TITLE: 
             Treatment of migraine during pregnancy and lactation.
 AUTHOR: 
             Miles CB
 SOURCE: 
             S D J Med 1995 Nov;48(11):373-7
 NLM CIT. ID: 
             96108153
 AUTHOR
 AFFILIATION: 
             Neurology Associates, Sioux Falls, SD, USA.
 ABSTRACT: 
             Migraine onset, frequency and severity are influenced by
             hormonal changes throughout the various female reproductive
             life events, including pregnancy. Migraine may worsen during the
             first trimester, but usually improves thereafter. The treatment of
             migraine during pregnancy and lactation is difficult because of
             the risks to the fetus and newborn. This paper reviews migraine
             throughout the female reproductive life events, as well as the acute
             and prophylactic treatment of the pregnant and lactating
             migraineur.

 TITLE: 
            Sumatriptan (Imitrex) transport by the human placenta.
 AUTHOR: 
            Schenker S; Yang Y; Perez A; Henderson GI; Lee MP
 SOURCE: 
            Proc Soc Exp Biol Med 1995 Dec;210(3):213-20
 NLM CIT. ID: 
            96128032
 AUTHOR
 AFFILIATION: 
            Department of Medicine, University of Texas Health Science Center
            at San Antonio 78284-7878, USA.
 ABSTRACT: 
            Sumatriptan (Imitrex), a selective 5-hydroxytryptamine receptor
            agonist, has been found to be of therapeutic benefit in the acute
            management of migraine. There is no information on the transfer
            of this agent across the human placenta. Accordingly, the current
            study assessed the transport of this drug across the normal term
            human placenta, using the isolated perfused single cotyledon
            technique. We found that only about 15% of a single dose of the
            agent placed in the maternal reservoir crossed into the fetal
            compartment over 4 hr. Given the average elimination half-life of 2
            hr for sumatriptan, it is evident that only very small amounts of the
            agent will cross from mother to fetus after single doses of Imitrex.
            Only the parent drug entered the fetal compartment. Metabolites
            were not detected in the perfusates, but there was evidence of some
            metabolism of sumatriptan in the placenta. The nature of the
            metabolites has not been determined. The mechanism of transfer of
            the drug across the placenta is passive (i.e., the clearance is similar
            to L-glucose which is passively transported), the rate of transfer is
            equal in both directions (maternal to fetal and in the reverse), and
            the drug does not cross into the fetus against a concentration
            gradient. This passive transport of sumatriptan across the placenta
            is consistent with its molecular weight, its water solubility, and its
            slow penetration across the blood-brain barrier in experimental
            animals.

 TITLE: 
             Headaches and women: treatment of the pregnant and lactating
             migraineur.
 AUTHOR: 
             Silberstein SD
 SOURCE: 
             Headache 1993 Nov-Dec;33(10):533-40
 NLM CIT. ID: 
             94124236
 AUTHOR
 AFFILIATION: 
             Comprehensive Headache Center, Germantown Hospital and
             Medical Center, Philadelphia, PA 19144.
 ABSTRACT: 
             Migraine is a hormonally sensitive episodic headache disorder
             which may worsen during the first trimester, but usually
             improves during later pregnancy. Its treatment can be difficult
             because of the risks of injury to the fetus and newborn. These
             risks include teratogenicity, embryo mortality, fetal growth
             abnormalities, and perinatal effect. This paper reviews the effects
             of drugs on the fetus and newborn, their FDA classification, and
             their use during both pregnancy and lactation. Specific
             recommendations are given.


 TITLE: 
            Migraine and pregnancy.
 AUTHOR: 
            Welch KM
 SOURCE: 
            Adv Neurol 1994;64:77-81
 NLM CIT. ID: 
            94120986