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Preventative treatments while breastfeeding.
While everything on the conception page is still safe, there are a few new options that become available to women for migraine when they are breast feeding. While there is some unknowns about antidepressants during pregnancy, while breastfeeding, the antidepressant duloxetine is particularly attractive. Duloxetine is given in capsule form because the medication breaks down in the presence of stomach acid. Since all infants have an acidic stomach even on day 1 of life, the small amount of duloxetine that is in breast milk cannot make it into the baby’s system. Duloxetine is Dr. Loftus’ preferred SNRI (selective serotonin and norepinephrine reuptake inhibitor) because it is more balanced than venlafaxine. Venlafaxine is considered more proven for migraine prevention but animal models of pain show the best response with equal activity of both serotonin and norepinephrine. Therefore, duloxetine, should be better.
While topiramate causes birth defects, it has been used safely in small studies for infants with hypoxic ischemic encephalopathy. The doses used were 10 mg/kg of the infants body weight. Lactation studies suggest infant exposure via mom is less than 1 mg/kg so this is safe.
Zonisamide does appear safe to use during pregnancy. The drug exposure to an infant is less than the drug exposure to a fetus. Therefore, the total level appears safe for an infant but if the infant is not gaining weight or does not want to eat, it could be a contributing factor
Acute treatments
The best oral agents for acute migraine are sumatriptan and Nurtec®. Sumatriptan is relatively poorly absorbed in the gut. The level in the breast milk is proportional to the level in the blood. Therefore, the infant gets exposed to the level in the breast milk but then it is poorly absorbed the blood level is very low.
Nurtec has been measured in breast milk when used by nursing mothers. The estimated exposure per body weight in the infant is 0.5% of the maternal exposure. For this reason it is presumed safe for use during breast feeding.
NSAIDs (non-steroidal anti-inflammatories) like ibuprofen and naproxen can be used as well. Do not take aspirin.
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Silvia N.(Patient Since 2022)
Dr. Loftus has extensive knowledge in his area and he is extremely vested in his patients well being. He takes time to understand the patient’s heath history to this date and he communicates through his portal amazingly often (mainly) with new patients still with acute pain, which is pretty uncommon (at least I haven’t experienced with any other type of doctors). This demonstrates how truly vested he is in his patients well being and how down to earth he is, despite being an expert in his area. His office and staff and great. They have the ability to perform onsite treatments if needed, which is a huge relief. I highly recommend Dr. Loftus and appreciate his true help!
Killian G.(Patient Since 2015)
It has been a pleasure being a patient of Dr. Loftus. I am sad to leave his care (as I am moving to Colorado). Not only did Dr. Loftus find a new neurologist in the area for me, he sent a referral with my patient history ahead of my arrival! My only regret as a patient of Dr. Loftus is that I did not start care with him sooner.
Providing headache and hyperhidrosis care & wellness for over 25 years.
Dr. Brian Loftus, M.D.
Dr. Loftus is Board Certified in Headache Medicine as well as Neurology. In private practice since 1994, Dr. Loftus’ practice has gotten busier and he has decided to concentrate his practice in areas that he can make a particular difference compared to other neurologist. Therefore, Dr. Loftus has chosen to focus his neurology practice on headaches & head pain, headaches during pregnancy, and hyperhidrosis. In the spring of 2006, Dr. Loftus relocated his practice from the Texas Medical Center to Bellaire, just 5 miles west. He has been named a Texas Monthly “Super Doctor” and an H Texas magazine “Top Doctor” multiple times.