Headache during pregnancy - Revision history

Danbot: Add MedicationDose entries for acetaminophen, metoclopramide

2026-03-20T21:16:06Z

Add MedicationDose entries for acetaminophen, metoclopramide

← Revisión anterior		Revisión del 21:16 20 mar 2026
Línea 65:		Línea 65:
	==Disposition==		==Disposition==


			==Medication Dosing==
			{{MedicationDose
			\| drug = Acetaminophen
			\| dose = 1000mg PO
			\| route = PO
			\| context = First-line analgesic
			\| indication = Headache during pregnancy
			\| population = Adult
			}}
			{{MedicationDose
			\| drug = Metoclopramide
			\| dose = 10mg IM/IV or PO
			\| route = IM/IV/PO
			\| context = Adjunct antiemetic/headache treatment
			\| indication = Headache during pregnancy
			\| population = Adult
			}}

	==See Also==		==See Also==

Josgood: /* Differential Diagnosis */

2023-03-11T02:40:19Z

Differential Diagnosis

← Revisión anterior		Revisión del 02:40 11 mar 2023
Línea 19:		Línea 19:
	**[[Meningitis]]		**[[Meningitis]]
	**[[Posterior reversible encephalopathy syndrome]]		**[[Posterior reversible encephalopathy syndrome]]
	**[[Pituitary apoplexy]] (Sheehan syndrome)		**[[Sheehan's syndrome\|Pituitary apoplexy]] (Sheehan syndrome)

	==Evaluation==		==Evaluation==

Elcatracho: /* Differential Diagnosis */

2022-01-24T17:27:22Z

Differential Diagnosis

← Revisión anterior		Revisión del 17:27 24 ene 2022
Línea 19:		Línea 19:
	**[[Meningitis]]		**[[Meningitis]]
	**[[Posterior reversible encephalopathy syndrome]]		**[[Posterior reversible encephalopathy syndrome]]
	**Pituitary apoplexy		**[[Pituitary apoplexy]] (Sheehan syndrome)

	==Evaluation==		==Evaluation==

ClaireLewis at 13:19, 22 October 2019

2019-10-22T13:19:06Z

← Revisión anterior		Revisión del 13:19 22 oct 2019
Línea 6:		Línea 6:

	==Clinical Features==		==Clinical Features==
	*Headache while pregnant		*[[Headache]] while pregnant

	==Differential Diagnosis==		==Differential Diagnosis==
	*Consider usual differential for ~~headaches~~		*Consider usual differential for [[headache]]s
	*Also consider ~~pre-eclampsia~~/eclampsia (~~esp~~ if >20 ~~WGA~~)		*Also consider [[preeclampsia]]/[[eclampsia]] (especially if >20 weeks gestation)
	*New onset of severe headache in no history of migraines → maintain high suspicion of<ref>Armon C et al. Neurologic Disease and Pregnancy. Updated Feb 24, 2015. http://emedicine.medscape.com/article/1149405-overview#a4</ref>:		*New onset of severe headache in no history of migraines → maintain high suspicion of<ref>Armon C et al. Neurologic Disease and Pregnancy. Updated Feb 24, 2015. http://emedicine.medscape.com/article/1149405-overview#a4</ref>:
	**[[Intracranial hemorrhage (main)\|ICH]]		**[[Intracranial hemorrhage (main)\|ICH]]
Línea 18:		Línea 18:
	***[[Cavernous sinus thrombosis]]		***[[Cavernous sinus thrombosis]]
	**[[Meningitis]]		**[[Meningitis]]
	**~~Reversible posterior leukoencephalopathy~~		**[[Posterior reversible encephalopathy syndrome]]
	**Pituitary apoplexy		**Pituitary apoplexy

Línea 30:		Línea 30:
	*Initial - [[acetaminophen]] 1000mg PO, and may add:		*Initial - [[acetaminophen]] 1000mg PO, and may add:
	**[[Metoclopramide]] 10mg IM/IV or PO		**[[Metoclopramide]] 10mg IM/IV or PO
	**[[Codeine]] 30mg PO
	*Other options		*Other options
	**[[Sumatriptan]] 100mg PO or 4-6mg SQ		**[[Sumatriptan]] 100mg PO or 4-6mg SQ
Línea 41:		Línea 40:
	**IV hydration		**IV hydration
	**Pre-treatment [[diphenhydramine]] 25mg for EPS		**Pre-treatment [[diphenhydramine]] 25mg for EPS
	**~~Antiemetic~~		**[[Antiemetics]]
			**[[Codeine]] 30mg PO
	**IV [[opioid]]		**IV [[opioid]]
	*Refractory migraine option 2<ref> Wang SJ et al. Droperidol treatment of status migrainosus and refractory migraine. Headache. 1997;37(6):377.</ref>:		*Refractory migraine option 2<ref> Wang SJ et al. Droperidol treatment of status migrainosus and refractory migraine. Headache. 1997;37(6):377.</ref>:
	**Triptan		**[[sumatriptan\|Triptan]]
	**Droperidol 2.5mg IV q30 min up to 3 doses		**[[Droperidol]] 2.5mg IV q30 min up to 3 doses
	*Consider peripheral nerve blocks		*Consider peripheral nerve blocks
	*Consider steroids in intractable migraines		*Consider [[steroids]] in intractable migraines
	**[[Prednisone]] 20mg PO QID x2 days or methylprednisolone 4mg PO, 21 tablets over 6 days		**[[Prednisone]] 20mg PO QID x2 days or methylprednisolone 4mg PO, 21 tablets over 6 days
	**Avoid [[dexamethasone]] and betamethasone		**Avoid [[dexamethasone]] and betamethasone
	**Avoid steroids in 1st trimester		**Avoid steroids in 1st trimester
	*No benefit of IV magnesium in meta-analysis<ref>Choi H, Parmar N. The use of intravenous magnesium sulphate for acute migraine: meta-analysis of randomized controlled trials. Eur J Emerg Med. 2014 Feb;21(1):2-9.</ref>		*No benefit of IV [[magnesium]] in meta-analysis<ref>Choi H, Parmar N. The use of intravenous magnesium sulphate for acute migraine: meta-analysis of randomized controlled trials. Eur J Emerg Med. 2014 Feb;21(1):2-9.</ref>

	===Pregnancy Categories of Common Medications===		===[[drug pregnancy categories\|Pregnancy Categories]] of Common Medications===
	*Class B - acetaminophen, caffeine, metoclopramide, promethazine		*Class B - [[acetaminophen]], [[caffeine]], [[metoclopramide]], [[promethazine]]
	*Class C - prochlorperazine (not enough human data but studies suggest safety), prednisolone, droperidol, ketorolac, 5-HT1 agonists (triptans), gabapentin, topiramate, calcium-channel blockers, TCAs		*Class C - [[prochlorperazine]] (not enough human data but studies suggest safety), [[prednisolone]], [[droperidol]], [[ketorolac]], 5-HT1 agonists (triptans), [[gabapentin]], [[topiramate]], [[calcium-channel blockers]], [[TCAs]]
	*Class D - valproate		*Class D - [[valproate]]
	*Class D in 3rd trimester - aspirin, ibuprofen, naproxen		*Class D in 3rd trimester - [[aspirin]], [[ibuprofen]], [[naproxen]]
	*Class D at term or prolonged use - codeine, morphine, beta-blockers		*Class D at term or prolonged use - [[codeine]], [[morphine]], [[beta-blockers]]
	*Class X - dihydroergotamine, ergotamine		*Class X - dihydroergotamine, ergotamine
	*Breastfeeding compatible - aspirin, caffeine, ibuprofen, naproxen, codeine, morphine, prednisolone, triptans (likely compatible), beta-blockers		*Breastfeeding compatible - aspirin, caffeine, ibuprofen, naproxen, codeine, morphine, prednisolone, triptans (likely compatible), beta-blockers

ClaireLewis: /* References */

2019-10-02T01:14:33Z

References

← Revisión anterior		Revisión del 01:14 2 oct 2019
Línea 75:		Línea 75:
	[[Category:OBGYN]]		[[Category:OBGYN]]
	[[Category:Neurology]]		[[Category:Neurology]]
			[[Category:Symptoms]]

ClaireLewis: /* Evaluation */

2019-10-02T01:14:08Z

Evaluation

← Revisión anterior		Revisión del 01:14 2 oct 2019
Línea 23:		Línea 23:
	==Evaluation==		==Evaluation==
	*Clinical suspicion guides labs and imaging		*Clinical suspicion guides labs and imaging
	*CT ± [[Lumbar puncture]] if increased ICP or infection suspected		*[[head CT\|CT]] ± [[Lumbar puncture]] if increased ICP or infection suspected
	*MRI preferred to CT (though radiation scatter minimal)		*[[brain MRI\|MRI]] preferred to CT (though radiation scatter minimal)
	**Avoid gadolinium		**Avoid gadolinium

Rossdonaldson1: Text replacement - "BBs" to "beta-blockers"

2016-08-03T23:41:59Z

Text replacement - "BBs" to "beta-blockers"

← Revisión anterior		Revisión del 23:41 3 ago 2016
Línea 58:		Línea 58:
	*Class D - valproate		*Class D - valproate
	*Class D in 3rd trimester - aspirin, ibuprofen, naproxen		*Class D in 3rd trimester - aspirin, ibuprofen, naproxen
	*Class D at term or prolonged use - codeine, morphine, ~~BBs~~		*Class D at term or prolonged use - codeine, morphine, beta-blockers
	*Class X - dihydroergotamine, ergotamine		*Class X - dihydroergotamine, ergotamine
	*Breastfeeding compatible - aspirin, caffeine, ibuprofen, naproxen, codeine, morphine, prednisolone, triptans (likely compatible), ~~BBs~~		*Breastfeeding compatible - aspirin, caffeine, ibuprofen, naproxen, codeine, morphine, prednisolone, triptans (likely compatible), beta-blockers
	*Breastfeeding contraindicated - dihydroergotamine, ergotamine		*Breastfeeding contraindicated - dihydroergotamine, ergotamine

Rossdonaldson1: Text replacement - "CCBs" to "calcium-channel blockers"

2016-08-03T12:08:46Z

Text replacement - "CCBs" to "calcium-channel blockers"

← Revisión anterior		Revisión del 12:08 3 ago 2016
Línea 55:		Línea 55:
	===Pregnancy Categories of Common Medications===		===Pregnancy Categories of Common Medications===
	*Class B - acetaminophen, caffeine, metoclopramide, promethazine		*Class B - acetaminophen, caffeine, metoclopramide, promethazine
	*Class C - prochlorperazine (not enough human data but studies suggest safety), prednisolone, droperidol, ketorolac, 5-HT1 agonists (triptans), gabapentin, topiramate, ~~CCBs~~, TCAs		*Class C - prochlorperazine (not enough human data but studies suggest safety), prednisolone, droperidol, ketorolac, 5-HT1 agonists (triptans), gabapentin, topiramate, calcium-channel blockers, TCAs
	*Class D - valproate		*Class D - valproate
	*Class D in 3rd trimester - aspirin, ibuprofen, naproxen		*Class D in 3rd trimester - aspirin, ibuprofen, naproxen

Rossdonaldson1: Text replacement - " diphenhydramine" to " diphenhydramine"

2016-08-03T11:49:08Z

Text replacement - " diphenhydramine" to " diphenhydramine"

← Revisión anterior		Revisión del 11:49 3 ago 2016
Línea 40:		Línea 40:
	*Refractory migraine option 1:		*Refractory migraine option 1:
	**IV hydration		**IV hydration
	**Pre-treatment diphenhydramine 25mg for EPS		**Pre-treatment [[diphenhydramine]] 25mg for EPS
	**Antiemetic		**Antiemetic
	**IV [[opioid]]		**IV [[opioid]]

Rossdonaldson1: Text replacement - "Tx" to "treatment"

2016-08-01T17:26:35Z

Text replacement - "Tx" to "treatment"

← Revisión anterior		Revisión del 17:26 1 ago 2016
Línea 40:		Línea 40:
	*Refractory migraine option 1:		*Refractory migraine option 1:
	**IV hydration		**IV hydration
	**Pre-Tx diphenhydramine 25mg for EPS		**Pre-treatment diphenhydramine 25mg for EPS
	**Antiemetic		**Antiemetic
	**IV [[opioid]]		**IV [[opioid]]