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Drug Combination for Headache During Pregnancy Shows Promise

May 7, 2013

New Orleans, LA -- The drug combination of metoclopramide and diphenhydramine (MAD) is a safe, effective headache treatment for pregnant women, especially when acetaminophen fails to provide relief, according to new research presented today at the Annual Clinical Meeting of The American College of Obstetricians and Gynecologists.

“Headaches are a common complaint during pregnancy, but several treatments are contraindicated in pregnancy,” said lead researcher Dorothea J. Mostello, MD, of the department of obstetrics, gynecology, and women’s health at Saint Louis University in Missouri. “Several studies have shown metoclopramide administered with diphenhydramine is effective in decreasing duration of headaches in non-pregnant patients, but there are no data in pregnant women.

“We wanted to see if the combination of metoclopramide and diphenhydramine was similarly effective in treating headache in pregnant women,” Dr. Mostello said. “Both medications are considered safe in pregnancy, reasonably priced, and generally available.” Metoclopramide is a prescription drug commonly used to treat heartburn due to gastroesophageal reflux. Diphenhydramine is an antihistamine found in several over-the-counter allergy medications and sleep aids.

Dr. Mostello studied the charts of 157 pregnant patients who received metoclopramide and diphenhydramine (MAD) intravenously to treat headache from November 2009 through December 2010. She analyzed the data to determine the percentage of headaches that improved with MAD versus the percentage of women who received additional pain medication, as well as the time it took until patients reported experiencing relief.

Of the patients that received MAD for headache symptoms, 117 of them (75%) received no additional headache medication within the next eight hours. Fifty-four of these women reported feeling better in an average of two and a half hours. Four adverse reactions were recorded: one episode each of itching, shortness of breath, involuntary muscle contraction, and feeling confused.

“Pregnant women will now have another effective treatment for headache when acetaminophen alone does not relieve the pain,” Dr. Mostello said. “Narcotics or barbiturates have long been the alternatives, and now they are not the only ones.”

This research only studied intravenous administration, so the effects of oral administration of MAD are unknown. A randomized trial is underway.

*Tuesday Poster #61: Metoclopramide and Diphenhydramine for the Treatment of Headache in Pregnant Women

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 57,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org

 

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