share
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.
Additional Information:
Share
Receive Optimal Care
Additional Information:
Katie S.(Patient Since 2015)
I have been going to Dr. Loftus for several years now and I cannot say enough wonderful things about his staff and Dr. Loftus. They go out of their way to all spend extra time with you as a patient and answer all your questions. I would highly recommend Dr. Loftus.
Jaden P.(Patient Since 2019)
Great doctor! Very easy to talk to and find answers to your health concerns.
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.