Health after childbirth
Migraine after pregnancy
Preventing and treating migraines
According to statistics, every second woman experiences headaches after childbirth. One of the common causes of this condition is migraine. What is this illness and how is it treated?
Anna Mikhailova Therapist, Cand. honey. Sciences, Central District Hospital, YaNAO, p. Krasnoselkup
What is a migraine?
Migraine is a disease characterized by recurring episodes of headache, often localized in one half of the head. Migraine refers to neurological diseases and is manifested by attacks of a headache of different frequency - 1-2 times a week up to 1-2 times a year.
Usually migraine covers one half of the head. Attacks of the disease in one person proceed in the same way and are most often repeated for many years.
At the beginning of the attack, there is a throbbing headache in the frontal, temporal region or in the eyeball, then the pain can become very violent, spreading, spreading to the entire half of the head (more rarely - to the entire head), accompanied by nausea, vomiting, light and phobia.
The following forms of migraine are distinguished:
- migraine without aura (simple migraine);
- Migraine with aura (classic, or associated, migraine).
Aura is a complex of symptoms, including visual, sensory, motor and other disorders that occur before a headache attack.
The attack of simple migraine is characterized by the presence of three phases: the phase of prodromal phenomena, the phase of the onset of headache and the phase of pain reduction. The phase of prodromal phenomena is manifested by a change in mood, the appearance of irritability, tearfulness, decreased efficiency, yawning, drowsiness, decreased appetite, thirst, and swelling of the face. Some people with migraine can determine the approach of an attack on these symptoms. The phase of prodromal phenomena usually occurs in a few hours or even days before the onset of a headache attack. Sometimes she may be absent.
Migraine with aura differs from a simple migraine in that the first phase in the development of an attack is the aura that precedes the phase of the onset of pain. Aura usually occurs immediately before the development of the headache, it is often short (lasting not more than an hour, usually from a few seconds to 20 minutes). The most frequent version of the aura manifests itself as visual disturbances in the form of sparkling zigzags, broken lines, lightning, flickering dots, balls, fiery figures, flares. Less often, visual illusions arise when all objects appear to be unnatural, enlarged or reduced, change color. Sometimes after this, for some time (up to 2-3 hours) a part or half of the field of view falls out. A sensitive aura is manifested by a speech disorder, a sensation of crawling, tingling, slowly spreading on one side of the face or other parts of the body, which can be replaced by a feeling of numbness. Sometimes the only sign of a sensitive aura is the numbness of the face or half of the head. Rarely observed motor aura, which is characterized by the appearance of muscle weakness that occurs on one side of the body. There may also be an olfactory aura, in which there is a sharp irritating odor.
A painful attack after prodromal phenomena or aura can begin at any time of the day, more often in the daytime and evening, less often at night. The intensity of pain increases over a period of 2-5 hours, with pain intensified by bright light, loud sound, and a sharp odor. Any touch to the body feels like pain. During an attack a person tries to close the curtains tightly, doors, go to bed and wrap themselves in a blanket. Usually the duration of the second phase is from 5 to 20 hours.
The phase of pain reduction is characterized by a gradual weakening of the headache, general weakness, drowsiness and lasts from a few hours to a day. The total duration of a migraine attack can be from 4 hours to 3 days.
Causes of migraine
The factors that provoke migraine attacks are most often stress and mental overexertion. Also, migraine attacks can be provoked:
- overfatigue, lack of night sleep or its excess, chronic lack of sleep, disturbance of the rhythm of sleep;
- hormonal disorders and fluctuations of the hormonal background in accordance with the phases of the menstrual cycle (migraine attack can occur during ovulation - the release of the egg from the ovary, during menstruation or at the end of the cycle);
- weather changes - heat or cold;
- fluctuations of atmospheric pressure;
- magnetic storms;
- catarrhal diseases.
Migraine attacks are common after eating foods that contain nitrites (meat, sausage products) and tyramine (cheeses, chocolates, bananas, dried fruits, pickled vegetables, citrus fruits, beer, alcoholic beverages, particularly red wine), beverages containing caffeine.
The development of a migraine attack is explained by the fact that under the influence of provoking factors a large number of biologically active substances and hormones are thrown into the bloodstream, and the blood vessels of the brain envelope can not quickly adapt to these changes, the regulation of the vascular wall tone is broken, their spasm develops, and then the spasm develops. So there is a paroxysmal, throbbing pain.
Arising immediately before the onset of an attack of aura headache is a consequence of local spasm of blood vessels and a decrease in blood flow in the brain. Then, in this area of the brain, the concentration of biologically active substances increases, which leads to edema and a decrease in the tone of the vessel wall, and a headache occurs. In this regard, it should be noted that with migraine headache, you do not need to take antispasmodics - medicines that dilate the blood vessels (for example, NO-SHPU, SPAZMALGON, etc.), since they will not relieve the headache, but only weight the symptoms.
The causes of the development of this disease are not fully understood. It is proved that hereditary factors play a significant role in the onset of migraine: migraine is inherited, more often on the maternal line, and in relatives of migraine sufferers, the disease occurs much more often. There is a theory about the inheritance not of the disease itself, but of predisposition to the reaction of the cerebral vessels to various stimuli.
Migraine after childbirth
Typically, migraine attacks after childbirth develop in women who have suffered from them and before pregnancy. However, sometimes migraine attacks first appear after childbirth.
The onset of the disease after delivery is more common in women who do not breast-feed, and is associated with fluctuations in estrogen and progesterone levels. The use of combined oral contraceptives (combination of estrogens and gestagens) after delivery also often leads to an increase in the frequency of seizures, especially when using drugs with a high estrogen content of non-feeding moms.
In addition, during the postpartum period, the woman faces various problems: lack of night sleep, physical and psychological fatigue, increased anxiety, often reaching the level of depression. These stressors provoke migraine attacks, moreover, with their prolonged exposure, migraine attacks can become more frequent than before pregnancy.
Diagnosis of the disease
The diagnosis of migraine should be established by a neurologist after a detailed examination of a woman and exclusion of other causes of headache. It is necessary to perform radiography of the skull and cervical spine, echoencephalography (ultrasound of the brain), electroencephalography (registration of bioelectrical activity of individual brain areas), if necessary - computer or magnetic resonance imaging of the brain. With the help of these studies, it is possible to eliminate osteochondrosis of the cervical spine, the pathology of the cerebral vessels (for example, aneurysms - expansion of the vessel wall), epilepsy (a disease characterizing the occurrence of various repeated seizures), brain tumors.
The following criteria are used for the diagnosis of migraine:
- At least five episodes of headache.
- Duration of attacks from 4 to 72 hours.
Headache has at least two of the following symptoms:
- one-sided localization of the headache (one half of the head hurts);
- the pulsating nature of pain;
- average or significant intensity of the headache, limiting during the attack the activity of the patient;
- increased headache in monotonous work or walking.
The presence of at least one of the following concomitant signs of a headache: nausea, vomiting, light and phobia.
For a migraine with an aura, in addition to these characteristics, the following criteria are mandatory:
- no aura symptom should last more than 60 minutes (if duration is longer, then most likely it is not migraine, and you need to look for another cause of headache);
- full reversibility of the symptoms of the aura (they all pass without a trace for an hour);
- The duration of the gap between the aura and the onset of headache should not exceed 60 minutes.
Treatment of migraine
For effective treatment of migraine, first of all, it is necessary to exclude the factors provoking the development of seizures. Therefore, if possible, avoid stress and anxiety, allocate sufficient time for sleep and rest (the duration of night sleep should be at least 6 hours, while sleep with interruptions for feeding attacks does not provoke). A day's sleep is useful with the child. Walking in the fresh air, daily moderate physical activity also helps to reduce the frequency of seizures. Be sure to comply with the diet with the exception of products that provoke the development of seizures (coffee, alcohol, highly allergenic foods - nuts, citrus fruits, chocolate, honey, sweets, etc.). This diet is fully consistent with the recommended diet of a nursing woman.
Non-medicated treatment. Important in the treatment of migraine is the use of non-drug methods that can prevent or significantly ease the course of an attack (acupressure, acupuncture, yoga, auto-training, aromatherapy, water procedures) and are safe during lactation. All these methods can be used both outside the attack to prevent it, and when the first harbingers of an approaching attack appear (prodromal period or aura).
Yoga and auto-training help calm the nervous system, relieve fatigue, so are useful to women after childbirth. When treating migraine with aromatherapy (aromatic oils), it is necessary to take into account the fact that sharp odors can provoke seizures, so the concentration of oils should not be high. You can use chamomile, mint, lavender oil: they have a soothing effect. Of water procedures someone helps a cool shower or rinsing the head with cool water, someone - a warm bath.
Drug treatment. Drugs against migraine after childbirth should be taken as prescribed by a neurologist with regard to breastfeeding, since most drugs are contraindicated during lactation, as they penetrate into breast milk and can have a negative effect on the baby's body.
Combined treatment with the use of medicamentous and non-drug methods is the most effective and allows you to reduce the frequency, duration and intensity of pain.
Medications used for migraine should be prescribed only by a doctor, depending on the intensity of the headache. The arsenal of these drugs is very large. But lactation imposes certain restrictions on the taking of drugs.
To relieve migraine attacks, the drug should be taken as soon as possible - if taken during an aura, about half the time the attack does not develop.
Several groups of drugs are used:
- Analgesics and non-steroidal anti-inflammatory drugs (analgesic effect): ANALGIN, PARACETAMOL, ASPIRIN, IBUPROPHEN, KETOPROFEN, KETOROLAK, NAPROXEN, INDOMETHACIN, DICLOPHENAK, etc. These drugs are effective in stopping a migraine attack of mild to moderate intensity. In the lactation period, PARACETAMOL is the safest drug for pain relief. The influence of IBUPROFEN, KETOPROFEN and NAPROXEN on the health of the child during lactation is not fully understood, therefore it is necessary to apply them carefully during breastfeeding, after consulting with the treating neurologist, if paracetamol is ineffective. The remaining analgesics during the lactation period are contraindicated and should be administered only after the termination of breastfeeding.
- Combination preparations containing several components (one or two analgesics and / or caffeine and / or codeine derivatives): BENALGIN, TEMPALGIN, CAFFETHIN, CITRAMON, SARIDON, SOLPADEIN, PENTALGIN, PANADOL EXTRA, etc. The combination of an analgesic with caffeine speeds up action of the drug, caffeine contributes to the normalization of the tone of the vessels of the brain, codeine has an additional analgesic effect.
During lactation, this group of drugs is contraindicated and may be used only after childbirth.
- Special preparations for the treatment of migraine (tryptans and derivatives of ERGOTAMIN): AMIGRENIN, SUMAMIGREN, IMIGRAN, ZOMIG, etc. These drugs narrow the cerebral vessels enlarged during an attack, reduce the excitability of nerve cells, and are used for moderate and severe migraine attacks. Controlled safety studies of these drugs for pregnant and lactating women have not been carried out, therefore during the lactation period, the use of these drugs is possible only according to the doctor's prescription, if the expected effect of treatment exceeds the potential risk for the child, and when PARACETAMOL is ineffective.
- Preparations containing an opioid analgesic, eg ZALDIAR (it contains TRAMADOL and PARACETAMOL). The use of ZALDIAR is indicated for headache of severe intensity, with ineffectiveness of triptans, however, during lactation the drug is contraindicated, and its use is possible only after the end of breastfeeding.
- Antiemetics: METHOCLOPRAMIDE, VOGALEN, DIMENHYDRINATE, etc. They are used for nausea and vomiting during an attack together with analgesics. During the lactation period, the preparations of METOCLOPRAMID and DIMENHYDRINATE are contraindicated, since they penetrate into breast milk. Treatment is possible only after the termination of breastfeeding.
Migraine: prevention of disease
In order for migraine attacks to occur as sparingly as possible, it is necessary to identify factors that provoke a headache and try to exclude them, or at least minimize their impact. If the attacks are frequent, occur more than 3 times a month, to identify provoking factors, it is best to keep a diary of seizures that will help to identify the most probable causes of the disease.
For women who have had migraine attacks before pregnancy due to the menstrual cycle, the best way to prevent the resumption of seizures is a long period of breastfeeding. For hormonal contraception in the postpartum period, such women are recommended new low-dose contraceptives containing only gestagens, since they do not contain an estrogen component that affects the development of migraine attacks.
Medication prophylaxis for seizures is prescribed only by a neurologist and is necessary in cases of frequent (more than 2 times a month) and severe migraine attacks, which are not amenable to treatment (when taking at least three tablets of the drug to take off the headache).
Several groups of drugs are used to prevent the occurrence of seizures: beta-blockers (ANAPRILIN), calcium channel blockers (VERAPAMIL), antidepressants (AMITRIPTYLIN, MELIPRAMINE), anticonvulsants (FINLEPSIN, PHENOBARBITAL), nootropics (PIRACETAM, AMINALON) and antioxidants (vitamins A, C, E, selenium). All preparations, except for vitamins, are not applied during lactation. Preventive treatment is carried out for several months.
It is also advisable to conduct non-drug preventive treatment: sessions of massage of the cervical collar zone, acupuncture, acupuncture. Procedures are recommended to be held 3-4 times a year for 10-15 sessions.