Updated August 18, 2016
Acetaminophen (Tylenol). Most people reach for it for every day headaches like it’s no big deal. Yet acetaminophen is one of the major contributors to liver disease in the US each year. Acetaminophen has also long been considered generally safe for use during all stages of pregnancy, making it the first-choice pain and fever medication for pregnant women. Given the large number of pregnant women using the drug (>50% in the United States; 50%-60% western European), even a small increase in risk of adverse outcomes in the offspring can have important implications for public health.
Tylenol has more recently come under new and serious scrutiny. Animal studies suggest that its use in pregnancy can have important implications for neurodevelopment and endocrine function, which is also important for neurodevelopment as well as normal sexual differentiation.
It has been associated with as much as a 37% increase in hyperkinetic disorder, a severe form of ADHD, and a 30% increase in ADHD in a study of over 64,000 Danish mothers who took the drug during pregnancy. Risks of ADHD in children went up to 50% in women who took Tylenol for 20 weeks or more during pregnancy.
Stronger associations were observed with use in more than one trimester during pregnancy, and the higher the frequency of use, the higher the risk of ADHD and hyperkinetic disorder.
A second more recent large study, of 7796 pregnant women who used acetaminophen at 18 and 32 weeks of pregnancy, again published in JAMA Pediatrics has confirmed the findings of this study, found that children exposed to acetaminophen prenatally are at increased risk of multiple behavioral difficulties, and the associations do not appear to be explained by unmeasured behavioral or social factors.
It is no surprise that Tylenol could be at the root of problems in developing babies – it depletes a chemical called glutathione that we rely on in our bodies for detoxification, and it also acts as a hormone disruptor. This study, published in JAMA Pediatrics, suggests that acetaminophen may influence fetal brain development.
This is also not the first time lack of acetaminophen safety in pregnancy has been raised – it has been linked to undescended testicles in males, an increased risk factor for infertility and later development of testicular cancer.
While it is unlikely that using acetaminophen a few times over the course of a pregnancy is likely to cause a problem, and the benefits way outweigh risk for fever reduction in pregnancy, these studies are a reminder that medications should not be used unquestioningly during pregnancy. “We should continually remain vigilant to the need to reappraise the evidence concerning the risk-benefit balances of medications in light of new research findings.”
Headaches are a common prenatal problem, and acetaminophen has been considered safe to use, whereas other commonly used headache medications including ibuprofen and aspirin, are not safe for use in pregnancy.
So what’s a mom to do?
Here are 5 safe, natural tips to help reduce headaches in pregnancy:
1. Apply a few drops of lavender oil, peppermint oil, or Tiger Balm to the temples; these have been shown to safely and effectively reduce headaches.
2. Many headaches are a result of neck and shoulder tension, so don’t overlook the value of massage, a gentle osteopathic manipulation, or craniosacral therapy for headache prevention and relief.
3. Magnesium can help reduce a tension headache; take 400 – 800 mg/day of magnesium glycinate, or if constipation is also a problem, magnesium citrate in the same dosage.
4. Take 2 ginger capsules once or twice daily if you feel a headache coming on; it is a natural anti-inflammatory herb that is considered safe in pregnancy
5. Take a hot bath with 2 cups of Epsom salts, and 5-7 drops of lavender essential oil – the combination of magnesium in the Epsom salts, the aromatherapy from lavender, and hot water is deeply relaxing and can help relieve a headache.
Additionally, there are several herbs that are generally considered safe for use in pregnancy, including chamomile and lavender as teas or tinctures for mild headaches, and cramp bark (use tincture, 1/2 tsp every 4 hours) and black cohosh (1/4 tsp every 4 hours, NOT TO BE CONFUSED WITH BLUE COHOSH which is NOT TO BE USED in pregnancy) which I use in combination for more moderate headaches.
For a really painful, hard to get rid of headache, I have used Jamaican dogwood (15-2o drops, every 4 hours, up to 4 doses, and not for more than one day, on occasion). Though it is often contraindicated in pregnancy, this is really due to lack of studies, and in this small amount, used infrequently, may be a reasonable alternative to acetaminophen. I also combine it with cramp bark.
Cannabis tincture (this is the herbal extract; I am not referring to smoking it or edibles here), though controversial, is also considered safe for infrequent use during pregnancy. It is highly effective, and in this form, does not cause a “high” – it just provides gentle pain relief. Tincture can be difficult to obtain.
If you have a sudden onset of a headache, a more severe headache than usual, any visual changes or upper abdominal pain with your headache, or if you have a history of high blood pressure, please see your midwife or physician promptly as these can be signs of more serious illness, like pregnancy induced hypertension or preeclampsia.
If you have frequent headaches, getting to the root cause by making sure you are getting enough sleep, reducing excessive inflammation with dietary and lifestyle changes, and making sure you are getting all of your nutrients, including essential fatty acids and protein, is key to optimal wellness and the best thing you can do for you and baby. You might also want to consider working with a functional medicine, integrative medicine, or naturopathic physician skilled in pregnancy care.
Wishing you glowing pregnancy wellness!
P.S. Want to learn more about herbal medicines that are safe to use during pregnancy so you can help other women? Herbal Medicine for Women is your premiere source for women’s herbal education — taught by an herbalist-midwife-MD with 30 years of experience and international renown in women’s herbal medicine.