Migraine Headaches While Breastfeeding: Causes and Treatment
Many women experience headaches during the postpartum period
Medically reviewed by Smita Patel, DO
After you give birth, a drop in estrogen and other hormone changes can sometimes lead to headaches. If you experience headaches while breastfeeding, it's important to know what medications are safe. If you're a migraineur, you may be understandably concerned about exposing your newborn to migraine medication while breastfeeding.
While options such as Tylenol (acetaminophen) are considered safe, aspirin and other choices are not.
Here's what you need to know about postpartum migraines caused by fluctuating hormones, as well as several methods used to treat a headache while breastfeeding.
Postpartum Migraines and Headaches: Causes
About 30% to 40% of all women experience headaches during the postpartum period, not just those who've dealt with migraines in the past. They typically begin during the first week after delivery. For the following six weeks, headaches tend to be more painful and last longer than usual. This is likely due to fluctuating hormones after birth.
Research consistently shows that anywhere from one-half to three-fourths of women who deal with migraines before pregnancy have fewer and less severe attacks while they're pregnant. Some women even experience no migraines at all.
However, research also shows that women who have menstrual migraines are more likely to experience them during pregnancy and during the postpartum period.
Explainer
If breastfeeding does help migraines, it's likely because it helps stabilize estrogen levels. The hormone naturally plummets after you give birth.
A 2017 review of studies found that about half of women with migraines saw their migraines return to pre-pregnancy levels within one month of giving birth. In another study, migraines returned within one month for 100% of women who bottle-fed their babies and only 43% of those who breastfed.
Whether or not breastfeeding can help stave off migraines is not certain, since other studies noted in the 2017 review didn't find this association.
Verywell / Cindy Chung
Related: Cluster Feeding Schedule in Newborns
What Can I Take for a Headache While Breastfeeding?
You have more migraine treatment options to choose from when you're breastfeeding, compared to when you're pregnant. When breastfeeding, medication is deemed safe if your baby gets less than 10% of the dose through your breast milk.
A 2013 study in the journal Headache researched migraine medications that healthcare providers could safely recommend to their breastfeeding patients. Their findings—as well as newer research—indicate which medications are safer and which ones should be avoided.
What to Try First
The following headache/migraine medications are the go-to choices while breastfeeding:
Tylenol (acetaminophen): Also known as paracetamol, Tylenol is considered the first-line pain relief treatment for headaches while you're breastfeeding or pregnant. If this medication alone doesn't work, it can be combined with other medications.
Advil, Motrin (ibuprofen): While you can take other nonsteroidal anti-inflammatory drugs (NSAIDs) like Aleve (naproxen) and Indocin (indomethacin) when you're breastfeeding, ibuprofen is preferred because there's more research on its safety and it has a short half-life.
Beta-blockers: As a migraine preventative, the beta-blockers Inderal LA (propranolol) and Lopressor (metoprolol) are currently considered the best prescription choices because so little is found in breast milk.
What to Try Next
When first-line treatments don't work or you can't use them for some reason, these are typically the next choices:
Triptans: The data on triptans, a common migraine pain relief medication, is limited in breastfeeding women, but Relpax (eletriptan) and Imitrex (sumatriptan) are currently considered the safest options.
Tricyclic antidepressants: Another choice when you're breastfeeding is amitriptyline or Pamelor (nortriptyline), which are tricyclic antidepressants that help with headaches.
Other Medications
Other options that you can consider to treat or prevent migraine pain include:
Anti-CGRPs: This class of medications includes options to help prevent migraines and two that can treat sudden migraines. Aimovig (erenumab), Ajovy (fremanezumab), and Emgality (galcanezumab) are taken as monthly injections for prevention, while Nurtec (rimegepant) and Qullipta (atogepant) are pills taken for prevention. Nurtec and Ubrelvy (ubrogepant) are also the only anti-CGRPs approved to help treat sudden migraines. Because anti-CGRPs are relatively new, there have been no clinical studies into the safety of use during pregnancy or breastfeeding. The makers of all four drugs advise working with a healthcare provider to weigh the risks and benefits of using anti-CGRPs while pregnant or breastfeeding.
Opioids: There is some concern about weaker opioids like codeine and tramadol causing infant sedation, breathing difficulties, constipation, or a poor suckling response, particularly when they're used repeatedly or at high doses. However, these medications can be taken occasionally for migraine pain while you're breastfeeding.
Antiepileptics: Lamictal (lamotrigine) and Neurontin (gabapentin) are the third-line in preventative medications and are safe to take while breastfeeding.
Corticosteroids: Oral prednisone and prednisolone are considered relatively safe to take when you're breastfeeding because your baby only gets 1% to 2% of the dose.
Botox: There haven't been any studies done on Botox (botulinum toxin type A) while breastfeeding, but it's unlikely that it transfers to breast milk.
Supplements: The preventative supplements magnesium and riboflavin are considered safe to take while breastfeeding.
Other, newer treatment options that may be safe during breastfeeding are nerve blocks as well as neuromodulation devices. These are good options to discuss with your neurologist or headache specialist. They can be very helpful for severe and frequent headaches.
Contraindicated Medications
Medications to avoid while breastfeeding include:
Aspirin: Don't take aspirin or aspirin-containing products when you're breastfeeding because the drug can cause adverse effects in your baby. Remember that there's often aspirin in over-the-counter headache medications like Excedrin and Excedrin Migraine.
Ergotamine: You should also avoid ergotamine and ergot alkaloids, vasoconstrictors that are used to treat migraines. Not only can they cause vomiting, diarrhea, and seizures in your baby, they can affect your milk production. Examples include Migranol, DHE-45, and migraine medications containing caffeine.
Calcium channel blockers: There isn't enough data on calcium channel blockers to know if they're safe for breastfeeding infants or not, so these should be avoided.
Takeaway
Remember, don't ever take any medication when you're breastfeeding without consulting your healthcare provider first.
A Word From Verywell
Obviously, the best treatment for migraines while you're breastfeeding is to not use medication at all and to avoid your migraine triggers. Getting enough sleep, avoiding unnecessary stress, managing mental health issues, and eating a balanced diet are all helpful, as are non-pharmaceutical treatments like heat, ice, rest, massage, and cognitive behavioral therapy (CBT). Acupuncture and biofeedback may also be helpful.
However, it may not be possible to effectively treat your migraines without medication. Talk with your team of healthcare providers in your third trimester about your plan for managing migraines while you're breastfeeding.
Frequently Asked Questions
How much Tylenol can I take while breastfeeding?
The recommended adult dose for Tylenol is 325 to 650 mg every four to six hours. While breastfeeding, you should always take the smallest effective dose. Be sure to check with your healthcare provider before taking Tylenol or any other medication while breastfeeding.
How long does Tylenol stay in breastmilk?
After taking a standard adult dose, peak levels of Tylenol in breastmilk occur within one to two-and-a-half hours and are much less than the dose that would typically be given to an infant. Research has found that the drug is no longer detectable in breastmilk after 12 hours.
What are the side effects of taking Tylenol while breastfeeding?
The side effects of taking Tylenol while breastfeeding are usually mild and similar to what you might experience if you take this drug at any other time. These may include nausea, stomach pain, or rash. Tylenol can cause life-threatening liver damage if you take more than the recommended dose or if you take it over a long period of time. Seek emergency care at once if you have vomiting, sweating, paleness, fatigue, or upper abdominal pain after taking Tylenol.
Read the original article on Verywell Health.
