Migraines While You're Breastfeeding

You probably know that breastfeeding is recommended by both the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP). But if you're a migraineur, you may be understandably concerned about exposing your newborn to migraine medication while breastfeeding. While options such as Tylenol (acetaminophen) are considered safe, aspirin and other choices are not.

Here's what you need to know about postpartum migraines and how to treat them when breastfeeding.

Migraines During the Postpartum Period

About 30% to 40% of all women experience headaches during the postpartum period, not just those who've dealt with migraines in the past. They typically begin during the first week after delivery. For the following six weeks, headaches tend to be more painful and last longer than usual. This is likely due to fluctuating hormones after birth.

Research consistently shows that anywhere from one-half to three-fourths of women who deal with migraines before pregnancy have fewer and less severe attacks while they're pregnant. Some women even experience no migraines at all.

However, research also shows that women who have menstrual migraines are more likely to experience them during pregnancy and during the postpartum period.

If breastfeeding does help migraines, it's likely because it helps stabilize your estrogen levels. The hormone naturally plummets after you give birth.

A 2017 review of studies found that about half of women with migraines saw their migraines return to pre-pregnancy levels within one month of giving birth. In another study, migraines returned within one month for 100% of women who bottle-fed their babies and only 43% of those who breastfed.

Whether or not breastfeeding can help stave off migraines is not certain, since other studies noted in the 2017 review didn't find this association.

migraine recurrence postpartum

Verywell / Cindy Chung

Using Migraine Medications While Breastfeeding

You have more migraine treatment options to choose from when you're breastfeeding, compared to when you're pregnant. When breastfeeding, medication is deemed safe if your baby gets less than 10% of the dose through your breast milk.

A 2013 study in the journal Headache researched migraine medications that healthcare providers could safely recommend to their breastfeeding patients. Their findings—as well as newer research—indicate which medications are safer and which ones should be avoided.

What to Try First

If you have migraines and are breastfeeding, your healthcare provider is likely to suggest one of these drugs. The following medications are the go-to choices:

  • Tylenol (acetaminophen): Also known as paracetamol, this is considered the first-line pain relief treatment for migraines when you're pregnant or breastfeeding. If this medication alone doesn't work, it can be combined with other medications.
  • Advil, Motrin (ibuprofen): While you can take other nonsteroidal anti-inflammatory drugs (NSAIDs) like Aleve (naproxen) and Tivorbex (indomethacin) when you're breastfeeding, ibuprofen is preferred because there's more research on its safety and it has a short half-life.
  • Beta-blockers: As a migraine preventative, the beta-blockers Inderal (propranolol) and Lopressor (metoprolol) are currently considered the best prescription choices because so little is found in breast milk.

What to Try Next

When first-line treatments don't work or you can't use them for some reason, these are typically the next choices:

  • Triptans: The data on triptans, a common migraine pain relief medication, is limited in breastfeeding women, but Relpax (eletriptan) and Imitrex (sumatriptan) are currently considered the safest options.
  • Tricyclic antidepressants: Another choice when you're breastfeeding is amitriptyline or Pamelor (nortriptyline), which are tricyclic antidepressants that help with headaches.

Other Medications

Other options that you can consider to treat or prevent migraine pain include:

  • Anti-CGRPs: This class of medications includes options to help prevent migraines and one that can treat sudden migraine. Aimovig (erenumab), AJOVY (fremanezumab), and Emgality (galcanezumab) are taken as a monthly injection for prevention while NURTEC (rimegepant) is a pill taken once every other day. NURTEC is also the only drug approved to help treat migraine in the moment. Because anti-CGRPs are relatively new, there have been no clinical studies into the safety of use during pregnancy or breastfeeding. The makers of all four drugs advise working with a healthcare provider to weigh the risks and benefits of using anti-CGRPs while pregnant or breastfeeding.
  • Opioids: There is some concern about weaker opioids like codeine and tramadol causing infant sedation, breathing difficulties, constipation, or a poor suckling response, particularly when they're used repeatedly or at high doses. However, these medications can be taken occasionally for migraine pain while you're breastfeeding.
  • Antiepileptics: Lamictal (lamotrigine) and Neurontin (gabapentin) are the third-line in preventative medications and are safe to take while breastfeeding.
  • Corticosteroids: Oral prednisone and prednisolone are considered relatively safe to take when you're breastfeeding because your baby only gets 1% to 2% of the dose.
  • Botox: There haven't been any studies done on Botox (botulinum toxin type A) while breastfeeding, but it's unlikely that it transfers to breast milk.
  • Supplements: The preventative supplements magnesium and riboflavin are considered safe to take while breastfeeding.

Other, newer treatment options that may be safe during breastfeeding are nerve blocks as well as neuromodulation devices. These are good options to discuss with your neurologist or headache specialist. They can be very helpful for severe and frequent headaches.

Contraindicated Medications

Medications to avoid while breastfeeding include:

  • Aspirin: Don't take aspirin or aspirin-containing products when you're breastfeeding because the drug can cause adverse effects in your baby. Remember that there's often aspirin in over-the-counter headache medications like Excedrin and Excedrin Migraine.
  • Ergotamine: You should also avoid ergotamine and ergot alkaloids, vasoconstrictors that are used to treat migraines. Not only can they cause vomiting, diarrhea, and seizures in your baby, they can affect your milk production. Examples include Migranol, DHE-45, and migraine medications containing caffeine.
  • Calcium channel blockers: There isn't enough data on calcium channel blockers to know if they're safe for breastfeeding infants or not, so these should be avoided.

Remember, don't ever take any medication when you're breastfeeding without consulting your healthcare provider first.

A Word From Verywell

Obviously, the best treatment for migraines while you're breastfeeding is to not use medication at all and to avoid your migraine triggers. Getting enough sleep, avoiding unnecessary stress, managing mental health issues, and eating a balanced diet are all helpful, as are non-pharmaceutical treatments like heat, ice, rest, massage, and cognitive behavioral therapy (CBT). Acupuncture and biofeedback may also be helpful.

However, it may not be possible to effectively treat your migraines without medication. Talk with your team of healthcare providers in your third trimester about your plan for managing migraines while you're breastfeeding.

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5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Petrovski BÉ, Vetvik KG, Lundqvist C, Eberhard-gran M. Characteristics of menstrual versus non-menstrual migraine during pregnancy: a longitudinal population-based study. J Headache Pain. 2018;19(1):27.  doi:10.1186/s10194-018-0853-3

  3. Ito S. Opioids in breast milk: Pharmacokinetic principles and clinical implications. J Clin Pharmacol. 2018;58(10):S151-S163. doi:10.1002/jcph.1113

  4. Hutchinson S, Marmura MJ, Calhoun A, Lucas S, Silberstein S, Peterlin BL. Use of common migraine treatments in breast-feeding women: a summary of recommendations. Headache. 2013;53(4):614-27. doi:10.1111/head.12064

  5. U.S. National Library of Medicine. Nortriptyline. August 2017.

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