Treating Migraines While You're Breastfeeding

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Breastfeeding is recommended by both the American College of Obstetrics and Gynecology (ACOG) and the American Academy of Pediatrics (AAP). Yet if you are a migraineur, you may be concerned about exposing your newborn to a migraine medication.

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

Please note that if you do breastfeed and suffer from migraines, speak with your doctor about the risks and benefits during your third trimester and after delivery. This is a complex topic and requires an individualized approach–meaning what is right for someone else may not be right for you.

Migraines During the Postpartum Period

Many women with migraines notice relief of their attacks during pregnancy. But what about the postpartum period? And does breastfeeding protect you from getting migraines? The evidence is somewhat conflicting.

For example, one prospective study in Cephalalgia examined 49 women with migraines who were pregnant. Of these women, 34 percent experienced a migraine after delivery during the first week and 55 percent experienced one within a month. Breastfeeding seemed to protect from migraine recurrence during the postpartum period.

Another prospective study in The Journal of Headache and Pain of 208 migraineurs also revealed a significant increase in headache in the first week postpartum. But other than that, the occurrence of headaches during the first six weeks postpartum did not differ from pregnancy. If women did get headaches during the postpartum period, they were more intense and lasted longer than those during pregnancy. In this study, breastfeeding did not play a role or affect the presence of headaches during the postpartum period.

Medications That May Be Considered Safe

A study in Headache titled: "Use of Common Migraine Treatments in Breast-Feeding Women: A Summary of Recommendations" researched migraine medications that doctors could safely recommend to their breastfeeding patients, using four widely known, excellent resources:

  •  American Academy of Pediatrics (AAP) policy statement: The Transfer of Drugs and Other Chemicals Into Human Milk.
  • Medications and Mothers' Milk by Thomas Hale, PhD (14th edition, 2010)
  • Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk by Gerald Briggs et al (9th edition).
  • National Library of Medicine's Drugs and Lactation Database (LactMed)

Here is a snippet of a few medications that may be considered safe during lactation and their "ratings." Remember, never take a medication for your migraine when breastfeeding without consulting your doctor first.

AAP stands for American Academy of Pediatrics. LRC stands for Lactation Risk Category and ranges from L1 to L5 with L1 being the safest and L5 contraindicated.

  • "Acetaminophen (Tylenol): Compatible with breastfeeding by AAP. LRC L1. Briggs category: compatible."
  • "Ibuprofen (Motrin): Compatible with breastfeeding by AAP. LRC L1. Briggs category: compatible."
  • Eletriptan (Relpax): This medication was not reviewed by the AAP.  LRC L2. Briggs category: compatible."
  • Sumatriptan: Compatible with breastfeeding by the AAP. LRC L3. Briggs category: probably compatible.

Some More Tidbits on Migraine Medications

  • The data on triptans, a common migraine medication is limited in breastfeeding women.
  • Medications contraindicated while breastfeeding are dihydroergotamine and ergotamine.
  • There is some concern about opioids causing infant sedation, apnea, constipation, or a poor suckling response.
  • Migraine preventive medications listed as L1 and "compatible," are magnesium and riboflavin.

Take Home Message

Talk with your team of doctors in your third trimester about your plan for managing migraines while breastfeeding. Fortunately, there are wonderful resources out there to help you and your doctors decide what is best for you and your baby.

View Article Sources
  • 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 Apr;53(4):614-27.
  • Kvisvik EV, Stovner LJ, Helde G, et al. Headache and migraine during pregnancy and puerperium:The MIGRA-study.J Headache Pain. 2011;12:443–451.
  • Lay CL, Broner SW. Special considerations in the treatment of migraine in women. Semin Neurol. 2006;26:217–22.
  • Sances G, Granella F, Nappi RE, et al. Course of migraine during pregnancy and postpartum: A prospective study. Cephalalgia. 2003;23:197–205.