(176) Medication Effectiveness for New-onset Headaches in 2nd & 3rd Trimester Pregnancies Refractory to Acetaminophen

Pregnant women experiencing new-onset headaches (NOH) is a common occurrence, yet management approaches are highly varied among providers and specialties, with uncertainty arising when a patient fails initial acetaminophen (APAP) treatment. This study sought to determine which alternative medication proved most effective for patients with NOH refractory to APAP.

Study Design:

We conducted a multi-center, prospective observational study from 7/2021 to 7/2022 and included all pregnant women diagnosed with NOH refractory to APAP (NOH-R) in the prenatal period with gestational ages ranging from 24 0/7 through 36 6/7 weeks-gestation. The primary outcomes included need to switch medication and patient-reported resolution confirmed by provider assessment, as discrete events. Patients with preexisting neurological disorders, severe/uncontrolled hypertension, or allergies to any included medications were excluded. Monotherapy oral medications including butalbital/acetaminophen/caffeine (B/A/C), magnesium oxide, and metoclopramide were included as covariates. Medication choice was determined by physician clinical assessment.

Results:

The study included 503 patients diagnosed with NOH-R. Baseline demographic factors were not significantly different. Patients who received magnesium oxide were less likely to need to switch to an alternative medication (42.3% v. 22.8%, p = 0.03). In stratified analysis, patients with BMI < 30 kg/m2 who received metoclopramide were more likely to report improvement (67.8% v. 31.9%, p = < 0.001). Primiparous patients who received B/A/C also had higher rates of improvement (42.8% v. 29.0%, p=0.04). When adjusting for confounding factors including maternal age, gestational age, race, and composite medical history, these differences remained significant.

Conclusion:

Magnesium oxide may be a more reliable alternative medication option in pregnant patients with NOH-R, with an extended potential for use of B/A/C with primiparous patients and metoclopramide for non-obese patients, respectively, should an additional medication become required.