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Headaches Through a Woman's Life

Bushman, Elisa T. MD*; Varner, Michael W. MD; Digre, Kathleen B. MD

Obstetrical & Gynecological Survey: March 2018 - Volume 73 - Issue 3 - p 161–173
doi: 10.1097/OGX.0000000000000540

Importance Headaches affect women across their life span, with menses, pregnancy, and menopause being times that pose unique challenges in diagnosis and treatment. The correct diagnosis and treatment of headache can prevent unnecessary interventions, the worsening of chronic headache disorders, and complications of secondary headaches.

Objective The objective of this article is to educate women's health care providers about the diagnosis, differential diagnosis, and treatment of headache during menses, pregnancy, the puerperium, and menopause to improve the quality of care for women with chronic and acute headache.

Evidence Acquisition Current articles were reviewed addressing headache during menses, pregnancy, the postpartum period, and menopause. Articles with the highest level of evidence were compiled in this article to provide a summary of recommendations.

Results Multiple diagnostic and therapeutic options for chronic and acute headache are available for women regardless of their stage in life or comorbidities.

Conclusions and Relevance The effects of headaches span a woman's life span, with puberty and menopause being times of increased frequency. Pregnancy is an at-risk time for women to develop secondary headache disorders. All women's health care providers should know how to screen for, diagnose, and treat headache at all stages of a woman's life. Effective treatment options are available for acute and chronic headache both during and outside pregnancy.

Target Audience Obstetricians and gynecologists, family physicians.

Learning Objectives After completing this activity, the learner should be better able to define the differences between primary and secondary headache disorders, interpret the differential diagnosis and treatment of menstrual-related migraines, analyze the diagnosis and treatment of headache in pregnancy, educate patients about secondary headaches in the postpartum period, discuss headache prevalence and treatment of headache during menopause, and propose treatment recommendations to women regardless of their comorbidities or stage in life.

*Resident Physician and †Professor, Department of Obstetrics and Gynecology, and ‡Professor, Departments of Neurology and Ophthalmology, University of Utah Health Sciences Center, Salt Lake City, UT

All authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

The authors have disclosed that the U.S. Food and Drug Administration has not approved the use of verapamil for the treatment of migraine as discussed in this article. Please consult the products’ labeling for approved information.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Research to Prevent Blindness, Inc.

Correspondence requests to: Elisa T. Bushman, MD, Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, 30 South 1900 East, Salt Lake City, UT 84132. E-mail:

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