Management of cluster headache and other trigeminal autonomic cephalalgias in pregnancy and breastfeeding

Eur J Neurol. 2021 Jul;28(7):2443-2455. doi: 10.1111/ene.14864. Epub 2021 May 18.

Abstract

Many clinicians lack experience in managing trigeminal autonomic cephalalgias (TACs) in pregnancy and lactation. In addition to cluster headache, TACs include hemicrania continua, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing/autonomic symptoms (SUNCT/SUNA). Treating these rare, severe headache conditions often requires off-label drugs that have uncertain teratogenic potential. In the last few years, several new treatment options and safety documentation have emerged, but clinical guidelines are lacking. This narrative review aimed to provide an updated clinical guide and good clinical practice recommendations for the management of these debilitating headache disorders in pregnancy and lactation.

Keywords: Horton's headache; SUNCT; breastfeeding; headache; hemicrania continua; paroxysmal hemicrania; pregnancy; trigeminal autonomic cephalalgias.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Breast Feeding
  • Cluster Headache* / diagnosis
  • Cluster Headache* / drug therapy
  • Diagnosis, Differential
  • Female
  • Humans
  • Pregnancy
  • SUNCT Syndrome*
  • Trigeminal Autonomic Cephalalgias* / diagnosis
  • Trigeminal Autonomic Cephalalgias* / drug therapy