ABSTRACT
Most epidemiological studies demonstrate that women suffering from migraine note significant improvement of their headaches during pregnancy. It is generally supposed, by both headache specialists and gynaecologists, that migraine does not involve any risk to the mother or the foetus. Specific investigations of the medical complications of pregnancy in migrainous women, however, have recently cast doubt on this assumption. Most studies, indeed, have revealed a significant association between migraine and hypertension in pregnancy (i. e., preeclampsia and gestational hypertension). Migraine has also been recently postulated as one of the major risk factors for stroke during pregnancy and the puerperium. There is thus an urgent need for prospective studies of large numbers of pregnant women to determine the real existence and extent of the risks posed by migraine during pregnancy.
Subject(s)
Hypertension, Pregnancy-Induced/epidemiology , Migraine Disorders/epidemiology , Pre-Eclampsia/epidemiology , Stroke/epidemiology , Blood Coagulation/physiology , Comorbidity , Female , Humans , Hypertension, Pregnancy-Induced/physiopathology , Migraine Disorders/physiopathology , Pre-Eclampsia/physiopathology , Pregnancy , Risk Factors , Stroke/physiopathology , Thromboembolism/epidemiology , Thromboembolism/physiopathology , Venous Thrombosis/epidemiology , Venous Thrombosis/physiopathologyABSTRACT
Migraine is a typical "women's disease": the fluctuations of sex hormones, in particular estrogens, during woman's reproductive life show a direct and major influence on migraine course. Even if during pregnancy a high percentage of migraineurs report an improvement of symptomatology, it is still controversial how to manage migraine crises occurring during pregnancy, considering that almost all drugs are partially or totally contraindicated during gestation. The most important drugs employed in acute attack management (triptans, non steroidal anti-inflammatory drugs, analgesics, antiemetics, ergot derivatives and combination products) are reviewed and the indications and contraindications of their use during the 3 trimesters of pregnancy and during lactation, taking into consideration the indications of the Food and Drug Administration and of the American Academy of Pediatrics, are analysed. Furthermore, the therapeutic effects of the 2 most important non pharmacological therapies used for migraine prophylaxis, biofeedback and acupuncture, are discussed. For this latter therapy, the personal preliminary positive experience using a predetermined formula of acupoints for the combined treatment of migraine and hyperemesis gravidarum is reported.
Subject(s)
Acupuncture Therapy , Biofeedback, Psychology , Lactation , Migraine Disorders/therapy , Pregnancy Complications/therapy , Relaxation Therapy , Abnormalities, Drug-Induced/etiology , Acetaminophen/adverse effects , Acetaminophen/therapeutic use , Acupuncture Points , Adult , Analgesics/adverse effects , Analgesics/therapeutic use , Analgesics, Non-Narcotic/adverse effects , Analgesics, Non-Narcotic/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Antiemetics/adverse effects , Antiemetics/therapeutic use , Aspirin/adverse effects , Aspirin/therapeutic use , Controlled Clinical Trials as Topic , Domperidone/adverse effects , Domperidone/therapeutic use , Ergotamine/adverse effects , Ergotamine/therapeutic use , Female , Fetus/drug effects , Humans , Hyperemesis Gravidarum/therapy , Infant, Newborn , Migraine Disorders/diagnosis , Migraine Disorders/drug therapy , Pregnancy , Pregnancy Complications/drug therapy , Pregnancy Trimester, Third , Prognosis , Risk Factors , United States , United States Food and Drug Administration , Vasoconstrictor Agents/adverse effects , Vasoconstrictor Agents/therapeutic useABSTRACT
OBJECTIVE: To estimate the HIV-1 seroprevalence, behavioural risks and attitude to HIV-1 infection among lesbians. SETTING: Institute of Infectious Diseases, University of Turin, Italy. SUBJECTS: From March 1992 to May 1993, 181 lesbians were tested for HIV-1 and included in the study. METHODS: Sociodemographic details, nonsexual risks for HIV-1, sexual behaviour, STD history and attitude to HIV-1 were obtained from an anonymous, standardised, self-administered, 30-item questionnaire. Snow-ball techniques were used to recruit the largest possible number of participants. RESULTS: 11 lesbians (6.1%) were found to be HIV-1 antibody positive. Of them, 10 were intravenous (i.v.) drug users. STD episodes were higher among lesbians with HIV-1 than without (p = 0.04), increasing in both groups over time. Syphilis, genital herpes and viral hepatitis were highly associated with HIV-1 (p = 0.000). In univariate analysis, i.v. drug use, bisexual behaviour, history of STDs, sex during menses and vaginal/anal manipulation were significantly linked to HIV-1 (p = 0.000). In multivariate analysis only history of i.v. drug use (p = 0.04) and bisexual behaviour (p = 0.06) remained independently associated with HIV-1. Seventy-one participants (39.3%) had already undergone AIDS testing. Only 3.5% admitted to be at risk for HIV-1 and 11% changed their sex habits after first hearing of AIDS. No lesbian had ever practised safe-sex. Television was the most important source of information on HIV-1 (84%). CONCLUSION: I.v. drug use was the most likely means of HIV-1 infecting the lesbians of Turin. The high rate of STDs and the low perceived risk to HIV-1 require programmes of STD prevention and AIDS information to be targeted at the lesbian community.
