Enxaqueca na gravidez: uma revisão integrativa
DOI:
https://doi.org/10.48208/HeadacheMed.2025.35Palavras-chave:
Enxaqueca, Gravidez, Pós-parto, Amamentação, Complicações fetaisResumo
Contexto
A enxaqueca é a cefaleia primária mais prevalente na gravidez, com implicações clínicas únicas que exigem abordagens de manejo especializadas.
Objetivo
Fornecer uma revisão abrangente da fisiopatologia, curso clínico, diagnóstico e manejo da enxaqueca durante a gravidez, o pós-parto e a lactação.
Métodos
Busca seletiva de literatura nas bases de dados PubMed, Scopus e Web of Science, complementada por ferramentas de inteligência artificial (Elicit e Consensus) para garantir a cobertura abrangente de evidências emergentes, de 2003 a 2025.
Principais Resultados
As flutuações hormonais impulsionam a fisiopatologia da enxaqueca, sendo que a estabilidade hormonal da gravidez geralmente melhora os sintomas em 60-70% das mulheres com enxaqueca sem aura durante o segundo e terceiro trimestres. No entanto, a enxaqueca com aura apresenta melhora menos previsível e podem ocorrer novos ataques. A enxaqueca materna, particularmente com aura, está associada a distúrbios hipertensivos, parto prematuro, parto cesáreo, restrição do crescimento fetal e aumento do risco de acidente vascular cerebral isquêmico. Comorbidades psiquiátricas, incluindo depressão e ansiedade, são frequentes e associadas a piores desfechos.
Manejo
Intervenções não farmacológicas constituem a base do tratamento. Quando a terapia farmacológica é necessária, o paracetamol é a primeira opção, os AINEs podem ser usados apenas no segundo trimestre e o sumatriptano é a opção mais segura entre os triptanos. O tratamento preventivo deve ser reservado para casos graves e refratários, com magnésio, propranolol e amitriptilina como opções baseadas em evidências.
Conclusão
A enxaqueca durante a gravidez e o pós-parto requer uma abordagem multidisciplinar que priorize estratégias farmacológicas seguras, monitoramento individualizado e otimização do estilo de vida para garantir os melhores resultados maternos e fetais.
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Copyright (c) 2025 María Karina Vélez-Jiménez, Pablo Schubaroff, Maria Loreto Cid-Jeffs, Ana Mercedes-Robles, Adriana Patricia Martinez-Mayorga, Ildefonso Rodriguez-Leyva, Daniel San-Juan, Javier Andrés Galnares-Olalde, Miguel Angel Morales-Morales, Kevin Espejo-Campos (Author)
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