Breastfeeding, Migraine Medications & Safety Concerns
For any woman considering pregnancy who lives with Migraine Disease, medication use is a significant topic of concern. And it doesn't end with delivery for women with Migraine who are considering breastfeeding their newborns.
Women with Migraine are often offered generalizations about how their Migraines will react to changes in hormones. It's not uncommon for even medical professionals to suggest to patients their Migraines will improve when they become pregnant or after they deliver their babies. The reality is that Migraine varies widely from person to person and pregnancy and the postpartum period are no exception. This makes it important to discuss medication with your health care providers in advance and get a plan in place.
A group of researchers who frequently treat patients with Migraine and other Headache Disorders researched the most commonly used Migraine medications to determine what safety information was available about each one when used during breastfeeding. They compiled their findings in this journal article, providing an easy to use resource for physicians who need to make these difficult decisions with their patients with Migraine.
They recommend doctors and patients discuss both acute treatment and preventive medications shortly before delivery and again a few months later. If your doctor doesn't initiate this kind of discussion, bring it up yourself. You may need to facilitate a meeting of the minds between your Headache Disorders specialist, obstetrician and other specialists such as a pediatrician to make the best decisions for your situation.
Some of the relevant factors in the decision making process include:
- Making a decision that prevents a breastfeeding mother from forgoing treatment for a Migraine attack, but that also supports her choice to keep breastfeeding despite the need for treatment.
- Most medications transfer through breast milk to some extent, but some drugs provide greater exposure to the breastfeeding infant than others.
- The age and health of the infant. The researchers note that drugs are cleared slowly from the systems of premature infants and by about seven months of age an infant's system clears drugs at the same rate as an adult's system.
- Alternating breast and bottle feeding (using stored breast milk or formula) may make it possible for the mother to use medications with short half lives, especially those for acute treatment of a Migraine attack.
Specific recommendations based on the research findings:
- Among acute Migraine medications, ibuprofen, diclofenac (Cambia) and eletriptan (Relpax) are associated with low levels in breast milk.
- Opioids should be used with caution in breastfeeding mothers because of the potential for sedation of the baby.
- Aspirin use is of concern because it can cause Reye's Syndrome in children.
- Preventive medications zonisamide, atenolol and tizanidine are not recommended.
Please share any questions you have about this research in the comments.
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