Peripheral nerve blocks in the treatment of migraine in pregnancy

Shravya Govindappagari, Tracy B. Grossman, Ashlesha K. Dayal, Brian M. Grosberg, Sarah E. Vollbracht, Matthew S. Robbins

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1169-1174
Number of pages6
JournalObstetrics and Gynecology
Volume124
Issue number6
DOIs
StatePublished - Dec 11 2014

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Nerve Block
Migraine Disorders
Peripheral Nerves
Pregnancy
Pain
Therapeutics
Headache
Pregnant Women
Injections
Acute Pain
Local Anesthetics
Pre-Eclampsia
Postpartum Period
Gestational Age

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Medicine(all)

Cite this

Peripheral nerve blocks in the treatment of migraine in pregnancy. / Govindappagari, Shravya; Grossman, Tracy B.; Dayal, Ashlesha K.; Grosberg, Brian M.; Vollbracht, Sarah E.; Robbins, Matthew S.

In: Obstetrics and Gynecology, Vol. 124, No. 6, 11.12.2014, p. 1169-1174.

Research output: Contribution to journalArticle

Govindappagari, Shravya ; Grossman, Tracy B. ; Dayal, Ashlesha K. ; Grosberg, Brian M. ; Vollbracht, Sarah E. ; Robbins, Matthew S. / Peripheral nerve blocks in the treatment of migraine in pregnancy. In: Obstetrics and Gynecology. 2014 ; Vol. 124, No. 6. pp. 1169-1174.
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