Can You Take Migraine or Headache Drugs While Breastfeeding?

What's safe and what's not when you're nursing.

Young woman holding baby son in blanket. Credit: Image Source / Getty Images

New mothers who experience migraine and other head pain disorders are often reluctant to take a medication to prevent or abort their head pain because they are afraid the medication may pass from their breast milk to the baby.

Gina is a good example. She's a breastfeeding mother who suffers from migraines — she's 42 and has had migraines since she was 18. Gina used to treat her migraines with pain pills or Imitrex (a triptan medication that narrows blood vessels around the brain), but once she became pregnant and then became a nursing mother, Gina sought other ways to treat her migraines.

Gina currently treats her migraines with what she calls a cocktail of OTC medicines and "a good, strong latte from Starbucks."

"Usually, I have to repeat this over two days.” Gina adds that even if she decided to use traditional medicines, she would have to stay away from anything that would sedate her because she still has to care for her children.

While she is still nursing her two-year-old, Gina would prefer a treatment more natural or homeopathic in nature, but for right now she goes with what works. She says if she wasn't a nursing mother, she would probably go back to Imitrex for treating her Migraines.

What Migraine Meds Are Safe While Breastfeeding?

Gina may be correct that she should avoid Imitrex while nursing her baby, since studies of triptans in this context are limited.

But many breastfeeding mothers assume that migraine and other headache medications cannot be taken while nursing, even though the current medical research shows that some commonly used medications are safe.

Here's a rundown of the latest information on migraine and other headache medications and whether or not the experts recommend using them while you're also breastfeeding your infant:

  • Non-steroidal anti-inflammatory medications such as ibuprofen and diclofenac. These are generally considered safe, although naproxen sodium should only be used for a short time.
  • Triptans like Imitrex, Relpax and others. These have generally not been recommended during pregnancy or breastfeeding, since there isn't enough information from medical studies to determine if they're safe or not. The published reports available, however, indicate the drugs might not affect breastfed babies.
  • Anti-seizure medication Topiramate (zonisamide). This drug poses potential dangers during breastfeeding. Some clinicians urge women who need to be on this medication to breastfeed only partially in order to reduce the exposure of their babies to the drug.
  • Ergotamine. Current recommendations urge women who are breastfeeding to wait 12 hours after a dose of ergotamine before nursing their infants. Adverse reactions in babies can include agitation, vomiting or diarrhea. This drug may also decrease milk production.
  • Reglan. Reglan, used to prevent migraine-related nausea, also has been recommended to increase nursing mothers' milk supplies. It's considered safe while you're breastfeeding. However, be aware that a known side effect of Reglan is depression, so if you're at risk for post-partum depression, you should talk to your doctor about this side effect.
  • Thorazine. This is an antipsychotic drug that's sometimes used to prevent severe nausea in migraine disorder. Very limited research indicates it's safe during breastfeeding if used by itself, but some breastfed babies will get sleepy as a result of exposure.
  • Opioid medications. These are already controversial in headache and migraine treatment. They shouldn't be used by women who are breastfeeding their babies, as they can cause drowsiness, inadequate weight gain, and other problems in infants.

Choosing the Best Drug (or Combination) While Nursing

The choices of drugs that may work best for a breastfeeding mother include:

  • a drug with a short half-life (they generally also peak rapidly)
  • a drug with a short pediatric half-life
  • a drug with a high molecular weight
  • a drug that has a low percentage of oral bioavailability

Breastfeeding mothers may be interested in herbal supplements or remedies to treat their migraines or headaches.

It’s important, though, to investigate these preparations and to talk with your doctor about them, since the Food and Drug Administration (FDA) does not regulate herbal supplements and strengths of these supplements vary from brand to brand. Also, just because something is labeled herbal or natural, it’s not necessarily safe for a nursing infant.

If a mother does not wish to use traditional medicines, comfort measures such as lying down in a dark room or using ice or heat on the head can be (somewhat) easy to do with a small infant. Mothers can also use a headache diary to track their migraines or headaches to see if there is a lifestyle change that will help alleviate head pain.

Chiropractic adjustments or massage therapy are also options nursing mothers can pursue if they want to avoid taking medications.

Resources for Medication Safety During Breastfeeding

Medications and Mothers’ Milk, by Dr. Thomas W. Hale, a pediatrician, pharmacologist and professor of pediatrics at Texas Tech University School of Medicine, is recognized as one of the best resources for understanding how medications affect a breastfeeding mother’s milk.

This book, which released its 16th edition in 2014, reviews hundreds of medications covered in current scientific literature. This book contains information that includes:

  • the half life of a drug (how long it takes the body to get rid of half the dosage of medication taken)
  • time to peak drug concentration in the mother’s blood plasma
  • molecular weight of the drug (a drug with a molecular weight at 200 or higher has less chance of entering breastmilk than drugs lower than 200)
  • oral bioavailability (the ability of a drug to reach systemic circulation after oral administration; listed as a percent, how orally bioavailable the drug is)
  • pediatric half-life of drugs

Finally, the U.S. Library of Medicine also maintains an online database on drugs and breastfeeding that's an invaluable resource for determining the safety of various headache and migraine medications. You can access the database at LactMed, a ToxNet Database.

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