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Смотреть статью "Головная боль при беременности и после родов"

Диагностика головной боли во время беременности

• Важно учитывать влияние беременности на частоту и тяжесть головной боли, а также безопасность лечения для плода.
• Пациентки с новыми головными болями во время беременности должны пройти обследование, чтобы исключить причины, связанные с беременностью, включая преэклампсию, особенно после 20 недель.
• Головная боль может быть признаком тяжелого течения преэклампсии и может сопровождаться другими симптомами, такими как нечеткость зрения и спутанность сознания.
• Пациентки с подозрением на преэклампсию должны обратиться к акушеру-гинекологу, а в случае отклонений в неврологическом обследовании — к неврологу.
• Беременные пациентки с головной болью и с подозрительными симптомами требуют немедленного обследования

Обследование пациенток с головной болью в послеродовом периоде

• Послеродовой период сопровождается гормональными изменениями, недосыпанием и стрессом, что увеличивает риск головной боли.
• Пациентки с артериальной гипертензией должны проверить наличие преэклампсии, которая может развиться в течение 48 часов после родов.
• Новые очаговые неврологические симптомы требуют консультации невролога.

Причины головной боли при беременности и в послеродовом периоде

• Если у пациентки нормальное давление и была нейроаксиальная анестезия, необходимо оценить наличие постпункционной головной боли.
• Головная боль напряжения и мигрень часто встречаются у пациенток без неврологических нарушений.
• Наиболее распространенными причинами головной боли являются головная боль напряжения и мигрень.
• У пациенток с острой послеродовой головной болью часто выявляются вторичные причины, такие как преэклампсия и постпункционная головная боль.

Общие принципы лечения головной боли при беременности и в послеродовм периоде

• Цель:
  • обеспечить материнский комфорт;
  • головная боль обычно не влияет на исход беременности.
• Лекарства:
  • избегать тератогенных препаратов.
  • Лечение основывается на рекомендациях для небеременных, учитывая безопасность для плода и минимальные дозы.
• Преэклампсия:
  • окончательное лечение — родоразрешение.
  • Начать антигипертензивную терапию и назначить сульфат магния для предотвращения судорог.
  • Головную боль можно облегчить ацетаминофеном.
• Послеродовой период:
  • не кормящие грудью получают стандартное лечение.
  • Кормящим следует избегать вредных препаратов и временно прекращать грудное вскармливание после триптанов.
• Постпункционная головная боль:
  • лечится пломбированием кровью; грудное вскармливание не противопоказано.
• Мигрень
  • Уровень эстрогена влияет на мигрень.
  • 60-70% женщин с мигренью отмечают улучшение во время беременности; 5% — ухудшение.
  • Повышенный риск инсульта связан с мигренью, особенно с аурой, и чаще возникает в послеродовом периоде.
• Головная боль напряжения
  • Течение беременности: частота не меняется.
  • 56-67% пациенток не замечают изменений, 40-28% отмечают улучшение.
  • Исход беременности: повышенный риск преждевременных родов (8,7% против 2,8%).
• Кластерная головная боль
  • Течение во время беременности: не зависит от гормонов.
  • Некоторые исследования показывают улучшение состояния у беременных.
  • Исход беременности: влияние на исход не описано.
• Медикаментозно-индуцированная головная боль
  • Возникает при частом приеме анальгетиков.
  • Лечение — прекращение приема препаратов.

Введение

Диагностическая оценка

Общие принципы лечения

Мигрень

Головная боль напряжения

Кластерная головная боль

Медикаментозно индуцированная головная боль

Резюме

Полезные материалы