女子栄養大学栄養科学研究所年報

Vol. 26 （2021）35

寄 稿〈6〉

Breastfeeding and Migraine: a brief review
Colin W. BINNS＊1, ＊2
Masaharu KAGAWA＊1, ＊3, ＊4, ＊5
Abstract (Approx. 200 words)
Migraine is an important cause of disability that occurs in atleast 14% of the world s population, including 212 million
persons in East Asia. The aim of this review is to explore possible
links between breastfeeding and reduced rates of migraine inmothers and children. Migraine episodes ﬂuctuate with levels ofsex hormones and are reduced in mothers in the post-partum
period while they are lactating. The reduction may be as much as
60% in lactating mothers compared to those mothers who are
feeding their infants formula. The reduction appears to be related
to stabilization of estrogen levels. One large scale retrospective
study (n=24011) found that there was a significant reduction in
migraine episode s in children aged 3-17.
The evidence of a short-term reduction in migraine inbreastfeeding mothers is of moderate strength. The link between
breastfeeding and migraine in children is only suggestive. Further
long-term cohort studies are required to test whether anassociation exists.
抄録
片頭痛は, 少なくとも東アジアの 2.12 億人を含む世界
人口の14％が抱える健康障害の原因である。本総説では,母乳育児と母親および子どもにおける片頭痛発生率の低下との可能性について探ることを目的とした。片頭痛症状の発現は性ホルモンの量で変動し, 出産後に授乳を行っている母親で改善が報告されている。人工栄養を与えている母親と比較して, 母乳を与えている母親における片頭痛の発生率は最大で 60％まで減少する。この現象はエストロゲンの量が安定することに因るものと思われる。大規模な後ろ向き研究（n=24,011）では, 3-17歳の子どもで片頭痛症状の発現の有意な減少が報告されている。
母乳を与えている母親では, 片頭痛の短期的な軽減効
果を示す根拠が適度に示されていた。母乳と子どもの片頭痛の関係は示唆できる程度であった。実際の関連性の有無を検証するためには, さらに長期的なコホート研究が必要である。
Introduction
The Drs Shozo and Aya Kagawa, founders of Kagawa
Nutrition University (KNU) were pioneers in research and in the
promotion of clinical and public health nutrition in Japan. They
gained an international reputation for establishing nutrition as adiscrete academic discipline in Japan where previously it wasviewed as a part of home economics or medicine. Drs Kagawa
conducted pioneering research into the B vitamins and theirimpact on health status as well as research from food science
perspectives1, 2). They established a research institute, currently
known as the Institute of Nutrition Sciences (IoNS) and the KNU
Nutrition Clinic to foster research activities and put researchoutcomes into practice. Today, KNU is taking a leading role inpromotion of folate intake for the prevention of chronic healthproblems with understanding genetic polymorphisms ofindividuals3).
If Drs Kagawa had been living in the 21st century at the timeof their work they would have been strong supporters ofbreastfeeding and its scientiﬁc value. Until the mid-20th century,
breastfeeding was universal in Japan and during their lives
breastfeeding, or not breastfeeding, would not have been a major
issue - its importance was simply acknowledged as a matter of life
or death4). In the last 50 years the importance of promoting
breastfeeding has emerged as a major public health issue as theavailability of commercial infant milk substitutes has had
detrimental eﬀects on infant health5, 6). Breastfeeding substantially
improves the health of infants and has beneﬁcial eﬀects on many
long-term chronic diseases for infants and mothers, including
postnatal depression and diabetes7). Recently there have been

✽1 School of Public Health, Curtin University, Kent Street, Bentley, Perth, Western Australia, 6102 Australia.

✽2 School of Applied Nutrition, Kagawa Nutrition University, 3-9-21 Chiyoda, Sakado, Saitama, 350-0288 Japan.

✽3 Institute of Nutrition Sciences, Kagawa Nutrition University, 3-9-21 Chiyoda, Sakado, Saitama, 350-0288 Japan.

✽4 School of Exercise and Nutrition Sciences, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, QLD, 4059 Australia.
✽5 Faculty of Public Health, Mahidol University, 420/1 Ratchawithi Rd, Thung Phaya Thai, Ratchathewi, Bangkok, 10400 Thailand.

36suggestions of beneﬁts to mothers who breastfeed in reduced ratesof migraine and dementia8, 9).
The Global Burden of Diseases (GBD) study has found thatheadache is a major global public health concern, one of the mostimportant causes of disability. It is estimated that in 2016, 1.04
billion persons (95% Uncertainty Interval 1.00-1.09) or 14.4%(13.8-15.0%) of the world s population, experienced migraine
headaches (GBD 2016 Headache Collaborators, 2018). Migraines
affect women three times more than men10, 11) and are mostcommon in women in the 15-49 year age group. The prevalenceis estimated to be slightly greater in higher income societies andoverall has decreased by 1.8% in the past 25 years12). About 18%
of women overall and 24% between 30 and 39 years of age suﬀers
from migraine13).
Several research studies have suggested important roles forhormones in of the aetiology of migraines. Fluctuations in thelevels of sex hormones are associated with the occurrence of
migraine attacks. Withdrawal of oestrogen may trigger migraine
pain, whereas levels of progesterone and testosterone function as
suppressors as they are involved in a range of metabolic pathways
that trigger inflammatory responses and the production ofneurotransmitters10, 11, 14, 15).
The aim of this commentary is to explore associations between:
1. Migraine prevalence in mothers who breastfeed theirinfants.
2. Migraine prevalence and in children who were breastfed, (orlater in life in adults who were breastfed).
Methodology
A literature search was undertaken using the keywords
migraine and breastfeeding in English, with no time
restrictions, using the databases PubMed and Web of Science. A
total of potential 171 references were identiﬁed an after screeningof abstracts for relevance, and the full texts of 74 papers wereretrieved.
Migraine headaches are deﬁned in lay terms as:
Migraines are headaches that typically last from 4-72 hours
and you may experience nausea and vomiting as well as sensitivity
to light or sound. Migraine suﬀerers frequently report throbbing
pain that worsens with normal activity. Migraines are associatedwith auras in some people. Auras are warning symptoms that may
occur before you experience a migraine. These warning symptoms
usually consist of visual disturbances such as flashing lights, orchanges in smell or perception. 16) The complete definitions of
migraine headaches from the International Headache Society
covers more than 40 pages of details17).

Breastfeeding Research The usual steps in understanding of causation of humanconditions is to undertake observation studies, beginning withcross-sectional observations and moving into more complex cohort
studies. Proposed mechanisms are usually explored in thelaboratory to establish biological plausibility. After associations areproposed using the results of observational studies a randomised
controlled trial is undertaken with double or triple blinding.
Research into infant nutrition, especially involving breastfeeding, ismore diﬃcult because of the important ethical issues involved18).
The known value of breastfeeding, and the risk of morbidly andmortality from use of artiﬁcial feeding substitutes, means that no
options are available for a true control group18). Evidence must be
accumulated from multiple cohort studies undertaken in diﬀerent
cultures and even then, it is also diﬃcult to adjust for all potential
confounding factors. The diﬃculties of understanding the eﬀects
of small diﬀerences in exposures in nutritional research are evenmore pronounced in infant feeding, as breastmilk is a living
biological ﬂuid that varies with infant age, maternal nutrition andhealth7). For these reasons the outcomes of breastfeeding researchoutcomes must be assessed diﬀerently to trials in clinical medicine
and pharmacology. However, overestimating the benefit ofincreasing the prevalence or duration of breastfeeding would haveno detrimental eﬀects, compared to a new drug with potentially
dangerous side eﬀects. In the assessment of breastfeeding the large
number of studies, large sample sizes and studies in many cultures
increases the importance if the results of breastfeeding researchand it should be ranked as a higher level of evidence.
Results and Discussion
Migraine headaches in East and South East Asia are estimatedto affect 212 million persons, a significant cause of disability12).
Among females of the reproductive age, although it has beenreported that migraines tend to improve during pregnancy andbreastfeeding10), a minority actually worsened their symptoms10, 19).
Recent studies report that migraines is a risk factor for
pregnancy complications, including pregnancy-associatedhypertension disorders and miscarriage, and also birth outcomessuch as low birth weight, preterm birth and caesarean delivery19-21).
However an earlier review suggested that there was no
relationship22). Further studies are needed as the exploration of
causes and the prevention of migraine may bring benefits topregnancy outcomes.
Breastfeeding inﬂuences hormone levels and has been shown to
reduce ovarian and breast cancers, which are also sensitive tohormonal changes6). Oestrogen secretion is stabilized during
pregnancy and lactation. In addition, breastfeeding stimulates
secretion of oxytocin that has been suggested to function as apotential analgesic agent for migraine 23). Consequently,

37

breastfeeding may be beneﬁcial in minimizing the occurrence of
migraines and associated pain. The first report in the literaturesummarised a series of case reports in the 1990s24). There havesince been several reports on associations between breastfeeding a
reduction in the severity and frequency of migraine in mothers25).
In a cohort study of 686 mothers in Brazil, 266 were identiﬁed as
migraine suﬀerers before pregnancy and after delivery those who
were exclusively breastfeeding had a 60% reduction in episodes in
the first 4 weeks after delivery25). Of the mothers who wereidentified antenatally as migraine suffers, of those who were
exclusively breastfeeding (n=53), 32% had a migraine attack
compared to 85% (n=40) in those using infant formula (n=40,
p<0.001)25).
A similar reduction was found in a cohort study of 208 mothers
recruited antenatally and followed to 12 months postpartum inJapan26). Of the 60 women who were identiﬁed as having migraine
there was an 85% remission rate in the third trimester. In the ﬁrst
6 months post-partum period the rates of migraine were 71% inbreastfeeding mothers, signiﬁcantly lower than the 95% in thoseusing bottle feeding26). A cohort of 96 mothers from Italy who had
migraine found that at 4 weeks postpartum in the mothers
breastfeeding 43% reported at least one episode of migraine
compared to 100% in the mothers who were breastfeeding.
A comprehensive review of headaches, including migraine inpregnancy concluded that most women notice their headache
either go away or greatly improve in the second and third
trimesters of pregnancy 27). Although there is probably a reduction
in migraine in women susceptible to headaches when breastfeeding
it still means that many breastfeeding women will require medicationand this can generally be given safely11, 28).
Several studies have raised the possibility that infants who arebreastfed have a reduction in migraine episodes later in life, aneffect proportional to the duration of breastfeeding9, 29). A large
retrospective analysis of 24011 adolescents in Croatia found that
8.3% had experienced migraine headaches. There was a signiﬁcant
inverse correlation between the duration of breastfeeding and theprevalence of migraine9, 29). However, in this study the history ofbreastfeeding was obtained retrospectively and as the control
group was children with other types of headache there was thepotential for misclassiﬁcation.
Breastfeeding in infants results in changes in the microbiome
which may be the mechanism for the association between
breastfeeding and reduced rates of some chronic disease risk
factors6). People who have migraine are more likely to be infectedwith Helicobacter pylori (H. pylori) 30, 31). Breastfeeding is associatedwith lower rates of H. pylori infection in infancy, but infection
rates increase throughout childhood suggesting that the protective
effect of breastfeeding is limited to the early years of life 32, 33).

Further research is required in this area, but it is possible thatbreastfeeding, a healthy microbiome, H. pylori infection andmigraine in children could be associated in some way as acomponent of the hypothesised gut-brain axis. The relationshipbetween H pylori infection, other gastro intestinal tract (GIT)
diseases (such as irritable bowel disease [IBS] and coeliac disease)and migraine, depression and other central nervous systemdiseases is termed the Gut-Brain axis34-36). Further research on
associations may find that a possible unifying mechanism is therelationship between the composition of the microbiome andbreastfeeding and central nervous system pathology.
Conclusion
Breastfeeding research is always difficult as there are many
confounding factors that require adjustment. This review provides
supportive evidence of a protective association between breastfeeding
and migraine in mothers and the possibility that protective eﬀects
may be evident in children who are breastfed. There are several
plausible biological models that support this suggestion whichmakes it worthy of further study. While there are many cohort
studies focusing on long-term beneﬁts of breastfeeding, few haveincluded any neurological outcomes. As an initial step it would be
useful to add questions on migraine to long-term cohort studies ofbreastfeeding, based on standard deﬁnitions. Strict adherence todefinitions of exposure and outcome would be needed. In themeantime, there are many other good reasons to support thepromotion of breastfeeding.
Conﬂict of Interest. The authors declare that they have noconﬂicts of interest to declare.
Contributions of the authors. Both authors contributed
equally to this review and take joint responsibilities for the content.
Ethics. This is a literature review and no ethics approval was
required.

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