disturbance and was admitted to our hospital. Her past medical history included hypertension, diabetes mellitus and infarction (...) in the right medulla oblongata 18 months prior to this event. Magnetic resonance (MR) angiography showed multiple irregular stenosis of the intracranial arterial system. Although MR images revealed no fresh ischemic or hemorrhagic lesions, she was diagnosed with reversible cerebral vasoconstriction syndrome (RVCS) associated with pregnancy. Cesarean section immediately resolved the headache-free ischemic RCVS. The postpartum course of the patient was uneventful as well as that of her baby. Follow-up MR

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2018 Oxford Medical Case Reports

5. Utilization of complementary and alternative medicine and conventional medicine for headache or migraine during pregnancy: A cross-sectional survey of 1,835 pregnant women. (PubMed)

Utilization of complementary and alternative medicine and conventional medicine for headache or migraine during pregnancy: A cross-sectional survey of 1,835 pregnant women. Little is known about women's use of health services affected by headache or migraine during pregnancy. This paper directly addresses the research gap reporting on the healthcare utilization among Australian pregnant women experiencing headache or migraine.In this retrospective observational study, data on 1,835 Australian (...) of healthcare practitioners for their headache or migraine. General practitioners (37.8%) were the most commonly consulted providers of pregnant women for their headache or migraine. Women with headache or migraine during pregnancy had worse health-related quality of life than those without. Education level and private health insurance status of pregnant women are the predictors of the use of healthcare practitioners for their management of headache or migraine (both p < 0.05).Headache or migraine during

2018 Complementary Therapies In Medicine

6. Headache and pregnancy: a systematic review. (PubMed)

Headache and pregnancy: a systematic review. This systematic review summarizes the existing data on headache and pregnancy with a scope on clinical headache phenotypes, treatment of headaches in pregnancy and effects of headache medications on the child during pregnancy and breastfeeding, headache related complications, and diagnostics of headache in pregnancy. Headache during pregnancy can be both primary and secondary, and in the last case can be a symptom of a life-threatening condition (...) . The most common secondary headaches are stroke, cerebral venous thrombosis, subarachnoid hemorrhage, pituitary tumor, choriocarcinoma, eclampsia, preeclampsia, idiopathic intracranial hypertension, and reversible cerebral vasoconstriction syndrome. Migraine is a risk factor for pregnancy complications, particularly vascular events. Data regarding other primary headache conditions are still scarce. Early diagnostics of the disease manifested by headache is important for mother and fetus life

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2017 The journal of headache and pain

7. Migraine and Tension Headache

flag warning signs requiring immediate or urgent evaluation: Systemic • Conditions: malignancy, HIV, pregnancy • Signs: fevers, sweats, rash, weight loss Neurologic • Symptoms: any neurologic symptoms other than classic aura (such as confusion or double vision) • Signs: optic nerve edema, abnormal neurologic exam Onset sudden ( 10 days or > 15 days per month, depending on the medication.) It is important to rule out MOH prior to initiating therapy for any acute headache. See p. 12. Menstruation (...) Migraine and Tension Headache ? 2018 Kaiser Foundation Health Plan of Washington. All rights reserved. 1 Migraine and Tension Headache Guideline Background 2 Diagnosis Red flag warning signs 2 Differential diagnosis 2 Imaging 3 Migraine versus tension headache 3 Medication overuse headache 3 Menstruation-related migraine 3 Tension Headache Acute treatment 4 Prophylaxis 5 Migraine Headache Acute treatment 6 Treatment of refractory migraine 7 Prophylaxis 8 Menstruation-related migraine

2018 Kaiser Permanente Clinical Guidelines

8. Headache

Medicines Agency (EMA) strengthens measures to avoid use of valproate medicines in pregnancy In March 2018, the EMA announced stronger measures aimed at avoiding the exposure of babies to valproate (...) not getting through to women, despite earlier steps aimed at ensuring this. Summary Migraine has a high prevalence in children (10%) and is a significant source of morbidity. Careful consideration of the broad differential diagnosis is important when evaluating a child with headache . The expectations (...) Headache Top results for headache - Trip Database or use your Google+ account Find evidence fast ALL of these words: Title only Anywhere in the document ANY of these words: Title only Anywhere in the document This EXACT phrase: Title only Anywhere in the document EXCLUDING words: Title only Anywhere in the document Timeframe: to: Combine searches by placing the search numbers in the top search box and pressing the search button. An example search might look like (#1 or #2) and (#3 or #4

2018 Trip Latest and Greatest

9. Headache

: New headache in pregnant woman. Radiologic Procedure Rating Comments RRL* MRI head without IV contrast 8 MRI is the modality of choice, however use of CT depends on local availability. O CT head without IV contrast 7 Use of CT depends on local availability and is helpful if there is a high suspicion for acute intracranial hemorrhage. ??? MR venography head without IV contrast 6 O MRA head without IV contrast 6 O MRI head without and with IV contrast 5 Pregnancy is a relative contraindication (...) encephalomyelitis. FDG-PET is not generally indicated for evaluation of suspected encephalitis or meningitis. New Headache in Pregnant Woman In general, pregnancy favorably impacts the course of migraine, but patients presenting with headache in pregnancy have higher yields of a pathologic etiology. A recent study found a 27% underlying etiology for headache in pregnant patients presenting to the emergency department [99]. Although the cornerstones of the workup are history, physical examination, and laboratory

2019 American College of Radiology

10. Headache

cloth / ice pack to head Sleep Avoid bright lights and loud sounds Avoid triggers if any have been identified. A headache diary to record frequency, intensity, suspected triggers, and the effect of medication is useful. Common triggers are: Food (missing meals, or food containing nitrites, MSG, aspartame or tyramine) Environmental (weather changes, strong odours, bright lights) Chemical (insecticides, perfumes, benzene) Hormonal (menstruation, pregnancy (1 st trimester), perimenopause) Drugs Others (...) . Clinically significant and contraindicated if an ergot taken within 24 hours. 4. Pregnancy and Lactation Nonpharmacologic measures are first choice during pregnancy. Migraine headaches often improve during pregnancy so medication may not be necessary. If needed, the occasional dose of acetaminophen is recommended. Triptans are relatively contraindicated during pregnancy although recent data suggests they may not increase risk to the fetus. Refer to patient's primary care provider if symptoms

2018 medSask

11. Hypertension in pregnancy: diagnosis and management

Reducing the risk of hypertensive disorders in pregnancy Symptoms of pre-eclampsia Symptoms of pre-eclampsia 1.1.1 Advise pregnant women to see a healthcare professional immediately if they experience symptoms of pre-eclampsia. Symptoms include: severe headache problems with vision, such as blurring or flashing before the eyes severe pain just below the ribs vomiting sudden swelling of the face, hands or feet. See the NICE guideline on antenatal care for advice on risk factors and symptoms of pre (...) are in a critical care setting if birth is planned within 24 hours. [2010] [2010] 1.8.3 Consider the need for magnesium sulfate treatment, if 1 or more of the following features of severe pre-eclampsia is present: ongoing or recurring severe headaches visual scotomata nausea or vomiting epigastric pain oliguria and severe hypertension Hypertension in pregnancy: diagnosis and management (NG133) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

12. Headache in Pregnancy

Headache in Pregnancy Headache in Pregnancy Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Headache in Pregnancy Headache (...) in Pregnancy Aka: Headache in Pregnancy , Migraine in Pregnancy , Antepartum Headache , Postpartum Headache From Related Chapters II. Types: Primary Headaches Improves with pregnancy in up to 70% of patients Some cases of first occur in first trimester Associated with aura III. Differential Diagnosis: Secondary Headaches in Antepartum Period See for other causes See s ( ) Consider after 20 weeks IV. Differential Diagnosis: Secondary Headaches in Postpartum Period (Postpartum Headache) See for other causes

2018 FP Notebook

13. CRACKCast E103 – Headache Disorders

IV or 30 to 60 mg IM Gastrointestinal upset; avoid this medication in elderly and in patients with renal insufficiency Second Line Agents: Morphine 4 to 8 mg IM or IV Opioids less efficacious than other treatment modalities Magnesium 2 g IV More efficacious in migraine with aura Valproic acid 1 g IV Contraindicated in pregnancy 5) List four migraine variants. Neuroimaging should be considered for older or immunocompromised patients with new-onset headaches, headaches associated with unexplained (...) blood). 5) Describe post-traumatic headache & hypertensive headache. PTH: Common post concussion or TBI Often the person has both anatomic and functional symptoms consistent with post-concussive syndromes Normal neuro exam, imaging normal HH: Meet criteria when BP > 180/120 mmHg and h/a → then resolves when the blood pressure is normalized Be sure to inquire about pregnancy or post-partum status (up to 8 weeks post!) No objective end-organ damage identified on labs or exam. First treat

2017 CandiEM

14. gammaCore for cluster headache

gammaCore for cluster headache gammaCore for cluster headache gammaCore for cluster headache Medtech innovation briefing Published: 22 October 2018 nice.org.uk/guidance/mib162 pathways Summary Summary The technology technology described in this briefing is gammaCore. It is used as a daily preventative measure for cluster headache and can be used to treat pain during a headache. The inno innovativ vative aspects e aspects compared with other vagus nerve stimulators is that gammaCore is applied (...) to the surface of the neck rather than surgically implanted. The intended place in ther place in therap apy y would be as well as standard care, most likely where standard treatments for cluster headache are ineffective, not tolerated or contraindicated. It would be prescribed by neurologists who provide specialist headache services. The main points from the e main points from the evidence vidence summarised in this briefing are from 5 studies: 3 randomised controlled trials, 1 open-label randomised trial

2018 National Institute for Health and Clinical Excellence - Advice

15. "THINK Trial: Treatment of Headache With IntraNasal Ketamine: A Randomized Controlled Trial Evaluating the Efficacy of Intranasal Ketamine Versus Standard Therapy in the Management of Primary Headache Syndromes in the Emergency Department"

"THINK Trial: Treatment of Headache With IntraNasal Ketamine: A Randomized Controlled Trial Evaluating the Efficacy of Intranasal Ketamine Versus Standard Therapy in the Management of Primary Headache Syndromes in the Emergency Department" "THINK Trial: Treatment of Headache With IntraNasal Ketamine: A Randomized Controlled Trial Evaluating the Efficacy of Intranasal Ketamine Versus Standard Therapy in the Management of Primary Headache Syndromes in the Emergency Department" - Full Text View (...) - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. "THINK Trial: Treatment of Headache With IntraNasal Ketamine: A Randomized Controlled Trial Evaluating the Efficacy of Intranasal Ketamine Versus Standard Therapy in the Management of Primary

2017 Clinical Trials

16. Metformin for women who are overweight or obese during pregnancy for improving maternal and infant outcomes. (PubMed)

Metformin for women who are overweight or obese during pregnancy for improving maternal and infant outcomes. There has been considerable interest in providing antenatal dietary and lifestyle advice for women with obesity or who are overweight during pregnancy, as a strategy to limit gestational weight gain and improve maternal and infant health. However, such antenatal interventions appear to have a modest effect on gestational weight gain and other clinical pregnancy and birth outcomes (...) with obesity or who are overweight, acting to reduce glucose production in the liver and improve glucose uptake in smooth muscle cells, and therefore improve the overall metabolic health of women in pregnancy and reduce the risk of known adverse pregnancy outcomes.To evaluate the role of metformin in pregnant women with obesity or who are overweight, on maternal and infant outcomes, including adverse effects of treatment and costs.We searched Cochrane Pregnancy and Childbirth's Trials Register

2018 Cochrane

17. Overview of pregnancy complications

Obstet Gynecol. 2000;183:S1-S22. http://www.ncbi.nlm.nih.gov/pubmed/10920346?tool=bestpractice.com Pre-eclampsia is usually asymptomatic but may present with headache, seizure, blurred vision, and abdominal pain. Risk factors include nulliparity (or first pregnancy with new partner), family history of pre-eclampsia, body mass index >30, maternal age >35 years, and multiple (twin) pregnancy. Hauth JC, Ewell MG, Levine RJ, et al. Pregnancy outcomes in healthy nulliparas who developed hypertension (...) Overview of pregnancy complications Overview of pregnancy complications - Summary of relevant conditions | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Overview of pregnancy complications Last reviewed: February 2019 Last updated: September 2018 Introduction Complications in pregnancy can result from conditions that are specifically linked to the pregnant state as well as conditions that commonly arise or occur incidentally in women who are pregnant

2018 BMJ Best Practice

18. Nausea and vomiting in pregnancy

Nausea and vomiting in pregnancy Nausea and vomiting in pregnancy - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Nausea and vomiting in pregnancy Last reviewed: February 2019 Last updated: March 2018 Summary Affects approximately 75% of pregnant women. Typically begins between the fourth and seventh week after the last menstrual period and resolves in the second trimester. Aetiology remains unclear. There is some (...) evidence that it is related to hormone levels of human chorionic gonadotrophin and oestrogen. Hyperemesis gravidarum represents the most severe form of nausea and vomiting of pregnancy. While there is lack of consensus of definition, most agree that clinical features include persistent vomiting, volume depletion, ketosis, electrolyte disturbances, and weight loss. Initial therapy should be conservative. This may include non-pharmacological treatments such as diet modification, emotional support, ginger

2018 BMJ Best Practice

19. Molar pregnancies

). Gestational trophoblastic disease includes tumours of fetal tissues, including hydatidiform moles, arising from placental trophoblasts. Syncytiotrophoblasts secrete human chorionic gonadotrophin and, therefore, this hormonal product is used as a tumour marker for the disease. History and exam presence of risk factors first trimester of pregnancy missed period vaginal bleeding unusually large uterus for gestational age headache and photophobia shortness of breath and respiratory distress severe nausea (...) Molar pregnancies Molar pregnancies - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Molar pregnancies Last reviewed: February 2019 Last updated: March 2018 Summary Chromosomally abnormal pregnancies that have the potential to become malignant. Higher possibility of gestational trophoblastic disease (GTD) for women less than 20 years of age or over 35 years of age, and in those who have experienced GTD in a previous

2018 BMJ Best Practice

20. Overview of pregnancy complications

Obstet Gynecol. 2000;183:S1-S22. http://www.ncbi.nlm.nih.gov/pubmed/10920346?tool=bestpractice.com Pre-eclampsia is usually asymptomatic but may present with headache, seizure, blurred vision, and abdominal pain. Risk factors include nulliparity (or first pregnancy with new partner), family history of pre-eclampsia, body mass index >30, maternal age >35 years, and multiple (twin) pregnancy. Hauth JC, Ewell MG, Levine RJ, et al. Pregnancy outcomes in healthy nulliparas who developed hypertension (...) Overview of pregnancy complications Overview of pregnancy complications - Summary of relevant conditions | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Overview of pregnancy complications Last reviewed: February 2019 Last updated: September 2018 Introduction Complications in pregnancy can result from conditions that are specifically linked to the pregnant state as well as conditions that commonly arise or occur incidentally in women who are pregnant

2018 BMJ Best Practice

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