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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
1. Susan Hutchinson, Michael J. Marmura, Anne Calhoun, Sylvia Lucas,  Stephen Silberstein, B. Lee Peterlin. "Use of Common Migraine Treatments in Breast-Feeding Women: A Summary of Recommendations." Headache 2013 Apr;53(4):614-27. doi: 10.1111/head.12064.

Comments

View Comments (4)
  • aviatorjj
    6 years ago

    This article makes it seem like it’s a piece of cake to find a migraine treatment plan during and after pregnancy. My neurologist would only give me Fiorocet during pregnancy which did not help. I frequently got the attitude from doctors that they did not want to treat me and my migraines bc of the risk to the baby bc so many migraine preventatives and acute meds are category C – Unknown cause to the baby. My Ob/gyn didn’t understand the severity of my migraines and pain. I was given the impression that they thought I was just another pregnant lady with pregnancy headaches and to tough it out until the baby was born.

    I wound up in the ER 7 times from migraines and becoming dehydrated. After the 7th visit, the next day I went into preterm labor and had my son 10 weeks early. I was devastated. More ob/gyn’s and neurologists need to be educated on how to treat someone with migraines during and after pregnancy.

  • Diana-Lee author
    6 years ago

    I’m truly sorry you feel that way, and even more sorry you and your family had to deal with the scary situation of delivering at 30 weeks.

    This article was intended to provide an overview of a research article. We can certainly cover those types of challenges in another piece, of course, but it’s important to know that all our information about treatment and prevention challenges is just as applicable to pregnant and postpartum women as to any other Migraineur.

    Please keep in mind that every Migraineur, especially someone with Chronic Migraine or a pregnant patient, should be seeing a Headache Disorders specialist. This is a physician with special knowledge about treating patients with Migraine and other Headache Disorders. Not all neurologists have this training. There are Headache Disorders specialists who are neurologists, but also those who are certified in general practice, pediatrics, etc. My last Headache Disorders specialist, for example, was board certified in psychiatry, neurology and pain management.

    Ultimately, treatment for pregnant and/or postpartum women should be a team approach between her ob/gyn, Headache Disorders specialist and anyone else treating the woman in question (or her child during the postpartum period, such as a pediatrician). I’m still in the trying to conceive phase of the journey, but have already established my team, which includes my ob/gyn, Headache Disorders specialist, perinatologist and primary care physician.

    Finally, more physicians need to be educated about treatment of Headache Disorders patients, period. This is in no way limited to their approach to pregnant and/or postpartum patients. Unfortunately the physician is not our target audience. Patients are.

    Thank you for sharing your concerns.

  • Ellen Schnakenberg
    6 years ago

    EXCELLENT topic Diana!

    I nursed both kids, but with the second I was able to manage it for a little over a year until she was weaned. This involved making some planning and concessions necessary.

    Because of my first child’s extreme allergies, we learned that nursing was going to be super important for my second child. But, so is treating my Migraines.

    We managed to make things work because of two basics:

    ++ Plan ahead and freeze as much ahead of time as possible. The makeup of breast milk changes as the child ages, but it’s fine to keep it in the freezer and use it up to a year after it’s collected.

    ++ Pump and dump. The not so eloquent term for using the frozen stores and a bottle after you’ve had to take abortive or rescue medications. When you use the frozen milk, you must continue to pump and dump what your body continues to produce. This is how your body continues to produce the right amount of milk for your baby, and is very important. Because of the meds nursing may not be safe for your infant, but because you’ve prepared ahead of time, you don’t need to worry about changing suddenly to a formula your infant may not tolerate well.

    Chances are, if you’re Migraining or postdroming, feeding your baby is not going to be something you worry much about passing on to someone else in the family once you’ve assured you are keeping them safe with your frozen stores.

    My last tip is to be sure you know when it is safe to begin feeding your baby again. Meds clear your system at different rates, so checking with your doctor is going to be really important.

    Nursing was great for my Migraines. Pregnancy kicked them up a notch or ten, but once I was over the postpartum changes, my Migraine frequency really dropped and stayed down until after weaning. It doesn’t work that way for everyone, but it was well worth all the effort we went through to keep my daughter healthy.

  • Diana-Lee author
    6 years ago

    Thank you so very much for sharing your personal experiences and tips about all this, Ellen!

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