Migraine medications

[gam]

Hi,

I'm a breastfeeding mom of a 4mth old and suffer from migraine headaches, particularly menstrual migraines (yes, I started my period almost immediately after birth). I am wondering what the research suggests about use of sumatriptan (Imitrex) and the effects on baby through the mother's milk. I have thus far been relying on NSAIDS (Naproxyn, Ibuprofen) assuming those were okay. But, I would like to hear any information on the negative effects of those as well. Any other suggestions would be appreciated.

Thanks for any help!

[jewels_c411]

I too would love to know about this. After the birth of my son, I have developed terrible migraines accompanied by nausea, I'm assuming hormonal. I am breastfeeding my 8 month old son and am suffering. I have been alternating Tylenol and Advil, but with not much relief. I was wondering about the safety of Imitex and if it is necessary to pump and dump with this medication. My son only eats about every 5 hours at this point.

Thank you!

[mmilla]

Dear gam and jewels,
Sumatriptan (Imitrex) is probably safe to use while breastfeeding.
Although the drug does enter milk, the amount absorbed by the infant's
gut would be quite small. Also, it has a short half-life (this is the
amount of time it takes for half of the drug to be eliminated from your
circulation) of 2 hours. My advice is to take the medication after you
breastfeed and wait 2 hours to nurse. This would minimze exposure.
Potential adverse effects to watch for are dizziness and flushing. NSAIDS
such as Ibuprofen are the preferred analgesic to use while breastfeeding
and are probably safe as well. Hope this is helpful.
Maria Milla, MD
InfantRisk Center

[mommy78]

I too suffer from debilitating Migraines. I have a 5mth that I love breastfeeding I also have a 6 & 4yr old. The headaches have become more frequent and I am unable to control the pain. I have taken tylenol, ibuprofen, lorcet plus all to no avail! I was wondering if you had any suggestions about migraine medications. I have been told about topomax but I am alarmed when seeing the side effects especially since I seem to be struggling with depression right now. I have not spoken with my physician about the depression but upon your suggestion of meds I will do so. Thank you!

[mmilla]

Dear Mommy78,
Topamax does transfer into milk, however studies have not shown it to cause any major adverse effects in the breastfed infant. If taking this medication while breastfeeding you need to closely monitor the infant for sedation. Another drug you might want to talk to your doctor about is Imitrex (Sumatriptan Succinate). Although it does transfer into milk, the amount that would be absorbed by the infant is quite small. Hope this is helpful.
Maria Milla,MD
InfantRisk Center

[mommy78]

Thank you so very much Dr. Milla. So grateful my lactation specialist Kelli turned me in your direction!

[Careya]

Hi, Pls could you advise on preventative meds for migraine, my Dr has suggested propanalol a beta blocker but the evidence I can find advises against nursing ...... I had a migraine when I met my Dr and forgot to mention I am nursing my 26mnth old. I go back in 1 week.
I am currently taking naproxen and getting between 2 - 5 migraines a week!
I am in the UK so I am not sure of the drug name in USA.
Many thx
Careya

[admin]

Careya:

There are few good choices for the chronic therapy of migraine during pregnancy. Metoprolol is a beta blocker that has show minimal teratology in pregnant women. The tricyclic antidepressant Amitriptyline is another drug that seems to be quite safe during pregnancy. I would most certainly NOT use valproic acid at all, not the triptans such as sumatriptan or other members of this family. Naproxen is unlikely to help much at all either and should NOT be taken during the last trimester of pregnancy.

Confer with your physician about amitriptyline at bedtime, or perhaps metoprolol.

Sorry I don't have a better choice for you.

Tom Hale Ph.D.
Professor

[623mommy]

Is Zomig also safe while breastfeeding? If not, I will get an Imitrex RX.

[carolinem1981]

My Dr has just switched me from Zomig ZMT to Relpax for my migraines and I am breastfeeding my 5 month old. Is that medication safe to take? I have not taken any yet because my doctor has admitted she is not up with breastfeeding and which medicines are safe, so I am worried about taking it. I have tried Imitrex already and it does not work for me. Zomig was working fine for me but it's no longer a medication the VA carries (and that's where I get my migraine meds from because they are terribly expensive) so that's why they said they have to switch to Relpax. I am also taking Propanaolol for my high BP but it's not controlling it well and might need to try a new medication.

[cpride]

Dear carolinem1981,

We do have data on how much Relpax (eletriptan) enters breastmilk. The relative infant dose (RID) (amount of your dose that enters breastmilk) is 0.02 percent. Most drugs with a RID of less than 10 percent are usually compatible with breastfeeding. The time eletriptan is most concentrated in your breastmilk (T max) is one and one-half hours after your dose so avoid breastfeeding during that time. It is usually best to breastfeed first then take your dose. The half-life (time it takes for half of the drug to be eliminated from the body) is 4 hours for eletriptan. If you can wait one half-life that is generally preferred, but since such a small amount of drug is available in breastmillk, avoiding the T max is probably adequate. Observe for sedation in your infant. If noted, wait longer before breastfeeding. Hope this information helps.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center

[cpride]

Dear 623mommy,

We do not have data on how much Zomig (zolmitriptan) penetrates breastmilk. We do know that zolmitriptan has better oral bioavailability (the amount of the drug that is available to be absorbed by the infant via breastmilk) compared with Imitrex (sumatriptan). We also know that the time zolmitriptan would be most concentrated in breastmilk would be two to four hours after the dose. The half-life (time it takes for half of the drug to be eliminated from the body) is three hours. It takes five half-lives for 98 percent of the drug to be eliminated. If you and your physician decide that zolmitriptan is the drug of choice for you, waiting 12 to 15 hours from your dose should be sufficient as long as you are not having symptoms of sedation and dizziness. If you are still having symptoms, wait longer to breastfeed. We prefer medications that we have data on. We have data on Imitrex (sumatriptan). The relative infant dose (amount of your dose that enters breastmilk) of sumatriptan is 3.5 percent to 15.3 percent. The time sumatriptan is most concentrated in your milk is 12 minutes after the dose is injected. The half-life is 1.3 hours; therefore, by four to five hours after your dose, most of the drug would be eliminated. If you are no longer having symptoms of flushing or dizziness after four to five hours, you should be able to resume breastfeeding. Hope this information helps.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center

[meliyet]

What do we know about dihydroergotamine DHE 45? My colleagues called me at home unable to find this in the 2010 book. I am working the NICU all wkend. Mom is 4 day post-op section. eclamptic delivered at 32 wks. Baby getting trophic feeds at this point. Appreciate an answer asap. thanks

[cpride]

Dear meliyet,

Dihydroergotamine mesylate (DHE 45) is an ergotamine drug used in the treatment of migraine headache and to enhance uterine contractions after delivery. We know that DHE 45 has high protein binding, and a large volume of distribution that would suggest only small amounts would enter into the milk compartment. The terminal half-life is 9 hours. DHE 45 is also poorly orally bioavailable so the infant would not be able to absorb much of the drug via breastmilk. Observe infant for hypertension. Since the infant is premature and may be on medications, possible untoward drug interactions are with CYP 3A4 inhibitors and macrolide antibiotics. Excessive dosing and prolonged administration may inhibit prolactin secretion and reduce mother's milk supply. Use during lactation is strongly discouraged. A similar medication called ergotamine is rated L 4 due to risk of decreasing prolactin, but only a minimal amount of the drug is absorbed by an adult. In summary, the risk to the infant would be low due to the kinetics of the drug, risk to the mother's milk supply especially if she had large doses and has been given multiple doses is high. Hope this information helps. If you have further questions, please call the InfantRisk Center at 806-352-2519.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center

[E&B'sMom]

Did you end up taking Relpax?

If so, did it have any effect on your baby? I too get debilitating migraines and started Relpax 40mg at onset years and years ago. I stopped using it once I got pregnant and throughout nursing my first. I now have my 2nd who is only 7 months and he's been more or less exclusively BF unless during one of the migraines I'm unable to nurse him for a while I supplement. I've had about 5-6 attacks and have gone without anything except taking Tylenol (which never helps). I never felt comfortable taking meds so I just waited them out but it's horrible, I get sick anywhere from 24-36 hours when I get them and am barely able to get out of bed. Most of the time I even vomit from them for at least a full day(sorry if TMI) I feel I'm At my wits end with them as I just struggled through one and I'm considering weaning my baby so I can take the Relpax which I know works but haven't come across and studies declaring its safe. Just wondering what your experience was with it.