What are your strategies for preventive migraine therapy in breastfeeding patients?  

Transfer to milk depends on how highly a medication is protein-bound. Measurable concentrations occur for drugs <70% bound. >85% bound is not expected to have a measurable concentration in infants. Propranolol, amitriptyline, and Depakote are >90% protein-bound so I consider them first. Bot...

For me, the treatment of migraine during nursing is an extension of that during pregnancy. My expectation of headaches during pregnancy is that they improve, certainly after the first trimester. I would expect that improvement to continue during nursing until the recurrence of menstruation. If this ...

I treat many lactating patients and refer them frequently to LactiMed or Hale’s for safety data. The choice of treatment will always be made collaboratively with the patient. In lactation, unlike pregnancy, most medications are going to be safe as the percentage of medication in the milk is ty...