From the Guidelines
Breastfeeding mothers with migraines should be treated with paracetamol as the first-line medication, with ibuprofen and sumatriptan considered safe alternatives, according to the most recent guidelines 1. When managing migraines in breastfeeding mothers, it's essential to consider the safety of the medication for the infant.
- The preferred acute medication is paracetamol, although ibuprofen and sumatriptan are also considered safe 1.
- For nausea associated with migraine, metoclopramide can be used 1.
- If preventive medication is required, propranolol is the recommended first choice as it has the best safety profile 1. Key considerations for breastfeeding mothers with migraines include:
- Timing medication intake right after breastfeeding to minimize infant exposure
- Staying hydrated
- Identifying personal triggers like lack of sleep, certain foods, or stress
- Avoiding certain medications like ergotamines, high-dose aspirin, and certain anticonvulsants due to potential risks to the infant
- Consulting a medical professional for severe or frequent migraines to determine the best course of treatment. The goal is to balance effective migraine treatment while minimizing medication transfer to breast milk, prioritizing the health and well-being of both the mother and the infant 1.
From the FDA Drug Label
Sumatriptan is excreted in human milk following subcutaneous administration. Infant exposure to sumatriptan can be minimized by avoiding breastfeeding for 12 hours after treatment with sumatriptan tablets. There are no data on the presence of zolmitriptan or its metabolites in human milk, the effects on the breastfed infant, or the effects of zolmitriptan and its metabolites on milk production. It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when rizatriptan benzoate is administered to a nursing woman.
The best medications for migraines in breastfeeding mothers are not explicitly stated in the provided drug labels. However, based on the available information:
- Sumatriptan: can be used, but breastfeeding should be avoided for 12 hours after treatment.
- Zolmitriptan: no data is available on its presence in human milk, so caution is advised.
- Rizatriptan: it is not known if it is excreted in human milk, so caution is advised.
When considering medication for migraines in breastfeeding mothers, it is essential to weigh the potential benefits and risks. The decision should be made on a case-by-case basis, taking into account the severity of the migraine, the potential impact on the mother's health, and the potential risk to the infant. Consultation with a healthcare provider is recommended to determine the best course of treatment 2, 3, 4.
From the Research
Medications for Migraines in Breastfeeding Mothers
- The following medications are considered compatible with breastfeeding based on expert recommendations:
- Ibuprofen
- Diclofenac
- Eletriptan 5
- Triptans, such as sumatriptan, have limited studies, but available data suggest that exposure to sumatriptan during pregnancy does not increase the risk of birth defects above the baseline rate, and the minimal amounts excreted into the milk are insufficient to cause any adverse effects on the breastfeeding infant 6
- Preventive medications not recommended for breastfeeding mothers include:
- Zonisamide
- Atenolol
- Tizanidine 5
- Paracetamol is the preferred drug for acute treatment throughout pregnancy and breastfeeding, and NSAIDs such as ibuprofen can also be used under certain circumstances 7
- The choice of treatment should take into account the balance of benefit and risk of medication, and clinicians should discuss both acute and preventive treatment options with breastfeeding mothers, keeping in mind the clinical features of the individual patient, and in consultation with their obstetrician and pediatrician 5, 7
Acute Migraine Treatment Options
- Acetaminophen, NSAIDs (ibuprofen, acetylsalicylic acid, naproxen sodium, and diclofenac potassium), and triptans (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan) have good evidence for efficacy and form the core of acute migraine treatment 8
- Clinical features to be considered when choosing an acute migraine medication include usual headache intensity, usual rapidity of pain intensity increase, nausea, vomiting, degree of disability, patient response to previously used medications, history of headache recurrence with previous attacks, and the presence of contraindications to specific acute medications 8
Preventive Migraine Treatment
- Migraine prophylaxis is recommended when more than 3 attacks occur per month, if attacks do not respond to acute treatment, or if side effects of acute treatment are severe 9
- Substances with proven efficacy for migraine prophylaxis include beta-blockers, calcium channel blockers, 5-HT antagonists, amitriptyline, and antiepileptic drugs (valproic acid, gabapentin, topiramate) 9