Migraine.

I am among the 18% of the female population who suffer from migraine headache.   My migraines recur at varying intervals:   I’ve gone years without any, and I’ve also had three in one week.   The first one hit me in 8th-grade debate class, and I thought I was having a stroke — in the course of fifteen minutes I went half-blind (literally — half my field of vision disappeared behind a shimmering, jagged veil), and then the headache, fatigue, and nausea arrived and took my breath away.  When my dad came to pick me up from school and I described the symptoms to him, he told me it was probably a migraine.  Oh.  So that was what my mom had been talking about for all those afternoons when she disappeared into a dark room to put a cold washcloth on her forehead. 

Some say they’re triggered by foods or stress or hormones; I’ve never noticed any correlation to anything I ate or any stressors, but then, I don’t keep detailed records of those.   I have learned that they are most likely to happen about a week before I ovulate, and after two of my pregnancies, I suffered my first postpartum migraine within days of my first postpartum ovulation.   It’s not a perfect correlation, though;  I’ve had a few when I was pregnant, and the three-in-a-week happened when MJ was five months old and I was still deep in lactational amenorrhea.   (I watched carefully for an ovulation for weeks after that, but it didn’t happen for five more months.)

For a couple of years before the Week of Three Migraines, my migraines had been curiously painless.  Still debilitating, because the shimmery blindness still cascaded across my vision and left me unable to drive, read, or take care of kids for an hour or two; and still exhausting, because after the "visual disturbance" passed I would tremble and need to lie down in a dark room for a few more hours.  But without the pain, hey!  I almost enjoyed it.  As long as I knew my kids were okay, cared for by someone else in another room, I could shut the door and just sort of float on the symptoms until they subsided.  Then I would go downstairs and eat an enormous amount of carbohydrates, and then it would all be over.   

The last few, though, really hurt.  So Mark finally convinced me to go to the doctor and get a prescription for Imitrex (sumatriptan succinate), which I gather is the drug-of-choice for occasional migraine sufferers these days.  Supposedly it is safer for the infants of breastfeeding mothers than are the ergotamine derivatives that are its alternatives.  You take it as soon as you have symptoms, and it’s no good to take it unless you take it right away; so I guess I’ll be keeping some in my car.  I will not know whether it’s the right drug for me until I’ve taken it.

Whenever I take a medication, I always ask the pharmacist about its compatibility with breastfeeding.  As I reviewed the patient information insert, I realized I forgot to ask another question I always ask.  The insert says:

Do not use IMITREX if you are pregnant, think you might become pregnant, are trying to become pregnant, or are not using adequate contraception, unless you have discussed this with your doctor.

"Adequate contraception" — what is that?   Everyone  who is using any contraception "might become pregnant," unless the contraception is removal of gonads or backed up by menopause.  Better not deconstruct this or I’ll be here all day.   

I use NFP, and I have a lot of confidence in it, but my policy w.r.t. medications is always to act as if I "think I might become pregnant."     This means, for example, that I rarely take ibuprofen, which has first-trimester risks.   Anytime I might want to take it,  I consider how likely it is that I might be pregnant and not know it (only about half the time, mind you, is this situation even possible), and weigh that against the benefit of the drug (minor tension headache or rapidly swelling sprained ankle).

There is some data about the safety of Imitrex during the first trimester of pregnancy, at least with regards to birth defects.  Three hundred thirty-four first-trimester exposures reported in GlaxoSmithKline’s data registry show no consistent pattern of birth defects nor a significantly high rate of them.   This does not mean, of course, that it is a good idea to use it when you know you are pregnant.  So I guess I will be using it with an eye on my menstrual cycle.  Since most of my migraines occur in the week prior to ovulation, when I am most certain I am not pregnant and when I can modify my behavior to practically ensure I will not become pregnant within a few weeks, it should not be a big problem.