AAPM Comments on AHRQ Key Questions for Systematic Review on Management of Primary Headaches in Pregnancy

We strongly believe that the management of migraines needs to be multidisciplinary. In looking at the interventions you have delineated, we would suggest a more inclusive expansion of the interventions for migraine reflecting the multidisciplinary nature of migraine treatment. Starting with lifestyle, we suggest including diet, hydration, sleep, and exercise. We would also encourage including behavioral strategies including therapy and support groups as well as complementary medicine such as vitamins, herbs, and acupuncture. We also suggest consideration be given to inclusion of procedural strategies such as greater occipital nerve blocks, trigger point injections, sphenopalantine ganglion blocks, and non-invasive neuromodulation devices (Cefaly, TMS, Gammacore). Regarding medical interventions, physicians differentiate medications for migraine into two distinct groups: preventives and rescue or abortive medications. Breaking the medications into distinct groups will help in the analysis. It would also be helpful to provide some clear guidance on what pharmacologic interventions are the safest and which are strongly contraindicated. Again, these indications will vary in pregnancy, in post-partum and in breastfeeding.

Thank you for this opportunity and please feel free to contact us if we can be of any further assistance.​