ACP American College of Physicians - Internal Medicine - Doctors for Adults

A 31-year-old woman with a history of migraine is evaluated in the office for several severe migraine attacks that are not well controlled with over-the-counter analgesics. The headaches are severe, are associated with severe nausea and vomiting, and began 2 weeks ago after she delivered a healthy baby boy. She is currently breast feeding.

Results of physical examination, including neurologic examination, are normal.

This patient should be taking frovatriptan for her migraine attacks. Frovatriptan and sumatriptan are both considered compatible with breast feeding by the American Academy of Pediatrics. The patient has not responded to first-line therapy with simple analgesics and is reporting severe migraine attacks, for which a triptan is indicated.

The American Academy of Pediatrics has given butalbital and acetaminophen a rating of caution and metoclopramide and prochlorperazine a rating of concern for mothers who are breast feeding. Therefore, these drugs should be avoided in such mothers. In addition, the patient has already reported a lack of response to over-the-counter analgesics, so extra-strength acetaminophen is not likely to result in marked improvement.

Key Point

• Using frovatriptan or sumatriptan for treatment of migraine is compatible with breast feeding, according to the American Academy of Pediatrics.