A Migraine Mama’s Advice on Balancing Medication Usage During Pregnancy and Breastfeeding

Many mothers find that growing and nourishing an infant does more than just fill us with awe, give us a “glow,” and cause us to pat our own stomachs on a near-constant basis. It also makes us feel like a nervous wreck.

Making lifestyle changes as a mother

We worry about every sensation we feel (and in some cases, don’t feel). We analyze every craving and every bite of food we put into our mouths. We give up – as much as we are able – all of our old vices, and resolve to exercise more, eat healthier, and stress less. And, for the most part, we do well enough.

Eventually, we learn to trust ourselves and our intuitions and to have faith that we are doing the best thing for ourselves and our babies. The new-mom anxiety lifts and we happily forge on. Unless, of course, we suffer from chronic illness.

Complications of motherhood and migraine

Women with migraines, like women with other chronic illnesses, know that sometimes what is best for us is not the same as what is best for our babies, and vice versa. The medications that help us manage our diseases may also carry the potential to harm our babies. And, by not medicating and choosing to put our babies first, we may be putting ourselves in real danger – either from our diseases themselves or from the co-existing conditions, like depression, that often accompany unrelenting pain. What, then, do we do?

Making decisions for myself and my child

It is a conundrum I struggled with during my pregnancy in 2012, and one I continued to struggle with throughout breastfeeding. Standard medical advice is to weigh the potential benefits to the mother against the potential costs to the baby and to make the decision from there. But, that’s hardly helpful advice to a new mother who feels ANY potential for harm to her baby is too much, especially if she is the cause.

Avoiding migraine medications during my first trimester

At first, I resolved to remain completely medication-free throughout my entire pregnancy. Most medications don’t work for me anyway, and I knew many women who said their migraines dramatically improved while pregnant, so I figured I’d be fine. Within the first six weeks of my first trimester, however, I knew that wasn’t going to work for me.

My pregnancy exacerbated my migraine symptoms

Pregnancy caused the dizziness, nausea, fatigue, and photosensitivity that normally accompany my migraines to magnify exponentially. For weeks, I lay curled up in bed watching barely audible TV shows on Netflix with my computer screen nearly completely dimmed. Any attempts at vertical movement caused the entire room to pitch and swirl around me. I was so sick I could barely eat, and I lost 15 pounds before I even made it in for my first OB visit. I knew, then, that my promises to myself to remain medication-free were simply unsustainable.

A new plan for my second trimester

Working with my ob-gyn, I came up with a plan that I felt I could live with. For the entire first trimester, I took nothing but Tylenol and an anti-nausea medicine routinely prescribed to pregnant women. The worry that something might harm my baby’s developing organs was too big a concern for me to consider anything else.  Once the second trimester started, however, I had a few more options.

Taking migraine medication for my third trimester

Together, my OB and I decided to try Fioricet, as needed. Though I still had concerns about using anything at all, it was one medication deemed generally safe during the second trimester, and so I took it. As infrequently as possible, but I took it. It helped a little, not much, but it was more effective than Tylenol and less harmful to the baby than anything else. That, as I saw it, was the best I could hope for.

Migraine frequency during and post pregnancy

Thankfully, my migraines ebbed some during my last trimester and vanished almost completely for the first few months postpartum. This enabled me to proceed through the remainder of my pregnancy and the first few months of nursing without worrying too much about medication. Later in the first year, I found myself struggling with the same issues all over again when my anxiety levels started to climb.

How does anxiety and depression impact an infant?

Confronted with research that told me, on the one hand, that a depressed or anxious mother could leave lasting epigenetic effects on her baby and, on the other, that most anti-anxiety and/or anti-depressant medications could have adverse effects on a nursing infant, I was left wondering which option I could possibly choose. Did I take nothing, and be less of the mother I should be, potentially damaging my son in the process? Or, did I take a medication that might affect his energy levels, sleeping and eating habits, and/or growth patterns? Eventually, I once again chose the medication that would, theoretically, offer me at least some benefit with the least potential for side effects for my son.

Deciding whether or not to medicate

As I write this, we’re still involved in this dance – me, my son, and medicine. For me, it continues to me a difficult one to master. I imagine it is much the same for the other mothers out there as well. The only advice I have to give is this: Simply by asking the question “Do I medicate or don’t I?” and worrying about the answer, you have already proven yourself to be a good mother. If you work closely in tandem with your ob-gyn, your pediatrician, and your other doctors, that should be good enough. And, that’s all any of us can ever realistically hope to be.

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