Watch as experts break down migraine and breastfeeding: how they are related, safe treatment options and more.
Before pregnancy and breastfeeding, it is important to understand migraine, the menstrual cycle and how they are connected. Migraine attacks are often triggered by the fluctuating hormones that occur during the menstrual cycle. The drop in estrogen levels triggers symptoms and attacks. This is called menstrually-related migraine.
During pregnancy, estrogen levels go up 500 times their usual level and stabilize. As such, migraine frequency usually goes down. After birth, estrogen levels drop and destabilize–and migraine attacks restart. So, how does this tie in with breastfeeding?
On August 15, 2022, the American Migraine Foundation (AMF) presented the Migraine and Breastfeeding webinar. Hosted by Dr. Catherine Stika, Clinical Professor of Obstetrics and Gynecology at Northwestern Medicine, and Dr. Claire Sandoe, Neurologist at Women’s College Hospital Centre for Headache in Toronto, the webinar answered questions and addressed concerns about breastfeeding while living with migraine and more.
Breastfeeding While Living with Migraine
Breastfeeding may actually provide relief from migraine symptoms and attacks. After giving birth and the placenta comes out, estrogen levels drop, which increases migraine frequency. However, after giving birth, many women experience lactation amenorrhea, a period of temporary infertility and an absence of monthly periods that accompanies breastfeeding. The length of lactational amenorrhea differs for each woman. But generally, it can last anywhere from one to two months up to six months or more. For some women who have migraine, breastfeeding and lactational amenorrhea can keep estrogen levels low and stable, which means they don’t experience migraine symptoms and/or attacks as often. However, as soon as their menstrual cycle starts again, so do their migraine attacks.
“The brains of people who have migraine just don’t like changes of any kind,” explains Dr. Sandoe. “Whether that’s hormones, weather, stress, eating, sleep or any of these things.”
If you’re breastfeeding or plan to breastfeed, you may have questions and concerns about how your migraine may affect your child. For example, if you take medication, you may wonder if that will affect breastfeeding your child. Dr. Stika and Dr. Sandoe presented an overview of various medications that are safe and unsafe to take when breastfeeding.
Safe and Unsafe Medications
If you take medications for migraine treatment, there is a chance that it could be present in breast milk. Always talk with your doctor to determine if medications are safe to take while breastfeeding.
“It’s always important to keep in mind that medications are great, but they should exist on the backbone of other things,” says Dr. Sandoe. “It is always a good idea to talk to your own doctor about which medications are right for you personally, but in general, there are a number of options that we think are safe [to take].”
Some safe medications include:
- Some triptan medications – talk to your doctor to learn which are safe for you.
- Some anti-nausea medications – please be aware that some medications like promethazine may increase or decrease milk production.
- Some beta-blockers
- Neuromodulation devices – please be aware that they are believed not to harm the baby. But, no studies have been done to see the (long-term) effects it has on lactation and babies.
Medications that are unsafe include:
- Aspirin – thought to cause Reye’s syndrome in babies. Reye’s syndrome is a serious (and sometimes fatal) illness that causes vomiting, seizures and sleepiness in the baby. However, baby aspirin can be used if your doctor deems it safe for you and your circumstances.
- Ergotamine – can cause nausea, vomiting and fatigue in the baby. It may also reduce milk production in the mother.
- Ditans – there are no studies done to determine its effects on lactation and breastfeeding, so it is recommended not to take it while breastfeeding.
- Gepants – can block Calcitonin Gene-Related Peptide (CGRP) molecules, which are important to developing blood vessels, brain, immune system and bones in babies.
- CGRP Monoclonal Antibodies (e.g. erenumab and fremanezumab) – like gepants, it can prevent the development of blood vessels, the brain, immune system and bones in babies
- Opioids – can cause neonatal death and are highly addictive.
- Butalbitals – more potent than opioids and not officially approved by the American College of Obstetricians and Gynecologists to be used during pregnancy or lactation. It is also not officially approved for migraine use, as it is meant to treat tension headache.
Though not a medication, use of onabotulinumtoxina (Botox®) is not typically recommended. More research is required to determine this, but the likelihood of crossing into breast milk is low. However, there are real risks if it gets into the bloodstream of a child.
“It’s important to remember that what the baby is able to absorb out of your breast milk is really different than…the effective concentrations in the mom” Dr. Stika reassures. “Typically, less of that comes across in the breast milk. What the baby gets into its bloodstream is much less.”
Be sure to consult with your doctor first about the medications you’re taking and how they may affect your pregnancy, child, breastfeeding and so on. It should also be noted that babies who are premature or newborns may react differently to medications compared to older babies.
Other Things to Keep In Mind When Breastfeeding
It isn’t only medications that are a concern, though. When your child no longer breastfeeds and your menstrual cycles start again, fluctuating hormones will return. This can trigger migraine attacks. There is also the uncertainty of maintaining your treatment plan. Of course, having a new baby at home requires a lot of time and effort. This results in issues like sleep deprivation, forgetting meals and so on, which can be major sources of stress. Stress is often a major trigger for those who live with migraine. There is also the possibility of letdown migraine from when the baby begins suckling. It is important to maintain your migraine preventative measures and treatment plan as much as possible.
“The idea is to pump at the end of a feeding so as to have more for the next one,” says Dr. Sandoe. “This helps avoid letdown and potentially have a partner do some of the feedings—like overnight.”
It is also important to understand that some babies just do not take to breastfeeding. If your child does not take to the breast, there are alternative ways, such as pumping and formula. “Breastfeeding is not always so easy,” Dr. Stika says. “It becomes this horrible vicious cycle of where people are feeling ‘I’m not a good mother if I don’t breastfeed.’”
“If it’s something that is keeping you from having a good relationship with your baby…then maybe that’s not the right thing [for you].” Dr. Sandoe adds.
Through all the breastfeeding and caring for your child, it is critical to keep hydrated. Dehydration is a leading cause of headaches. When breastfeeding, you are losing a huge amount of fluids. Keep a water bottle with you at all times and track how much you drink per day. Try to aim for at least eight glasses a day. If you are breastfeeding, consult with your doctor if you need to drink more.
Raising and caring for a baby is a rewarding experience, but it can come with all sorts of concerns, especially when living with migraine. We hope this webinar provides you with the information you need to care for and raise your baby.