Near daily headaches making pregnancy hell

[faelavie]

Hi all. I'm hoping someone in a similar situation to me can give me some advice or reassurance but don't worry if not.... I just need to get this out somewhere as I feel I'm going mad.

I've suffered from migraines and headaches since childhood, and started taking daily amitriptyline for them a few years ago which changed my life. Frequency of headaches was massively reduced, honestly I'm not exaggerating when I say those tablets really improved my quality of life.

Found out I was pregnant in February (I'll be 11 weeks tomorrow). I asked my GP about the amitriptyline and was told to stop taking them straight away. I burst into tears.
I was told that women often find that their headaches get much better during pregnancy, and to wait and see if this happens to me.

So far, there's been no improvement. My headaches are either daily, or every two days at least. Sometimes they are my classic right sided migraine.... Other times, a bad tension headache.... Today, the pain has moved over to the left side of my head.

I'm allowed paracetamol or Co-codamol only. Paracetamol alone does absolutely nothing. Co-codamol helps a bit more, but makes me so constipated, and also very dazed and "high" so I am unable to drive or go to work. I've tried everything else I can - 4head stick, cold compress/ice pack, but once the pain takes hold it is near impossible to get rid of.

I've taken ibuprofen on a couple of occasions when I know I shouldn't have. But I was literally clawing at my head in pain and would've done anything to get some relief.... Ibuprofen does help but once I feel a bit better I just feel horrible guilt that I may have put my baby at risk.

I've been signed off work for weeks. I'm going back to the GP tomorrow and will ask for yet more time off as I do not feel ready to go back in this state. However I will have to go back to work soon as I'm coming up to the point I won't be paid sick pay anymore. I'm the breadwinner in my house and this cannot happen.

This pregnancy has been miserable, I am either in horrible pain or I wake up afraid of whether the pain will start later on in the day or not. I haven't enjoyed a moment of this pregnancy because of this and am even beginning to wish it never happened. My midwife has put me as a "moderate risk" in the mental health category.

My blood pressure has been fine whenever it's been checked and I haven't had any proteinuria so they're not worried about pre-eclampsia risk at the moment.

I know I'm close to the second trimester when things are supposed to improve but everything seems to be getting worse and I'm terrified I've got six more months of this. I can't carry on like I am, I have to go back to work, I have to live my life, but I can't do it when in constant pain.
Honestly I spend most days wanting to bash my head against the wall until I knock myself out.

I'm sorry if I found whiney. I know I'm lucky to be pregnant and that loads of women don't get the chance. I know I'd be devastated deep down if something bad happened to the baby. But I'm at the end of my tether and would do anything for some relief to this nightmare I'm living in.

I'm not sure what else to say to the GP tomorrow. I'm thinking of asking to go back on the amitriptyline. At my booking appointment my midwife said I might have to and just get extra monitoring. Has anyone here ever taken this medication during pregnancy? Would really appreciate any help.

Have you considered trying a chiropractor? I have found when I go through spells of killer headaches if I go to see mine they dispel instantly. Chiropractic treatment is safe throughout pregnancy

I'm sorry to say I didn't find anything that helped my headaches. I did find that they eased off at around 22+ weeks though which was a massive relief. Hope you feel better soon.

Maybe ask the GP for Dihydrocodeine? It’s a type of codeine that’s safe in pregnancy. Other than that, I don’t think there will be much more the GP can offer you

Thanks for replies.

Saw GP today and they agreed to put me back on the amitriptyline. I am so so relieved!

Hi @faelavie

I've only recently got my BFP but also take daily amitriptyline for prevention of migraines and headaches.

I haven't seen my GP yet, but when DH and I started TTC I did some reading up on whether I should stop the amitriptyline first.
What I found was that it should be fine to continue taking it through pregnancy.

Obviously there are various other elements that could make it a no-go, and I don't know you, but the drug itself in a low dose if you're used to it shouldn't cause problems, and stopping may be more harmful (if the headaches are sufficiently bad!)

GPs will likely be working off the general advice, which is not to start amitriptyline or continue a high dose in pregnancy. When you look at the info from neurologists and migraine specialists, you get more detail.

I can send you links if that would help, don't have access to them right now but wanted to share and hopefully reassure

@GreyWolf Thank you so much for your reply. I was on 20mg daily. My pregnancy was unplanned so I didn't stop taking the amitriptyline until I was told to, at about week 6. Now my GP tells me I can take them again, 5 weeks after stopping them, as the benefits to me would seem to outweigh the risks. I wish I'd never stopped taking them as the past few weeks have been hell. I'd love to see your links whenever you have the time :) thanks so much!

Oh gosh, I do feel for you. I have always had regular headaches and have never found paracetamol very good. No where near as bad as you’re though. I have struggled with headaches throughout my pregnancy, on and off, sometimes having one which lasts days with no relief. Then weeks I’ve been fine. The worst I’ve had was sat night, couldn’t sleep, was sick 3 times and honestly it was the worst I’ve ever felt. Cocodsmol did help in the end once I sent hubby out for some st 10am Sunday when the shops opened.

Really hope it improves for you now you’re back on your original meds. Headaches are seriously miserable xxxx

Sorry @faelavie, this will be a really long post!

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National Migraine Centre:
www.nationalmigrainecentre.org.uk/migraine-and-headaches/migraine-and-headache-factsheets/migraine-in-pregnancy/

Under “drugs to prevent migraine”:
Low dose amitriptyline is a safe alternative

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Institute of Health Economics, Alberta, Canada:
www.ihe.ca/download/ambassador_program_guideline_for_management_of_primary_headache_in_adults_clinical_practice_guideline_background_document_july_2017.pdf

P155
Does not say that amitriptyline is contraindicated in pregnancy, though it does for others e.g. divalproex sodium

P172
iii. If migraine drug prophylaxis is necessary during pregnancy, the best choice is a beta-blocker (propranolol or metoprolol) or if these are contraindicated or ineffective, amitriptyline or nortriptyline.

P259
^i. Migraine drug prophylaxis is best avoided during pregnancy if at all possible. Strategies involving trigger management, maintenance of good hydration, regular meals, regular sleep and attention to other lifestyle factors should be considered.
ii. (new) Magnesium is considered the safest migraine prophylactic during pregnancy.
iii. If migraine drug prophylaxis is necessary during pregnancy, the best choice is a beta-blocker (propranolol or metoprolol) or if these are contraindicated or ineffective, amitriptyline or nortriptyline.^

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SIGN (Scottish Clinical Guidelines):
www.sign.ac.uk/assets/sign155.pdf

Other medications highlight that they should be avoided during pregnancy e.g. valproate P6 – not so with amitriptyline (nothing is mentioned about pregnancy P15)

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Brain & Spine:
www.brainandspine.org.uk/wp-content/uploads/2018/02/BSF_migraine.pdf

P4
Again, no mention of contraindication in pregnancy for amitriptyline, thought mentioned for other medications e.g. topiramate

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Dudley Formulary:
www.dudleyformulary.nhs.uk/download/16/headache-migraine-guidelines

Again, no mention of contraindication in pregnancy for amitriptyline, thought mentioned for other medications e.g. topiramate

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Negro et al. systematic review, 2017:
www.ncbi.nlm.nih.gov/pmc/articles/PMC5648730/pdf/10194_2017_Article_816.pdf

P12
The tricyclic antidepressants (TCA) are considered the safest second-line option when β-blockers are contraindicated or ineffective. Amitriptyline is preferred.

P19 – same statement repeated
When preventive pharmaceutical treatment is needed for migraine metoprolol and propranolol are the first choice followed by amitriptyline.

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Migraine Trust
www.migrainetrust.org/living-with-migraine/coping-managing/pregnancy-breastfeeding/

Last paragraph under “Conventional medication and pregnancy”
Amitriptyline is a safe alternative.

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MedScape:
emedicine.medscape.com/article/1149405-overview#a4

Table 2. Pregnancy and Breastfeeding Risk for Medications Used to Prevent Migraine
During pregnancy, risk rating: C

This risk rating means:
Category C - Risk to humans has not been excluded
www.medscape.com/answers/1149405-164861/how-is-the-risk-of-neurologic-medications-during-pregnancy-determined

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@modgepodge Thank you, headaches are so lousy, I'm sorry you struggled too. I do have some co-codamol, but it doesn't always work, and makes me crazy constipated. I think if I used it 4 times a day like the GP recommended I would never poo again!

@GreyWolf Thanks so much for those links, I have had a good read and am definitely reassured! Can't wait until the tablets start kicking in again so that I can get back to some form of normality!

Hi @faelavie im just reading your thread from 5 years ago and have the same issue with headaches. They are debilitating and ruining daily life atm. The obstetrician has prescribed me amatryptaline which I have never taken before and which really worries me as I’m so nervous about putting the baby at risk but I’m desperate. Can I ask how your experience was with taking them and if baby and you were ok in the end?