If simple analgesics, e.g. paracetamol and ibuprofen, are insufficient to treat symptoms, sumatriptan is the drug of choice for the treatment of acute migraine. Although there is limited data about the safety of 5HT1receptor agonists (triptans) in breastfeeding, adverse effects in breastfed infants would not be expected, especially considering their short term use. Although some sources suggest deferring breastfeeding for a period (often 8 hours) after each dose, there is no evidence to support the need for this caution in practice.
Propranolol or metoprolol are preferred to pizotifen or clonidine for the prophylaxis of migraine as they have a greater safety profile in normal adult use and significant evidence of safety in breastfeeding.
Sumatriptan is the preferred choice in breastfeeding for treatment of cluster headache; verapamil is the preferred choice for prophylaxis.