Headache in a nursing mother: a guide to medications

What painkillers can you take while breastfeeding?

When breastfeeding, it is safe to take the following painkillers: Paracetamol, Ibuprofen, Drotaverine (“No-shpa”), Ketorolac (“Ketorol”, “Ketanov”, “Ketalgin”). Injections of lidocaine or articaine are suitable for pain relief during dental treatment. For local anesthesia for bruises and some other injuries, you can use ointments based on diclofenac.

Treatment of headaches

To relieve pain, you can use simple painkillers that are safe for children: paracetamol, ibuprofen, ketoprofen. Potent drugs are contraindicated because they can pass into milk. There are also ways to relieve pain without using drugs:

• provide yourself with rest, try to establish a sleep schedule;
• take a warm bath with the addition of sea salt and herbal infusions;
• apply a few drops of essential oils (lavender, mint, eucalyptus) to the area behind the ears;
• massage your neck and head.

The doctor will prescribe complex treatment for back diseases and circulatory disorders after breastfeeding is completed. During this period, it is important to avoid stress and follow general recommendations.

Terms of use

Dr. Komarovsky, for example, recommends avoiding the use of painkillers while breastfeeding or pregnant, as some drugs simply have not undergone proper clinical studies. However, if a woman cannot tolerate severe pain, there is no point in waiting for it to go away on its own or using dubious traditional methods. Here are a few rules that will help you quickly deal with the problem and avoid harming yourself and your child:

• It is important to understand: painkillers only relieve the symptom, but do not cure the disease itself. Therefore, in case of painful discomfort, it is recommended to consult a doctor, find the cause of the discomfort and eliminate it. So, if you have a toothache, visit the dentist; if you have pain in your ear, visit an ENT doctor. If the root cause is not eliminated, the pain will occur again and again, requiring another dose of medication.
• Even for a drug prescribed by a doctor, check the instructions, or rather the section “Use during pregnancy and breastfeeding.” There are no prohibitions - take it, and in the recommended dosage. But! The quantitative transfer of drugs into mother's milk has been studied only for a few drugs. Therefore, in most cases, you will see that the drug has not been studied during pregnancy and lactation, or pregnancy and lactation are contraindications for use (precisely due to the lack of studies on this group). Some mothers try to reduce the harm of drugs by reducing the dose. It is not recommended to do this; the expected effect will not happen (especially if we are talking about products that are acceptable during breastfeeding!).
• Look in the instructions for an indicator that is important for us - the drug elimination period. As a rule, it is the same for blood plasma and breast milk. This way you can calculate the period when the drug leaves your body. Analgesics penetrate into the blood and into mother's milk at the same time: this requires only half an hour, the maximum concentration occurs after 1–1.5 hours. And they appear longer – up to 2–7. The half-life of paracetamol, for example, is about 3, and acetylsalicylic acid - up to 7.

Headache in a nursing mother: a guide to medications

Headache... Almost every young woman encounters this ailment from time to time. And most probably know how to quickly eliminate an unpleasant symptom - swallow the appropriate pill. A nursing mother, alas, cannot afford such carelessness. She needs medications that will relieve the pain without harming the baby. But do they exist?

Unfortunately, almost all pharmacological drugs pass into breast milk. This means that any medicine that a nursing mother takes can reach the baby. If the instructions for the drug do not contain information about whether it can be taken during lactation, you should consult your doctor. But there are situations when such consultation is impossible for some reason. To prevent headaches from taking you by surprise, it is useful to learn as much as possible about it, as well as to become more familiar with the medications designed to eliminate this unpleasant symptom.

The many faces of “torture”

Headache can be different - constant and paroxysmal, strong and not very strong, unexpected and slowly developing, increasing; sometimes it acts as an annoying “background” or attacks a person in such attacks that it seems that existence itself is no longer possible. In addition, the head may hurt only in one area (for example, in the temporal region), or it may be covered in pain all over. Complaints of headache can be the main or only symptom of more than 40 different diseases: infections of any origin, the effects of drugs, chemicals or alcohol (for example, contraceptives, nitroglycerin, caffeine, household chemicals), as well as osteochondrosis of the cervical spine[1 ], depression, hypertension (increased blood pressure), hypotension (lowered blood pressure), diseases of the kidneys, nervous system, ENT organs, eyes, etc.

One of the most common forms of headache is tension headache.

(70%). It occurs in response to mental stress, which is the result of acute or chronic stress. In this case, the person experiences a feeling of tightening, squeezing, a “helmet” or “hoop” around the head. As a rule, this pain is diffuse, of weak or moderate intensity, it does not intensify from physical activity. It most often occurs sporadically, so to eliminate it, a “one-time” medication can be taken.

What is possible and what is not

Analgesics (an - negation, algos - pain) are usually used to treat headaches, and the most famous drug in this group is analgin. However, in a number of countries the production and sale of this drug is prohibited, since even its one-time use carries the potential risk of life-threatening complications such as hematopoietic suppression, severe kidney damage, and anaphylactic shock [2].

Therefore, ANALGIN is contraindicated during pregnancy and breastfeeding.

Analgin is also part of a large number of combined painkillers, such as SEDALGIN, PENTALGIN, TEMPALGIN

etc.
In addition, they contain medicinal substances that enhance the analgesic effect. The phenobarbital, codeine phosphate and caffeine contained in SEDALGIN are dangerous for the newborn (as well as for the embryo and fetus). Most of the components pass into breast milk. Phenobarbital may cause central nervous system depression in the newborn. Caffeine will “add” regurgitation, agitation and poor sleep. Codeine can cause depression of the central nervous system in a child, and also interferes with the transport of milk from the alveoli (sacs) of the mammary gland to the ducts. Thus, any drugs containing these components should not be used during breastfeeding.
According to the American Committee on Food and Drug Safety (FDA - Food and Drug Administration), the following analgesics are compatible with breastfeeding:
PARACETAMOL, IBUPROFEN, NAPROXEN, KETOPROFEN. Paracetamol (PANADOL, EFFERALGAN, CALPOL)
acts directly on the pain centers in the brain.
In addition to pain relief, it has an antipyretic effect. Headache is not the main indication for the use of IBUPROFEN, NAPROXEN, KETOPROFEN
; they are more often used for pain and inflammation in the joints.
The effect of these drugs on lactation and the child’s health has not been fully studied, so they should be used with caution during breastfeeding, and if possible, limit it to a single dose.

If the cause is vascular pathology

According to statistics, migraine is the cause of 25% of headaches :

a condition in which attacks of severe throbbing headaches appear in one half of the head, which is caused by spasm of cerebral vessels.
Young women are most often affected by migraines. An attack can be triggered by emotional stress, a long break between meals or drinks, or lack of sleep. In addition to headaches, nausea, vomiting, and sensitivity to light and sound may occur. For the treatment of migraine, the most commonly used drugs are ergot derivatives -

ergotamine
preparations .
This group includes: DIHYDROERGOTAMINE
(Digidergot nasal spray),
ZOMIG
,
RIZATRIPTAN
.

These drugs narrow the intracranial vessels dilated during an attack and reduce the excitability of nerve cells. Adequate and strictly controlled studies of the safety of these drugs in pregnant and lactating women have not been conducted. Therefore, during breastfeeding, the use of the above-mentioned drugs is possible only after consultation with a doctor, if the expected effect of therapy outweighs the potential risk to the child

.

In children whose mothers took ergotamine

, adverse reactions such as nausea, vomiting, and convulsions were reported.
Headache due to arterial hypertension
is not as common as is commonly believed. However, a rise in blood pressure may be accompanied by severe, pressing, throbbing pain in the neck and back of the head. Today, the treatment of hypertension in nursing mothers is a serious problem. The fact is that in modern practice there are no controlled comparative clinical trials with a sufficient number of participants. Many studies have examined only the therapeutic concentrations of drugs in the blood and breast milk, and not the effect on the child.

For example, the duration of breastfeeding was not assessed taking into account the use of medications, and whether the child refused to feed when the mother was taking these medications.

Let's consider the main groups of drugs for the treatment of arterial hypertension, most often used in everyday practice:

1. atenolol, metoprolol, propranolol

(better known as
ANAPRILIN
or
OBZIDAN
),
nebivolol
(
NEBILET
) are representatives of the group of so-called
beta-blockers
that block the functioning of receptors (nerve cells) located in the heart and blood vessels.
As a result, the effect of the hormone norepinephrine on them is prevented, and, as a result, the heart rate slows down and blood pressure decreases. Unfortunately, studies of these drugs have shown high concentrations in breast milk. There have been cases where, when using ATENOLOL
by nursing mothers, children experienced shortness of breath and rapid heartbeat.

Therefore, ATENOLOL is not recommended for use by breastfeeding women.

Relatively low concentrations in breast milk were found for
PROPRANOLOL AND NEBIVOLOL
.
The latter is officially approved for use in pregnant women. As for the use of this medicine during lactation, its effect on the child has not been clearly studied, therefore NEBIVOLOL cannot be recommended for nursing women
.

2. enalapril (ENAP, RENITEK), captopril (CAPOTEN)

belong to the so-called
angiotensin-converting enzyme inhibitors
.
This enzyme promotes the transition of a specific substance - angiotensin I
to
angiotensin II
, which has a pronounced vasoconstrictor effect. Drugs in this group block the enzyme, and the conversion process is inhibited. As a result, the vessels do not narrow and blood pressure does not increase. The inhibitors mentioned are found in the smallest quantities in breast milk. However, recommendations for their use by nursing mothers are contradictory: in the official pharmacological reference books of our country (Register of Medicines of Russia, Vidal), the use of these drugs during pregnancy and breastfeeding is contraindicated, and some foreign sources contain data on their use during lactation.

If a “one-time” headache occurs in a nursing mother, she can take PARACETAMOL once. Any headache that persists for a relatively long time requires evaluation.

If a nursing mother gets sick,

She should follow several rules during treatment:

* do not engage in self-healing. Treatment should only be prescribed by a doctor (not even a pharmacist);

* if it is necessary to choose a drug, one should be guided, first of all, not by the criterion of its effectiveness, but by the degree of safety for the child;

* if the properties of the prescribed drug cause concern to the mother, she should ask the doctor to tell her about the possible effect of the drug on the baby or ask to prescribe an alternative drug;

* when taking pharmacological drugs, it is important to monitor the appearance of side effects in the child (allergies, loose stools, etc.);

* you should make maximum use of the possibilities of gentle treatment: physiotherapeutic methods, restoratives;

* if the use of medications is necessary, then it is better to take them immediately after feeding, before the maximum accumulation of the drug in the blood has occurred;

* if you need to take a medicine that is absolutely not suitable for a nursing mother, breastfeeding will have to be stopped during treatment, and in order to maintain lactation, it is necessary to express and pour out the milk, since these portions will also contain a pharmacological agent. After completing the course of treatment, you can return to breastfeeding.

[1] Osteochondrosis of the spine is a chronic disease caused by thinning of the cartilaginous intervertebral discs, as a result of which the roots of the spinal nerves are compressed, pain in the spine and limitation of movements appear.

[2] Anaphylactic shock is a severe allergic reaction in which, in response to the introduction of any substance into the body, a sharp drop in blood pressure occurs, which disrupts the functioning of the body, in which case immediate resuscitation assistance is required.

Magazine "Mom and Baby"

Author: Svetlana Vavilonskaya, gynecologist, employee of the Department of Clinical Pharmacology, Moscow State Medical Dental University

Dental treatment

Some young mothers are afraid to go for dental treatment because they read somewhere that anesthesia can have a bad effect on the quality of breast milk. In reality, this is not so: the doctor gives a local injection, which has a short-term effect and is quickly eliminated from the body, and therefore does not cause any harm to the baby’s health? As stated in the online magazine “Doctor Zubov”. So it is possible and necessary to treat teeth with pain relief during lactation. It is better to clarify in advance which drug will be administered to you, and inform the dentist about breastfeeding. In this case, the doctor will select the optimal remedy that will not only provide excellent pain relief during dental treatment, but will also be eliminated from the body as quickly as possible.

Prevention methods

The first months of a child’s life are a huge responsibility and stress. At this time, the mother’s body experiences heavy stress, to which it reacts with a prolonged headache. However, if you follow several recommendations from doctors, you can avoid deterioration in health and other dangerous consequences:

• use pillows and other feeding devices - they relieve stress on the spine;
• eat well, take complexes of vitamins and microelements if necessary;
• take time for walks - a sufficient amount of oxygen is necessary to nourish brain cells;
• Avoid stress and allow yourself periodic rest.

At the Clinical Brain Institute, you can undergo a complete examination, which will allow you to quickly and accurately determine the cause of your headaches. The doctors of our center are specialists of a narrow and broad profile with many years of experience in treating various diseases. The effectiveness of therapy will depend on the timely use of prescribed medications, as well as on the implementation of additional recommendations, including adherence to diet and regular exercise.

Clinical Brain Institute Rating: 5/5 — 1 votes

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List of approved drugs

Now a woman can turn to the Internet for help: just enter the appropriate name of the medicine into a search engine, and several sites will tell you whether it is allowed to be taken during pregnancy or lactation. For example, there is a universal reference book e-lactation. If we talk about painkillers, which are usually used for severe headaches and toothaches, as well as during extremely painful periods, here is a complete list of tablets that you can take, as well as intramuscular, external and rectal agents:

• Preparations containing paracetamol reduce temperature and pain, and also help to subside inflammatory processes. The main part leaves the body a couple of hours after administration.
• Ibuprofen-based drugs work for toothache, discomfort in joints and muscles. Suppositories and tablets relieve fever and help cope with the symptoms of ARVI. When using medications, less than one percent of the active substance gets into the milk - this is completely safe for the baby.
• Of the antispasmodics, that is, drugs that relax smooth muscles and relieve spasms, no-spa is allowed during breastfeeding. The drug eliminates discomfort in the intestines and can be used for stomach cramps or renal colic.
• If a nursing mother needs to treat caries or remove a tooth, injections of ultracaine or lidocaine can be used to anesthetize these processes. They quickly provide an analgesic effect and are then just as quickly eliminated from the body.
• In case of particularly severe pain syndrome, it is allowed to take “Ketorol” (also known under the names “Ketanov” and “Ketalgin”). This non-steroidal anti-inflammatory drug quickly provides pain relief. Used for migraines and menstrual pain. Two hours after administration it passes into breast milk, but its concentration is so low that even American and European doctors allow Ketorol to be taken by nursing mothers.
• Diclofenac. If the pain appears as a result of a bruise, sprain or other “sports” injury, doctors suggest using special anti-inflammatory pain-relieving ointments. The substance does not affect the quality and quantity of milk in any way and is quickly eliminated from the body. Diclofenac is contraindicated in people with high blood pressure or peptic ulcers.

Diseases and disorders that provoke cephalalgia during lactation

Specialists involved in the diagnosis and treatment of pain identify about 200 different conditions that cause headaches in women during the lactation period.

The most common among them are the following:

• Depression after childbirth. It leads to persistent emotional depression and the appearance of migraines.
• Hashimoto's disease. Malfunctions of the thyroid gland lead to disruption of blood supply, circulation and innervation of all tissues of the body, including the brain.
• Osteochondrosis of the cervical spine, provoking cranialgia with prolonged uncomfortable position of the mother during feeding.
• Carrying a child in your arms leads to disruption of the blood supply to brain tissue.
• Complications after pain relief during labor.
• Conditions that cause dehydration of the body. Dehydration leads to a rapid waste of all the mother's reserves used to produce milk for the baby. A decrease in the amount of fluid provokes pathological impulses in the brain, which reacts to this with pain.
• Hormonal imbalances. A woman who has given birth quite often has abnormal levels of oxytocin, vasopressin and other hormones. The body reacts to these vibrations with pain impulses.
• Conditions of high blood pressure caused by both the presence of hypertension and symptomatic hypertension.
• Consequences of traumatic head injuries.
• Previously suffered infectious and inflammatory processes of the brain - encephalitis, meningitis, meningoencephalitis, arachnoiditis.
• Exacerbations of diseases of the maxillary sinuses.

Only a doctor can determine the cause of painful sensations in the head. You should not engage in self-diagnosis and self-medication, but immediately consult a specialist. This action will prevent mistakes and cause harm to both mother and child.

Prohibited drugs

All of these pills are almost certainly in your medicine cabinet. But they are strictly prohibited for women who are breastfeeding. This list included:

• Analgin. In most countries, this drug is generally prohibited for use (not only by nursing women), as it contains a substance that provokes the development of agranulocytosis. If it gets into breast milk, it has an extremely negative effect on the functioning of the baby’s kidneys and circulatory system. Analgin is part of Baralgin, Tempalgin, Spazmalgon, Pentalgin, Spazgan. Approved for use only in the most extreme cases, at high temperatures that are not affected by other medications. Then an intramuscular injection of analgin with diphenhydramine and papaverine is given. However, only a doctor can prescribe such radical methods!
• "Nimesil" ("Nise", "Nimid" and other drugs based on nimesulide). Has an almost instant pain relieving effect. But due to the lack of a sufficient number of clinical studies, it is prohibited for use by pregnant and lactating women, as well as children under 12 years of age.
• Acetylsalicylic acid (aspirin and citramone). It negatively affects the functioning of the gastrointestinal tract of the baby and contributes to disruption of the kidneys and hematopoietic system.