Migraine management with peripheral nerve blocks during pregnancy: a case report

Çetin H., Vurallı D.

Global Migraine & Pain Summit, 6th MENA Meeting & 4rd Turkish African Meeting Of Headache And Pain Management 2022, Antalya, Türkiye, 2 - 05 Kasım 2022, ss.55

  • Yayın Türü: Bildiri / Özet Bildiri
  • Basıldığı Şehir: Antalya
  • Basıldığı Ülke: Türkiye
  • Sayfa Sayıları: ss.55
  • Gazi Üniversitesi Adresli: Evet

Özet

Background: While pregnancy may reduce migraine attack frequency, many women have a stable or worsening course and may even experience first-time migraine attacks. Despite the high prevalence of migraine, acute treatment of migraine can be difficult during pregnancy, because of a lack of medication trials and fears of teratogenicity. Peripheral nerve blocks are common interventions for migraine which provide rapid pain relief with minimal side effects. Aim The aim of this case report is to raise awareness among doctors of migraine management with peripheral nerve blocks during pregnancy. Method/ Case Report A 41 year old, 14-week pregnant patient was admitted to our headache outpatient clinic with a complaint of headache. She had headaches since she was 15 years old. She had a bilateral, pulsating headache with accompanying photophobia, phonophobia, and nausea. She did not have any aura symptoms. The pain intensity was severe with a visual analogue scale score of 9/10 and continued for up to 72 hours. Her headache got worse in the second trimester where she developed daily headaches. She had no accompanying neurological complaints. She had a history of anxiety disorder and asthma. Her neurological examination and brain imaging was normal. We performed bilateral greater occipital nerve blocks with lidocaine. She benefited from the therapy. She was followed during the pregnancy period and her headache relieved with repetitive bilateral greater occipital nerve blocks as needed. Results Repetitive greater occipital nerve blocks with lidocaine decreased the headache frequency to less than once a week and decreased the headache intensity more than 50% and decreased the need for acute migraine medications such as paracetamol. Conclusion Nerve blocks are safe and effective treatment options for migraine and other headache disorders as an acute therapy as well as for short-term prevention in pregnancy.