Migraine Treatment During Pregnancy And Lactation

In the first 14 days after the first day of the last menstrual period (assuming an even 28-day cycle!), it can be assumed that there is no pregnancy.

  1. In a regular cycle, ovulation occurs about 14 days before menstruation.
  2. Six days after ovulation, the fertilized egg implants in the uterus and thus the first contact between “mother and child”.
  3. Therefore, drug treatment of migraine attacks is possible for approximately three weeks after the first day of the last menstrual period without ending the fetus. There has been no contact with the maternal blood up to that point.
  4. An existing pregnancy can be diagnosed with newer pregnancy tests from the 6th to the 10th month. The day AFTER ovulation can be detected, i.e. there are a few “uncertain” days about three weeks after menstruation. It is advisable to carry out a pregnancy test before taking acute medication.

Treatment Of Migraine Attacks During Pregnancy Or Breastfeeding

Paracetamol was previously considered the safest painkiller in pregnancy. Based on previous data, the safety seemed beyond doubt. Pregnant women were recommended to take this painkiller for pain during pregnancy almost without hesitation. Due to current studies, however, a careful rethinking of this recommendation is necessary. The intake of paracetamol by the pregnant woman and contact with the unborn child with the drug seems to lead to a significantly increased risk of developing asthma and respiratory diseases in the children and possible infertility in boys. 

In recent years there has been a significant increase in the incidence of asthma globally. Paracetamol is the most commonly used pain killer. It is the number 1 most frequently used drug. At the same time, the frequency of asthma in the population has increased significantly in recent years. Paracetamol can lead to a reduction in glutathione in the lungs. It is believed that glutathione plays a vital role in developing asthma. Of particular concern is the well-founded suspicion of a significantly increased risk of the development of an anomaly in the position of the testicles in boys (cryptorchidism). 

This can later lead to reduced fertility and an increased risk of developing malignant testicular tumors in those affected. Sperm count and sperm vitality later in life can be reduced. Combined use of two analgesics in pregnant women was associated with a seven-fold increased rate of neonatal cryptorchidism. It is suspected that the effects of one 500 mg acetaminophen tablet could be more harmful to the unborn child than the ten most common environmental pollutants. 

Paracetamol has been considered a safe, harmless, tolerable and inexpensive pain killer in therapeutic doses. The danger that irreversible liver cell damage and even liver failure can be triggered in an overdose of more than 150 mg per kg of body weight has already led to a limitation of the pack size in the context of self-medication. The new studies justified a significant rethinking of the application of possible, planned or existing pregnancy. You should avoid taking painkillers during pregnancy and breastfeeding. In individual cases, if the pain is particularly severe, acute medication can be considered after medical advice. 

However, it must be taken into account that, in particular, so-called simple painkillers such as paracetamol only have a partial and short-term effect on the severe attack of pain, but at the same time can cause long-term risks of complications for the unborn child. The studies criticized that a causal connection had not yet been proven. However, until the exact relationship is clarified, the principle must apply: In case of doubt, for the unborn life and against the intake of paracetamol, especially in combination with other painkillers. Contrary to previous recommendations, it is therefore not advisable to take paracetamol in mono- and especially combined preparations in the event of a possible or existing pregnancy.

Magnesium iv (e.g., Mg 5-Sulfate Amp. 10% Injection)

  1. Pregnancy: There have been no reports of harmful effects during human pregnancy.
  2. Lactation: There have been no reports of adverse effects during human breastfeeding.

Imigran 25mg/100mg (Tablet, Nasal Spray, Suppository)

  1. Pregnancy: Strict indication. Sufficient experience of use in humans is not available. The animal experiment yielded no evidence of embryotoxic/teratogenic effects.
  2. Lactation: Avoid breastfeeding for 24 hours after use. The substance passes into breast milk. An impairment of the baby has not yet become known. 

Treatment Of Nausea

Meclozine 25 mg (Tablet)

  1. Pregnancy: Strict indication. After extensive use in humans, there was no suspicion of an embryotoxic/teratogenic effect. However, animal experiments provided clues of embryotoxic/teratogenic effects. These seem to be of no importance to humans.
  2. Lactation: Strict indication. The substance is likely to pass into breast milk. Meaning leads to a reduction in milk production or

Dimenhydrinate 50mg/150mg (Coated Tablets, Suppositories)

  1. Pregnancy: Strict indication, especially in the 3rd trimester. After extensive use in humans, there was no suspicion of an embryotoxic/teratogenic effect.
  2. Lactation: contraindicated. Substance passes into breast milk. Depending on the dose, method of administration and duration of medication, the infant’s condition may be temporarily impaired.

Metoclopramide 20 mg (Drops, Tablets, Suppositories)

  1. Pregnancy: Strict indication in the 1st trimester. Sufficient experience of use in humans is not available. The animal experiment yielded no evidence of embryotoxic/teratogenic effects.
  2. Lactation: contraindicated. Substances appear in breast milk only in small amounts. Since the influence of dopamine antagonists on the child’s nervous system has not been clarified, their use is contraindicated.

Migraine Prophylaxis:

Magnesium 600 mg/day (Capsule/Drinking Granules)

  1. Pregnancy: There have been no reports of adverse effects during human pregnancy.
  2. Lactation: Reports of harmful effects during lactation in humans have not become known

Beta-Blockers (Propranolol) 100-200mg/day

  1. Pregnancy: In the newborn, Bradycardia, hypotension, hypoglycemia, and respiratory depression (neonatal asphyxia) are possible. Therefore, stop therapy 48-72 hours before the expected delivery date. If this is not possible, newborns must be carefully monitored for 72 hours after delivery.
  2. Lactation: Strict indication. Depending on the concentration in breast milk, beta-blocking symptoms are possible (Bradycardia, respiratory depression).

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