Migraine treatment during pregnancy and breastfeeding
Desire to become pregnant
In the first 14 days after the first day of the last menstruation (assuming a regular 28-day cycle!), it can be assumed that there is no pregnancy.
- In a regular cycle, ovulation occurs approximately 14 days before menstruation.
- Six days after ovulation, the fertilized egg implants in the uterus, thus marking the first contact between “mother and child”.
- Therefore, medication to treat migraine attacks is possible for approximately the first 3 weeks after the first day of the last menstruation without endangering the fetus, because until then there is no contact with the mother's blood.
- An existing pregnancy can be detected with newer pregnancy tests from the 6th to 10th day AFTER ovulation, meaning that there are some “uncertain” days about 3 weeks after menstruation, during which it is recommended to take a pregnancy test before taking any acute medication.
Treatment of migraine attacks during pregnancy or breastfeeding
Paracetamol: Current warning against taking it during pregnancy
Paracetamol was previously considered the safest pain reliever during pregnancy. Based on earlier data, its safety seemed beyond doubt. Pregnant women were advised to take this pain reliever for pain during pregnancy with virtually no concerns. However, current studies necessitate a careful reassessment of this recommendation.
The use of paracetamol by pregnant women and subsequent exposure of the unborn child to the drug appears to significantly increase the risk of developing asthma and respiratory diseases in their children, as well as potential infertility in boys. Globally, there has been a marked increase in the prevalence of asthma in recent years. Paracetamol is the most frequently used pain reliever in Germany and ranks first among the most commonly prescribed medications. Simultaneously, the prevalence of asthma in the population has risen significantly in recent years. Paracetamol can lead to a reduction in glutathione levels in the lungs. Glutathione is believed to play a crucial role in the development of asthma.
Of particular concern is the well-founded suspicion of a significantly increased risk of developing cryptorchidism (undescended testicles) in boys. In affected individuals, this can later lead to reduced fertility and an increased risk of developing malignant testicular tumors. Sperm count and sperm viability may be reduced later in life. The combined use of two painkillers in pregnant women was associated with a sevenfold increased rate of cryptorchidism in newborn boys. It is suspected that the effects of a single 500 mg paracetamol tablet on the unborn child could be more harmful than the ten most common environmental pollutants.
Paracetamol, in therapeutic doses, has long been considered a safe, harmless, well-tolerated, and inexpensive pain reliever. However, the risk of irreversible liver cell damage leading to liver failure in cases of overdose exceeding 150 mg per kg of body weight has already led to limitations on package sizes for self-medication. New studies have prompted a significant reassessment of its use in cases of possible, planned, or existing pregnancy.
Generally, painkillers should be avoided during pregnancy and breastfeeding. In individual cases of particularly severe pain, acute medication may be considered after consulting a doctor. However, it must be taken into account that so-called simple painkillers like paracetamol only have a partial and short-term effect on severe pain attacks, while simultaneously posing lasting lifelong risks of complications for the unborn child. The studies have been criticized, with the argument that a causal link has not yet been definitively proven. Until the exact relationship is clarified, however, the principle must apply: when in doubt, prioritize the unborn child and avoid taking paracetamol, especially in combination with other painkillers. Based on the new data, the short-term benefits and long-term lifelong risks are not in balance during a possible or existing pregnancy.
Contrary to previous recommendations, the use of paracetamol in mono- and especially combination preparations is therefore discouraged in the case of possible or existing pregnancy.
- Magnesium IV (e.g., Mg 5-sulfate ampoules 10% injection solution)
baby
pregnancy
No reports of harmful effects during pregnancy in humans have been reported.
Breastfeeding
No reports of harmful effects during breastfeeding in humans have been reported
.
- Imigran 25mg/100mg (tablet, nasal spray)
pregnancy
Strict indications apply. Sufficient experience with its use in humans is lacking. Animal studies showed no evidence of embryotoxic/teratogenic effects.
breastfeeding
Avoid breastfeeding for up to 24 hours after application.
The substance passes into breast milk. No harm to the infant has been reported to date.
Treatment of nausea
- Meclozine 25 mg (tablet)
pregnancy
Strict indications apply. Extensive use in humans has not revealed any suspicion of embryotoxic/teratogenic effects. However, animal studies have shown evidence of embryotoxic/teratogenic effects. These appear to be irrelevant to humans.
breastfeeding
Strict indications apply. The substance is likely to pass into breast milk. The substance leads to a reduction in milk production
or
- Dimenhydrinate 50mg/150 mg (coated tablets, suppositories)
pregnancy
Strict indications are required, especially in the third trimester. Extensive use in humans has not revealed any suspicion of embryotoxic/teratogenic effects.
breastfeeding
Contraindicated. The substance passes into breast milk. Depending on the dose, method of administration, and duration of medication, the infant's well-being may be temporarily affected
or
- Metoclopramide 20 mg (drops, tablets, suppositories)
pregnancy
Strict indications apply during the first trimester. Sufficient experience with its use in humans is lacking. Animal studies showed no evidence of embryotoxic/teratogenic effects.
breastfeeding
Contraindicated. These substances appear in breast milk only in small amounts. However, since the effects of dopamine antagonists on the infant nervous system are unclear, their use is contraindicated.
Migraine prophylaxis:
- Magnesium 600 mg/day (capsule/drinking granules)
pregnancy
No reports of harmful effects during pregnancy in humans have been reported.
breastfeeding
No reports of harmful effects during breastfeeding in humans have been reported
.
- Beta-blocker (propranolol) 100-200mg/day
pregnancy
Bradycardia, hypotension, hypoglycemia, and respiratory depression (neonatal asphyxia) are possible in newborns. Therefore, discontinue therapy 48–72 hours before the expected delivery date. If this is not possible, newborns must be carefully monitored for up to 72 hours after delivery.
breastfeeding
Strict indications apply. Depending on the concentration in breast milk, beta-blocking symptoms are possible (bradycardia, respiratory depression).