| Head Pain Disorders and Breastfeeding | |
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August 1 - 7 is being celebrated as World Breastfeeding Week. According to the World Alliance for Breastfeeding Action:
“This year's WBW theme, Breastfeeding: Healthy Mothers and Healthy Babies, underscores the urgent need to protect, promote, and support the health and well-being of mothers as well as the need to protect, promote, and support breastfeeding, for healthier babies and children.”
In celebration of World Breastfeeding Week, we bring you this feature by guest author Deborah Wirtel:
A new mother has many things on her mind – excitement over a new bundle of joy and a whole new family, the baby’s health, breastfeeding, colic and sleepless nights.
However, with all the excitement and changes in life that come with a new baby, one of the last things a new mother wants to think about is chronic head pain and how it will affect her caring for her baby and how her medications may affect her breastmilk and her baby.
August 1-7 is World Breastfeeding Week. The World Alliance for Breastfeeding Action and La Leche League International are two of many organizations that promote breastfeeding education and support during World Breastfeeding Week and year round. Helping mothers breastfeed during illness and medication use is one of the areas of focus for breastfeeding education.
Gina is a breastfeeding mother who suffers from Migraines. She’s 42 and has had Migraines since she was 18. Gina used to treat her Migraines with pain pills or Imitrex, but once she became pregnant and a nursing mother, Gina sought other ways to treat her Migraines.
Gina currently treats her Migraines with what she calls a “cocktail of Tylenol, Sudafed and caffeine; a good, strong latte from Starbuck’s. Usually I have to repeat this over two days.” Gina adds that even if she decided to use traditional medicines, she would have to stay away from anything that would sedate her because she still has to care for her children.
Gina says that while she is still nursing her two-year-old, she would prefer a treatment more natural or homeopathic in nature, but for right now she goes with what works. She says if she wasn’t a nursing mother, she would probably go back to Imitrex for treating her Migraines.
Many breastfeeding mothers assume that Migraine and other headache medications can not be taken while nursing. Actually, with information about the drugs used and help from her doctor, a breastfeeding mother may decide that she does want to treat her Migraines or headaches medically.
“Medications and Mothers’ Milk,” by Thomas W. Hale, R.Ph., Ph.D., associate professor of Pediatrics and associate professor of Pharmacology at Texas Tech University School of Medicine in Amarillo, TX., is recognized as one of the best resources for understanding how medications affect a breastfeeding mother’s milk. His reviews of hundreds of medications contain information known in current scientific literature.
This book contains information such as:
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the half life of a drug (how long it takes the body to get rid of half the dosage of medication)
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peak time to drug concentration in the mother’s blood plasma
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molecular weight of the drug (a drug with a molecular weight at 200 or higher has less chance of entering breastmilk than drugs lower than 200)
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oral bioavailability (the ability of a drug to reach systemic circulation after oral administration; listed as a percent, how orally bioavailable the drug is)
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and pediatric half-life.
This information can help the breastfeeding mother and her physician decide if the mother wishes to take the Migraine or headache medication and continue breastfeeding.
Triptans such as Imitrex, Zomig, Maxalt, and Amerge are medicines commonly prescribed as Migraine abortives (information on the newest triptans, Axert and Frova are not yet available from this publication). Most doctors would suggest a mother wean her baby if she’s going to take this medication, or “pump and dump,” – meaning the mother should pump her breastmilk and throw it away while feeding her baby formula or previously pumped breastmilk. But with information from “Medications and Mothers’ Milk,” it’s possible for the mother to decide to continue to breastfeed while taking a triptan.
Injectable Imitrex, for example, reaches peak concentration in the mother’s plasma in 12 minutes; the half-life is 1.3 hours. A mother with a Migraine may take this information and time her baby’s nursing session to make sure the baby receives virtually no exposure to the drug through her breastmilk.
Migraines aren’t the only head pain a new mother might experience. Even though cluster headaches affect more men in general, women also get cluster headaches and need to treat them for relief.
Triptans are also used to treat clusters, but two other common treatments, DHE or ergotamine, are contraindicated in breastfeeding mothers. Use of either of these medicines may cause ergotism (excessive vomiting and diarrhea) in the infant. However, other treatments, such as inhaled oxygen, may be considered.
Preventative medicines are used to try to cut the frequency, severity and duration of Migraines, clusters and tension headaches. Once again, by using “Medications and Mothers’ Milk,” a mother and her doctor can examine the preventatives used and may decide if choosing one is safe for the mother and baby.
The choices of drugs that may work best for a breastfeeding mother include:
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a drug with a short half-life (they generally also peak rapidly)
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a drug with a short pediatric half-life
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a drug with a high molecular weight
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a drug that has a low percentage of oral bioavailability
Breastfeeding mothers may be interested in herbal supplements or remedies to treat their Migraines or headaches. It’s important, also, to investigate these preparations; the Food and Drug Administration (FDA) does not regulate herbal supplements and strengths of these supplements vary from brand to brand. Also, just because something is labeled herbal or natural, it’s not necessarily safe for a nursing infant.
If a mother does not wish to use traditional medicines, comfort measures such as lying down in a dark room or using ice or heat on the head can be easy to do with a small infant. Mothers can also use a headache diary to track their Migraines or headaches to see if there is a lifestyle change that will help alleviate head pain.
Chiropractic adjustments or massage therapy are also options nursing mothers can pursue if they wish to avoid taking medicines.
With careful study of Migraine and headache medications and consultation with a doctor, most mothers who experience Migraine or chronic head pain may decide they can safely breastfeed their infants and treat their pain at the same time.
Deborah Wirtel is a lay breastfeeding counselor and Migraine sufferer. She is a forum host on headaches.about.com.
1 Hale, Thomas W., Medications and Mothers’ Milk, Ninth Edition, 2000 Pharmasoft Publishing
2 Texas Tech University School of Medicine, Thomas W. Hale, R.Ph. Ph.D., Associate Professor of Pediatrics "Breastfeeding Pharmacology"
© Deborah Wirtel, 2002
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