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 the role of migraine in the postpartum period and what medications may be safe when breastfeeding.

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Migraines During the Postpartum Period

Headaches occur during the postpartum period for 30% to 40% of all women, not just in those who've dealt with migraines in the past, and they're usually during the first week after delivery. During the first six weeks postpartum, headaches tend to be more painful and last longer, though they may start to get better afterward. This is thought to be due to the fluctuation in hormones after birth.

In terms of migraines specifically, research consistently shows that anywhere from one-half to three-fourths of women who deal with migraines before pregnancy notice that they have fewer and/or less severe attacks while they're pregnant, with some women even experiencing no migraines at all. But a 2017 systematic review of studies on headaches in pregnancy cites a study that found that in 55% of migraineurs, migraines tend to start up again in the same patterns as pre-pregnancy within one month postpartum.

Interestingly, the same study also found that 100% of migraineurs who bottle-fed their babies had their migraines come back within one month while only 43% of those who breastfed did, showing a potentially protective effect when breastfeeding. That said, 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
Illustration by Cindy Chung, Verywell

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

Research also shows that when you have migraines that are associated with your menstrual cycle, you're more likely to experience them during pregnancy and in the postpartum period.

Using Migraine Medications While Breastfeeding

There are more medication options for treating migraines while you're breastfeeding than while you're pregnant. A medication is deemed safe if your baby gets less than 10 percent of the dose through your breast milk.

A 2013 study in the journal Headache, still widely considered a viable reference for physicians, researched migraine medications that doctors could safely recommend to their breastfeeding patients. The researchers used four widely-known, reliable resources, and their findings—as well as newer research—indicate the best choices for medications to treat migraines, as well as options to avoid.

Best Medication Options

If you suffer from migraines and are breastfeeding, your doctor is likely to suggest one of these drugs.

First-Line Treatments

These medications are the go-to choices to treat migraines when you're breastfeeding:

  • 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 caffeine.
  • 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: In terms of preventative medication for migraine, the beta blockers Inderal (propranolol) and Lopressor (metoprolol) are currently considered the best prescription choices because so little is found in breast milk.

Second-Line Treatments

When first-line treatments don't work or you can't use them for some reason, these second-line options are available:

  • 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 preventative choice when you're breastfeeding is amitriptyline or Pamelor (nortriptyline), both types of tricyclic antidepressants.

Other Medications

Other options that you can consider using to treat migraine pain or as preventative medications include:

  • 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 percent to 2 percent 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: For 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. Note that there's 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 Cafatine.
  • 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 doctor 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 unnecessarily 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 (CPT). Acupuncture and biofeedback may also be viable options.

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

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Article Sources
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  1. Negro A, Delaruelle Z, Ivanova TA, et al. Headache and pregnancy: a systematic review. J Headache Pain. 2017;18(1):106.  doi:10.1186/s10194-017-0816-0

  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 Suppl 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. Nortriptyline. US National Library of Medicine. August 2017.

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