Comorbidities of Primary Headaches During Pregnancy and the Perinatal Period: An Integrative Review
DOI:
https://doi.org/10.14738/bjhr.1202.18496Keywords:
headache, comorbidities, pregnancy, postpartumAbstract
Introduction: This article provides an overview of available information regarding Primary Headaches (PH) during pregnancy and the postpartum period with a focus on their comorbidities such as psychiatric disorders (depression, anxiety, stress, post-traumatic stress disorder), sleep disorders, abuse and potential trigger factors such as assisted reproductive techniques and smoking. Methods: A systematic search was conducted on five electronic databases, PubMed, Embase, Web of sciences, Scopus and Cochrane Library, spanning from January 1983 to August 2024, for pertinent manuscripts. The collected datasets were summarized and synthesized descriptively. Results: Nineteen manuscripts were incorporated into the analysis. Among them, half employed self-report methods to classify headaches, while 14 utilized validated questionnaires and scales to evaluate psychiatric and sleep disorders, as well as intimate partner violence. Additionally, the results of a case study and a letter to the editor were also included in the compilation. Primary Headaches are associated with psychiatric and sleep disorders, intimate partner violence and assisted reproductive techniques during perinatal period. Depression, anxiety and stress are more prevalent among pregnant individuals suffering from migraines compared to those without the condition. Discussion: Accurate diagnosis is crucial for the effective management of headaches experienced by pregnant and postpartum women. This review underscores the necessity for research studies evaluating headaches and their correlated conditions at various points around the perinatal period. The implementation of early screening protocols and crafting customized treatment strategies can greatly improve the quality of care offered to women during the perinatal period.
References
World Health Organization. Atlas of headache disorders and resources in the world (2011).
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia: an international journal of headache. 2018 Jan;38(1):1–211. doi:10.1177/0333102417738202
Saldanha IJ, Roth JL, Chen KK, Zullo AR, Adam GP, Konnyu KJ, Cao W, Bhuma MR, Kimmel HJ, Mehta S, Riester MR, Sorial MN, Balk EM. Management of Primary Headaches in Pregnancy. Comparative Effectiveness Review No. 234. (Prepared by the Brown Evidence-based Practice Center under Contract No. 290-2015-00002-I.) AHRQ Publication No. 20(21)-EHC026. Rockville, MD: Agency for Healthcare Research and Quality; November 2020.
Negro A, Delaruelle Z, Ivanova TA, et al. Headache and pregnancy: a systematic review. The journal of headache and pain. 2017 Oct 19;18(1):106. doi:10.1186/s10194-017-0816-0
Robbins MS, Farmakidis C, Dayal AK, Lipton RB. Acute headache diagnosis in pregnant women: a hospitalbased study. Neurology. 2015 Sep 22;85(12):1024–30. doi: 10.1212/WNL.0000000000001954
Sances G, Granella F, Nappi RE, et al. Course of migraine during pregnancy and postpartum: a prospective study. Cephalalgia. Apr; 2003 23(3):197–205. doi: 10.1046/j.1468-2982.2003. 00480.x
Goldszmidt E, Kern R, Chaput A, Macarthur A. The incidence and etiology of postpartum headaches: a prospective cohort study. Can J Anaesth-J Can Anesth. Nov; 2005 52(9):971–977. doi: 10.1007/BF03022061
Gennaro S, Bloch JR. Postpartum health in mothers of term and preterm infants. Women Health. 2005; 41(3):99–112. doi: 10.1300/J013v41n03_06
Caponnetto V, Deodato M, Robotti M, et al. Comorbidities of primary headache disorders: a literature review with meta-analysis. European Headache Federation School of Advanced Studies (EHF-SAS). J Headache Pain. 2021 Jul 14;22(1):71. doi: 10.1186/s10194-021-01281-z 191
Wood M, Burch RC, Hernandez-Diaz S. Polypharmacy and comorbidities during pregnancy in a cohort of women with migraine. Cephalalgia. 2021 Mar;41(3):392-403. doi: 10.1177/0333102420975394
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71 https://doi.org/10.1136/bmj.n71
Cripe SM, Sanchez S, Lam N, et al. Depressive symptoms and migraine comorbidity among pregnant Peruvian women. J. Affect. Disord. 2010 Apr;122(1-2):149-53. doi: 10.1016/j.jad.2009.07.014
Orta OR, Gelaye B, Qiu C, Stoner L, Williams AM. Depression, anxiety and stress among pregnant migraineurs in a pacific-northwest cohort. J Affect Disord. 2015 Feb 1; 172:390-6. doi: 10.1016/j.jad.2014.10.032
Welander NZ, Mwinyi J, Asif S, Schiöth HB, Skalkidou A, Fransson E. Migraine as a risk factor for mixed symptoms of peripartum depression and anxiety in late pregnancy: A prospective cohort study. J Affect Disord. 2021 Dec 1; 295:733-739. doi: 10.1016/j.jad.2021.08.119
Wikman A, Axfors C, Iliadis SI, Cox J, Fransson E, Skalkidou A.J. Characteristics of women with different perinatal depression trajectories. Neurosci Res. 2020 Jul;98(7):1268-1282. doi: 10.1002/jnr.24390
Katon W, Russo J, Gavin A. Predictors of postpartum depression. J Womens Health (Larchmt) 2014 Sep; 23(9):753-9. doi: 10.1089/jwh.2014.4824.
Erdoǧan, F. F., Öztürk, A., Ünalan, D., Mazicioǧlu, M., Serin, I. S., & Tucer, B. (2012). Prevalence of and influencing factors for chronic headaches among pregnant women. International Journal of Gynecology & Obstetrics, 117(2), 144–147. https://doi.org/10.1016/J.IJGO.2011.11.027
Lopes, B. C. S., Lima, C. de A., Ferreira, T. S. B., de Freitas, W. M. L., Ferreira, T. B., de Pinho, L., Brito, M. F. S. F., & Silveira, M. F. (2023). Perceived stress and associated factors in pregnant women: a cross-sectional study nested within a population-based cohort. Revista Brasileira de Saude Materno Infantil, 23. https://doi.org/10.1590/1806-9304202300000169-en
Passchier J, Kaminsky MM, Paarlberg KM, Van Geijn HP. Stress during pregnancy is unrelated to headache change in migraineurs. Headache. 1996 Mar;36(3):189. doi: 10.1046/j.1526-4610.1996.3603189. x.
Ozdemir, K., Sahin, S., Sevimli Guler, D., & Unsal, A. (2022). Headache and distress during pregnancy. International Journal of Gynecology and Obstetrics, 157(3), 686–693. https://doi.org/10.1002/ijgo.13904
Çapık, A., Apay, E.., & Sakar, T. (2015). Determination of Distress Level in Pregnant Women. Anatolian Journal of Nursing and Health Sciences, 18(3), 196–203.
Friedman LE, Aponte C, Hernandez RP, et al. Migraine and the risk of post-traumatic stress disorder among a cohort of pregnant women. J Headache Pain. 2017 Dec;18(1):67. doi: 10.1186/s10194-017-0775-5
Williams MA, Aurora SK, Frederick IO, Qiu C, Gelaye B, Cripe SM. Sleep duration, vital exhaustion and perceived stress among pregnant migraineurs and non-migraineurs. BMC Pregnancy Childbirth. 2010 Nov 3; 10:72. doi: 10.1186/1471-2393-10-72.
Qiu C, Frederick IO, Sorensen T, et al. Sleep Disturbances among Pregnant Women with History of Migraines: A Cross-sectional Study. Cephalalgia. 2015 October; 35(12): 1092–1102. doi:10.1177/0333102415570493
Gelaye B, Do N, Avila S, et al. Childhood Abuse, Intimate Partner Violence and Risk of Migraine Among Pregnant Women: An Epidemiologic Study. Headache. 2016 Jun;56(6):976-86. doi: 10.1111/head.12855
Ferrari Audi CA, Segall-Corrêa AM, Santiago SM, Pérez-Escamilla R. Adverse health events associated with domestic violence during pregnancy among Brazilian women. Midwifery. 2012 Aug;28(4):356-61. 192
Gaul C, Stiller R, Erni S, Ettlin DA, Sándor PS. Cluster headache triggered by high-dose gestagens in the context of in vitro fertilization: a case report. Cephalalgia. 2007 Dec;27(12):1418-20. doi: 10.1111/j.1468-2982.2007.01429. x.
Giaxi, P., Bala, C., Maniatelli, E., Charos, D. and Vivilaki, V. Risk Factors Associated with Cephalalgia during Pregnancy and Postpartum in a Sample of Greek Women. Open Journal of Medical Psychology, 12, 82-93. doi: 10.4236/ojmp.2023.122005.
Turner DP, Smitherman TA, Eisenach JC, Penzien DB, Houle TT. Predictors of headache before, during, and after pregnancy: a cohort study. Headache. 2012 Mar;52(3):348-62. doi: 10.1111/j.1526-4610.2011. 02066.x
Christian P, West Jr KP, Katz J, et al. Cigarette smoking during pregnancy in rural Nepal. Risk factors and effects of beta-carotene and vitamin A supplementation. Eur J Clin Nutr 2004 Feb;58(2) :204-11. doi : 10.1038/sj.ejcn.1601767
Emamian F, Khazaie H, Okun ML, Tahmasian M, Sepehry AA. Link between insomnia and perinatal depressive symptoms: A meta-analysis. J Sleep Res. 2019 Dec;28(6): e12858. doi: 10.1111/jsr.12858.
González-Mesa E, Kabukcuoglu K, Blasco M, et al. Comorbid anxiety and depression (CAD) at early stages of the pregnancy. A multicultural cross-sectional study. J Affect Disord. 2020 Jun 1; 270:85-89. doi:
Maghami M, Shariatpanahi SP, Habibi D, et al. Sleep disorders during pregnancy and postpartum depression: A systematic review and meta-analysis. Int J Dev Neurosci. 2021 Oct;81(6):469-478. doi: 10.1002/jdn.10118.
Paulson JL. Intimate Partner Violence and Perinatal Post-Traumatic Stress and Depression Symptoms: A Systematic Review of Findings in Longitudinal Studies. Trauma Violence Abuse. 2022 Jul;23(3):733-747. doi: 10.1177/1524838020976098
Galli F, Gambini O. Psychopharmacology of headache and its psychiatric comorbidities. Handb Clin Neurol. 2019; 165:339-344. doi: 10.1016/B978-0-444-64012-3.00020-4
Torelli P, Lambru G, Manzoni GC. Psychiatric comorbidity and headache: clinical and therapeutical aspects. Neurol Sci. 2006 May;27 Suppl 2: S73-6. doi: 10.1007/s10072-006-0574-2
World Health Organization, Depression and Other Common Mental Disorders: Global Health Estimates. Geneva (2017). Licence: CC BY-NC-SA 3.0 IGO
Woody CA, Ferrari AJ, Siskind DJ, Whiteford HA, Harris MG. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. J. Affect. Disord. 2017 Sep; 219:86-92. doi:
Minen MT, De Dhaem OB, Van Diest AK, et al. Migraine and its psychiatric comorbidities. J Neurol Neurosurg Psychiatry. 2016 Jul;87(7):741-9. doi: 10.1136/jnnp-2015-312233
Karimi L, Wijeratne T, Crewther SG, Evans AE, Ebaid D and Khalil H. The Migraine-Anxiety Comorbidity Among Migraineurs: A Systematic Review. Front. Neurol. 2021 Jan 18; 11:613372. doi: 10.3389/fneur.2020.613372
Ross LE, McLean LM. Anxiety disorders during pregnancy and the postpartum period: a systematic review. Journal of Clinical Psychiatry.2006 67(8), 1285-1298. doi: 10.4088/jcp. v67n0818
Woods SM, Melville JL, Guo Y, Fan MY, Gavin A. Psychosocial stress during pregnancy. Am J Obstet Gynecol. 2010 Jan;202(1):61. e1-7. doi: 10.1016/j.ajog.2009.07.041
Viero FT, Rodrigues P, Trevisan G. Cognitive or daily stress association with headache and pain induction in migraine and tension-type headache patients: a systematic review. Expert Rev Neurother. 2022 Mar;22(3):257-268. doi: 10.1080/14737175.2022.2041414 doi: 10.1016/j.midw.2011.05.010
Lutgendorf MA. Intimate Partner Violence and Women’s Health. Obstet Gynecol. 2019 Sep;134(3):470-480. doi: 10.1097/AOG.0000000000003326
Stevens NR, Miller ML, Puetz AK, Padin AC, Adams N, Meyer DJ. Psychological Intervention and Treatment for Posttraumatic Stress Disorder During Pregnancy: A Systematic Review and Call to Action. J Trauma Stress. 2021 Jun;34(3):575-585. doi: 10.1002/jts.22641
Yildiz PD, Ayers S, Phillips L. The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis. J Affect Disord. 2017 Jan 15; 208:634-645. doi: 10.1016/j.jad.2016.10.009
Mullington JN, Haack M, Toth M, et al. Cardiovascular, inflammatory and metabolic consequences of sleep deprivation. Prog Cardiovasc Dis 2009 Jan-Feb; 51(4):294-302. doi: 10.1016/j.pcad.2008.10.003
World Health Organization. Regional Office for Europe. WHO technical meeting on sleep and health: Bonn Germany, 22–24 January 2004.
Zhang B, Wing YK. Sex differences in insomnia: a meta-analysis. Sleep 2006 Jan; 29(1):85–93. doi: 10.1093/sleep/29.1.85
Tamanna S, Geraci SA. Major sleep disorders among women: (women’s health series). South Med J. 2013 Aug;106(8):470-8. doi: 10.1097/SMJ.0b013e3182a15af5
[ Martin PR, MacLeod C. Behavioral management of headache triggers: avoidance of triggers is an inadequate strategy. Clin Psychol Rev 2009 Aug;29(6):483-95. doi: 10.1016/j.cpr.2009.05.002
Song TJ, Yun CH, Cho SJ, Kim WJ, Yang KI, Chu MK. Short sleep duration and poor sleep quality among migraineurs: a population-based study. Cephalalgia. 2018; 38:855–864. doi: 10.1177/0333102417716936
Sadeghniiat K, Rajabzadeh A, Ghajarzadeh M, Ghafarpour M. Sleep quality and depression among patients with migraine. Acta Med Iran. 2013; 51:784–788.
Walters AB, Hamer JD, Smitherman TA. Sleep disturbance and affective comorbidity among episodic migraineurs. Headache. 2014; 54 :116–124. Doi : 10.1111/head.12168
Lateef T, Swanson S, Cui L, Nelson K, Nakamura E, Merikanga K. Headaches and sleep problems among adults in the United States: findings from the National Comorbidity Survey-Replication study. Cephalalgia. 2011; 31:648–653. doi: 10.1177/0333102410390395
World Health Organization, Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and nonpartner sexual violence. 2013 ISBN 978 92 4 156462 5
Bo M, Canavese A, Magnano L, Rondana A, Castagna P, Gino S. Violence against pregnant women in the experience of the rape centre of Turin: Clinical and forensic evaluation. J Forensic Leg Med. 2020 Nov; 76:102071. doi: 10.1016/j.jflm.2020.102071
Schulman EA, Hohler AD. The American Academy of Neurology position statement on abuse and violence. Neurology. 2012;78: 433–435. doi: 10.1212/WNL.0b013e318245d21c
Roque AM, Weinberg J, Hohler AD. Evaluating exposure to abuse and violence in neurological patients. Neurologist. 2013 Jan;19(1):7-10. doi: 10.1097/NRL.0b013e31827c6c26 194
Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatmentseeking: potential need and demand for infertility medical care. Human Reproduction, Volume 22, Issue 6, June 2007, Pages 1506-1512. doi: 10.1093/humrep/dem046
Lankreijer K, D'Hooghe TM, Apers S, Sermeus W, Repping S, Dancet EA. Hormonal medication in medically assisted reproduction: a systematic review of assessments from patients. Reprod Biomed Online. 2019 Mar;38(3):341-363. doi: 10.1016/j.rbmo.2018.12.047
Amir BY, Yaacov B, Guy B, Gad P, Itzhak W, Gal I. Headaches in women undergoing in vitro fertilization and embryo-transfer treatment. Headache. 2005 Mar;45(3):215-9. doi: 10.1111/j.1526-4610.2005. 05047.x
Lopes Fujita AT, Rodrigues-Junior AL, Cândida Gomes N, Spinosa de Martinis B, Baddini-Martinez JA. Sociodemographic and psychological features associated with smoking in pregnancy. J Bras Pneumol. 2021 Sep 1;47(5): e20210050. doi: 10.36416/1806-3756/e20210050
Riaz M, Lewis S, Naughton F, Ussher M. Predictors of smoking cessation during pregnancy: a systematic review and meta-analysis. Addiction. 2018 Apr;113(4):610-622. doi: 10.1111/add.14135
Albers L, Ziebarth S, Von Kries R. Modifiable risk factors for primary headache. A systematic review. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2014 Aug;57(8):952-60. doi: 10.1007/s00103-014-1997-1
[ Rasmussen BK. Migraine and tension-type headache in a general population: precipitating factors, female hormones, sleep pattern and relation to lifestyle. Pain. 1993 Apr;53(1):65-72. doi: 10.1016/0304-3959(93)90057-V
Chen TC, Leviton A, Edelstein S, Ellenberg JH. Migraine and other diseases in women of reproductive age. The influence of smoking on observed associations. Arch Neurol. 1987 Oct;44(10):1024-8. doi: 10.1001/archneur.1987.00520220030011 Abbreviations tension-type headache (TTH) Assisted reproductive technology (ART) Primary Headache Disorders (PHDs) Post Partum Depression (PPD) trigeminal autonomic cephalgia’s (TACs) In Vitro Fertilization (IVF) chronic migraine (CM) Intimate partner violence (IPV) episodic migraine (EM) Post-traumatic stress disorder (PTSD) Generalized anxiety disorder (GAD)
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