Abstract
Objectives/Background: Nearly 12% of Americans experience migraine, with 75% of that group represented by women aged 15-55 years, notably including peak childbearing years. This presents a therapeutic dilemma for pregnant patients, given that most medications for migraine range from unknown teratogenicity in human pregnancies, at best, to known teratogenicity, severely limiting their utility. However, migraine causes significant disability and impairment in the lives of pregnant patients, necessitating treatment. We conducted a retrospective chart review and phone survey to evaluate the safety profile and effectiveness of bilateral occipital nerve blocks to treat migraine during pregnancy. Methods: We conducted a retrospective review of charts of women aged 18-50 years who received bilateral occipital nerve blocks at the Stanford Headache Clinic between January 1, 2014 and December 31, 2020 during their pregnancies for the treatment of migraine and followed up with phone call surveys to address fetal outcomes as well as effectiveness of the nerve blocks. Results: Thirty patients met inclusion criteria, and 21 responded to our survey. Of the 21 surveyed, none experienced significant pregnancy complications, negative fetal outcomes, or an increased rate of miscarriage. Participants receiving nerve blocks noted a reduction in pain on a visual analog scale from an average of 7 to 2 (p < 0.001) as well as from 9 days to 4 days of acute medication use per month (p = 0.002). Conclusion: Based on this limited retrospective cohort study, serial occipital nerve blocks may offer a safe and potentially effective option for treatment of migraine during pregnancy. Occipital nerve blocks may improve the overall quality of life, decrease disability rates, and decrease the use of potentially teratogenic therapies in pregnant women. Future larger and prospective studies are needed to better assess the safety profile and effectiveness of occipital nerve blocks for pregnant patients with migraine.