- Describe your topic.
- Our topic nomination is Headaches in Pregnancy. The following is a list of clinical questions practitioners consider when managing such cases: a. Which headache symptoms require prompt/urgent evaluation? b. When is imaging indicated for headaches during pregnancy? c. What are the treatment options for migraine during pregnancy (include both acute and preventative treatment)? d. What are the treatment options for tension or cluster headaches during pregnancy? e. How is medication overuse headache diagnosed and treated? f. How should headache associated with preeclampsia be evaluated and treated? g. How should postpartum headache be evaluated and treated? h. When is screening for depression warranted in the workup of headaches? The population of interest includes pregnant patients with headaches (general, tension, cluster) or migraines. The interventions we would like to know more about include prophylactic drug intervention (verapamil, prednisolone) for cluster headaches, physiotherapy or OTC analgesics for tension headaches, MRI or CT imaging for general headaches, and preventive measures (hydration, avoidance of precipitants) or acute treatment options (paracetamol, anti-emetics, NSAIDs) for migraines. The outcomes include recurrence, rate or severity of headaches or migraines.
- Describe why this topic is important.
- This is an important topic for review because although headaches during pregnancy can be benign, they can also be an indication that a woman is suffering from a more dangerous condition such a stroke, hemorrhage, eclampsia, or cerebral venous thrombosis. Clinicians need guidance on how to quickly, accurately identify whether a woman is suffering from one of these more serious issues. Additionally, pregnant women more commonly suffer from migraines and tension headaches which can be unpleasant to manage while pregnant. Guidance on treatment options for these conditions is needed to improve the quality of life for pregnant women.
- Tell us why you are suggesting this topic.
- We are nominating the topic of headaches in pregnancy because evidence based guidance on diagnosis and treatment options for migraines, tension headaches, and cluster headaches are needed to ensure clinicians are appropriately prepared to care for pregnant women with these conditions.
- Target Date.
- Describe what you are doing currently and what you are hoping will change because of a new evidence report.
- ACOG is currently working on new clinical guidance in the form of a Practice Bulletin on Headaches in Pregnancy. We hope that a new evidence report will provide more definitive information on treatment options for the different types of headaches pregnant women may experience, to improve their overall health and wellbeing.
- How will you or your group use the information from a new evidence report?
- A new evidence report on headaches in pregnancy will be used to develop future clinical guidance in the form of Practice Bulletins or Committee Opinions on this topic. Clinicians will then be better qualified to identify, make appropriate treatment decisions, and improve health outcomes for pregnant women with headaches.
- How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
- ACOG will share the information in this report with its 57,000 members through our website, and will update our clinical guidance to be reflective of the findings from this report.
- Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
- International Headache Society, American Headache Society, American College of Physicians, Society for Maternal-Fetal Medicine, Society for Academic Specialists in General Obstetrics and Gynecology
- Information About You: (optional)
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- Provide a description of your role or perspective.
- Professional society
- If you are you making a suggestion on behalf of an organization, please state the name of the organization.
- The American College of Obstetricians and Gynecologists
- Please tell us how you heard about the Effective Health Care Program.
- AHRQ Alert/Correspondence
