Migraines and Breastfeeding

Elise Armoiry
May 14
5 min read

In this article, we address the topic of migraines and breastfeeding: symptoms, causes, and treatments compatible with breastfeeding based on transfer into breast milk.

Migraine Symptoms

Migraines are intense, recurrent headaches that affect part or all of the head.

They can be particularly debilitating and are often characterized by intense and specific symptoms, such as:

Pulsating pain: it generally affects one side of the head, with a throbbing or pulsating sensation.
Photophobia and phonophobia: people suffering from migraines are often sensitive to light (photophobia) and sounds (phonophobia).
Nausea and vomiting: these symptoms may accompany the migraine pain.
Aura: some migraines are preceded or accompanied by visual disturbances (flashes of light, blind spots), sensory disturbances (tingling, numbness), or speech disturbances.
Intense fatigue: extreme fatigue may persist after the migraine attack, also known as the resolution phase.

Migraines During Pregnancy: A Temporary Remission

During pregnancy, particularly in the second and third trimesters, many women who suffer from migraines notice a reduction or even disappearance of attacks. This improvement is often linked to hormonal fluctuations, notably the rise in estrogen levels, which stabilizes the nerves and blood vessels of the brain, thereby reducing migraine episodes.

However, this remission is generally only temporary. As soon as hormone levels drop after delivery, migraines may return — and even worsen in some women.

Return of Migraines After Delivery

After delivery, hormone levels drop sharply, particularly estrogen, often triggering the recurrence of migraines. Fatigue, stress, and disrupted nights also play a role in triggering attacks. Furthermore, the breastfeeding woman may find herself facing a dilemma: how to manage migraines effectively while preserving the safety of her infant?

Migraine Treatments and Breastfeeding

Treatments compatible with breastfeeding

Here is an overview of medications commonly used to treat migraines in breastfeeding women, while remaining compatible with breastfeeding.

1.1 Paracetamol (Acetaminophen)

Paracetamol is one of the safest analgesics during breastfeeding. It is well tolerated by infants when the mother takes it at recommended doses. It can be effective in relieving mild to moderate migraines.

1.2. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Ibuprofen: Considered safe during breastfeeding, ibuprofen can be used to treat moderate pain. It is rapidly eliminated by the body and very little passes into breast milk.
Diclofenac: It is also compatible with breastfeeding and may be prescribed for more intense migraines.

1.3. Triptans

Triptans are medications more specific to migraines, used to relieve moderate to severe attacks. They induce vasoconstriction, particularly at the level of cranial blood vessels, which relieves pain.

Among them:

Sumatriptan: This is one of the most studied triptans in breastfeeding women. Studies show that very little medication passes into breast milk, and it is often prescribed to mothers suffering from acute migraines. The manufacturer advises delaying breastfeeding for at least 12 hours after taking the dose to minimize the risk of transfer. However, this recommendation would primarily apply to premature infants, as there should be no notable adverse effects in most infants (reference: LactMed).
Rizatriptan and Eletriptan: Although less studied, they may also be used with caution under medical supervision.

Note: Painful and burning nipples and breast pain have been reported after doses of sumatriptan and other triptans. This has sometimes been accompanied by a decrease in milk production.

2. Migraine Medications to Avoid While Breastfeeding

Aspirin: Aspirin can be present in significant amounts in breast milk and may pose risks to the infant, including coagulation disorders and Reye's syndrome. It is preferable to avoid this medication during breastfeeding.
Ergotamines: These medications are used to treat severe migraines, but they are not recommended during breastfeeding as they can inhibit lactation and cause serious adverse effects in the infant.
Preventive (prophylactic) migraine treatments and breastfeeding
Beta-blockers

These are medications primarily used in cardiology. Among them, metoprolol and propranolol have a specific indication for preventive migraine treatment.

The CRAT website (French Reference Centre on Teratogenic Agents) provides the following information regarding metoprolol: "Based on available data on metoprolol and breastfeeding, its use is best avoided in a breastfeeding woman. Depending on the maternal condition, and with the prescriber's agreement, labetalol or propranolol would be preferred, as their use is possible during breastfeeding."

Amitriptyline (LAROXYL)

This is an antidepressant that has an indication for preventive migraine treatment and other related headaches (known as tension headaches). In these indications, it is used at much lower doses than for the treatment of depression. The amount of amitriptyline ingested via breast milk is low: the infant receives approximately 2% of the maternal dose (in mg/kg).

The CRAT indicates that "its oral use at standard dosage is possible in a breastfeeding woman."

Topiramate (TOPAMAX and its generics)

This is an antiepileptic drug with an indication for preventive treatment of migraine in adults following rigorous evaluation of possible therapeutic alternatives. The amount of topiramate ingested via breast milk is substantial, as the plasma concentrations of topiramate in breastfed infants reach 10 to 20% of maternal plasma concentrations. The CRAT advises against its use in breastfeeding women due to potential adverse effects in the infant (diarrhea, slow weight gain, etc.).

Non-Pharmacological Methods

Some breastfeeding women prefer to avoid medications or limit them as much as possible. There are non-pharmacological alternatives that may help relieve migraines:

Coffee: caffeine passes into breast milk, and it is recommended not to exceed 300 mg per day during breastfeeding. This can make the baby agitated and keep them awake. A standard cup of coffee contains an average of 90 to 95 mg of caffeine.
Rest and hydration

Fatigue and dehydration can trigger migraines. Adequate sleep and regular hydration are essential. In the postpartum context, it is helpful to arrange for support, for example from family, a babysitter, or a postpartum doula.

Cold compresses

Applying a cold compress to the forehead or back of the neck can help relieve the pain.

Relaxation techniques

Yoga, meditation, or deep breathing exercises can help reduce stress, a migraine trigger.

Balanced diet

Avoiding dietary triggers such as chocolate, cheese, or red wine can reduce the frequency of attacks.

Conclusion

Migraines can be a significant challenge for breastfeeding women, but solutions exist to relieve the pain without compromising the infant's health. It is essential to work with your healthcare professional to establish an appropriate treatment plan, taking into account the severity of the migraines and the safety of breastfeeding: the available reference resources are mentioned in this article.

A simplified version of this article intended for parents can be found on the My Baby Moon website.