Last update Feb. 5, 2022

Migraine

Compatible

Safe substance and/or breastfeeding is the best option.

Breastfeeding does not make migraine worse, and most migraine treatments are safe while breastfeeding, so migraine almost never forces you to stop breastfeeding. (Burch 2020 and 2019, Bordini 2016, Wells 2016, Amundsen 2015, Davanzo 2014 , Beseler 2008, Loder 2007)

Breastfeeding can prevent migraine recurrence postpartum: 100% of mothers who do not breastfeed have a recurrence in the first month, compared to only 43% of those who do breastfeed. (Sances 2003)

TREATMENT:

For treatment, ibuprofen or paracetamol are compatible alone or in combination with low doses of codeine or caffeine. Diclofenac, ketorolac, and naproxen are also compatible; metoclopramide, domperidone, dimenhydrinate, and prochlorperazine are considered safe in breastfeeding. (Anderson 2019, Worthington 2013, Hutchinson 2013, Pringsheim 2012, MacGregor 2007, Silberstein 1993)

Among the triptans, sumatriptan and eletriptan are the safest. (Burch 2020, Anderson 2019, Davanzo 2014, Worthington 2013, Hutchinson 2013, Duong 2012, Jürgens 2009, Raña 2008, MacGregor 2007)

It is necessary to avoid preparations that are combinations of drugs and derivatives of phenazone or ergot, barbiturates and sedatives.

PREVENTIVE MEDICATIONS:

As prophylaxis, propranol, atenolol, metoprolol, magnesium, various antiepileptics (gabapentin, valproate, topiramate, levetiracetam) and antidepressants such as verapamil or amitriptyline, escitalopram, paroxetine or sertraline are compatible.(Burch 2020, Anderson 2019, Davanzo 2014, MacGregorgens 2009).

OnabotulinumtoxinA is not detectable in maternal plasma after intramuscular use; therefore, its excretion in human milk is unlikely. (Anderson 2019).

Monoclonal antibodies such as erenumab, fremanezumab, and galcanezumab have very high molecular weights that prevent their excretion in human milk and cannot be absorbed from the infant's gut (Anderson 2019). A 22-month-old infant whose mother was taking eremumab did not experience any developmental or infectious side effects. (Henze 2019)


See below the information of these related products:

  • Amitriptyline (Safe substance and/or breastfeeding is the best option.)
  • Botulinum Toxin (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
  • Diclofenac (Safe substance and/or breastfeeding is the best option.)
  • Eletriptan Hydrobromide (Safe substance and/or breastfeeding is the best option.)
  • Erenumab (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
  • Gabapentin (Safe substance and/or breastfeeding is the best option.)
  • Ibuprofen (Safe substance and/or breastfeeding is the best option.)
  • Ketorolac Trometamol (Safe substance and/or breastfeeding is the best option.)
  • Metamizole (Unsafe. Moderate/severe adverse effects. Compatible under certain circumstances. Follow-up recommended. Use safer alternative or discontinue breastfeeding from 5 to 7 T ½ . Read Commentary.)
  • Naproxen (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
  • Paracetamol (Safe substance and/or breastfeeding is the best option.)
  • Sumatriptan (Safe substance and/or breastfeeding is the best option.)
  • Valproate, Valproic Acid (Safe substance and/or breastfeeding is the best option.)
  • Verapamil Hydrochloride (Safe substance and/or breastfeeding is the best option.)

See below the information of these related groups:

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.
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References

  1. Burch R. Epidemiology and Treatment of Menstrual Migraine and Migraine During Pregnancy and Lactation: A Narrative Review. Headache. 2020 Jan;60(1):200-216. Abstract
  2. Anderson PO. Migraine Drug Therapy During Breastfeeding. Breastfeed Med. 2019 Sep;14(7):445-447. Abstract
  3. Burch R. Headache in Pregnancy and the Puerperium. Neurol Clin. 2019 Feb;37(1):31-51. Abstract
  4. Henze T. Erenumab During Breastfeeding. Breastfeed Med. 2019 Aug 5. Abstract
  5. Wells RE, Turner DP, Lee M, Bishop L, Strauss L. Managing Migraine During Pregnancy and Lactation. Curr Neurol Neurosci Rep. 2016 Abstract
  6. Bordini CA, Roesler C, Carvalho Dde S, Macedo DD, Piovesan É, Melhado EM, Dach F, Kowacs F, Silva Júnior HM, Souza JA, Maciel JA Jr, Carvalho JJ, Speciali JG, Barea LM, Queiroz LP, Ciciarelli MC, Valença MM, Lima MM, Vincent MB. Recommendations for the treatment of migraine attacks - a Brazilian consensus. Arq Neuropsiquiatr. 2016 Abstract Full text (link to original source) Full text (in our servers)
  7. Amundsen S, Nordeng H, Nezvalová-Henriksen K, Stovner LJ, Spigset O. Pharmacological treatment of migraine during pregnancy and breastfeeding. Nat Rev Neurol. 2015 Apr;11(4):209-19. Review. Abstract
  8. Davanzo R, Bua J, Paloni G, Facchina G. Breastfeeding and migraine drugs. Eur J Clin Pharmacol. 2014 Abstract
  9. 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 Abstract Full text (link to original source) Full text (in our servers)
  10. Worthington I, Pringsheim T, Gawel MJ, Gladstone J, Cooper P, Dilli E, Aube M, Leroux E, Becker WJ; Canadian Headache Society Acute Migraine Treatment Guideline Development Group. Canadian Headache Society Guideline: acute drug therapy for migraine headache. Can J Neurol Sci. 2013 Sep;40(5 Suppl 3):S1-S80. Review. Abstract Full text (in our servers)
  11. Pringsheim T, Davenport W, Mackie G, Worthington I, Aubé M, Christie SN, Gladstone J, Becker WJ; Canadian Headache Society Prophylactic Guidelines Development Group. Canadian Headache Society guideline for migraine prophylaxis. Can J Neurol Sci. 2012 Abstract Full text (in our servers)
  12. Duong S, Bozzo P, Nordeng H, Einarson A. Safety of triptans for migraine headaches during pregnancy and breastfeeding. Can Fam Physician. 2010 Abstract Full text (link to original source) Full text (in our servers)
  13. Jürgens TP, Schaefer C, May A. Treatment of cluster headache in pregnancy and lactation. Cephalalgia. 2009 Abstract
  14. Raña-Martínez N. Migraña en la mujer. [Migraine in females]. Rev Neurol. 2008 Abstract
  15. Beseler-Soto B, Paricio-Talayero JM, Sánchez-Palomares M, Benlloch-Muncharaz M, Santos-Serrano L, Landa-Rivera L. MIgraña en la mujer. [Migraine and female]. Rev Neurol. 2008 Abstract
  16. MacGregor EA. Migraine in pregnancy and lactation: a clinical review. J Fam Plann Reprod Health Care. 2007 Abstract Full text (link to original source) Full text (in our servers)
  17. Loder E. Migraine in pregnancy. Semin Neurol. 2007 Abstract
  18. Sances G, Granella F, Nappi RE, Fignon A, Ghiotto N, Polatti F, Nappi G. Course of migraine during pregnancy and postpartum: a prospective study. Cephalalgia. 2003 Abstract
  19. Wojnar-Horton RE, Hackett LP, Yapp P, Dusci LJ, Paech M, Ilett KF. Distribution and excretion of sumatriptan in human milk. Br J Clin Pharmacol. 1996 Abstract Full text (link to original source) Full text (in our servers)
  20. Silberstein SD. Headaches and women: treatment of the pregnant and lactating migraineur. Headache. 1993 Abstract

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