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Abstract Details

Decreasing Burden of Chronic Migraine in Pregnancy by Addressing Medication Overuse Headache
Headache Posters (7:00 AM-5:00 PM)
Typically, women with migraine improve during pregnancy. However, this trend is less certain for patients with chronic migraine. We wanted to identify if women whose headaches worsened during pregnancy were more likely to have chronic migraine and medication overuse headache. We evaluated how patients’ migraines had been managed prior to being seen in the headache clinic, and other patient characteristics.
Identify the diagnosis and treatment of pregnant patients with headache referred to the tertiary headache clinic at the University of Washington.
All new patients referred to our headache clinic complete a detailed patient intake questionnaire prior to their first visit.  Our database has questions regarding current pregnancy, headache characteristics, and headache management. All patient data are analyzed by headache providers, who collected information about previous diagnoses and treatments, and diagnose headache disorders using the ICHD-3 criteria. 
In our study 37  pregnant patients were diagnosed with migraine, 78% had chronic migraine, and 59% had medication overuse headache (MOH).  63% of these patients were overusing acetaminophen. Other medications in MOH included ibuprofen, opioids, and triptans, and some patients overused multiple medications. 86% of patients were newly diagnosed with chronic migraine and MOH.

We conclude that chronic migraine and medication overuse represent a high burden in pregnancy and should be addressed. Emphasis on correct diagnosis by determining total headache days per month while obtaining headache history can improve the correct diagnosis of chronic migraine. Obtaining the number of days of acute medications use per month can improve MOH diagnosis. Current recommendations emphasize treatment of migraine with acetaminophen in pregnancy, but in chronic migraine this can often lead to medication overuse headache. Safer treatment options for chronic migraine such as neuromodulation, occipital nerve blocks, supplements and lifestyle changes should be emphasized, especially in pregnant patients.

Ami Zarrillo Cuneo, MD (University of Washington)
Dr. Cuneo has nothing to disclose.
Daniel Krashin, MD (Seattle VA) Dr. Krashin has nothing to disclose.
Natalia Murinova, MD, FAAN (University Of Washington) Dr. Murinova has nothing to disclose.