Key takeaways: Nipple vasospasm happens when blood vessels in the nipple tighten, causing color changes and burning or throbbing pain, often after feeds or in the cold. Fixing latch problems, keeping nipples warm, and avoiding triggers help. Some people need prescription treatment. It’s sometimes mistaken for thrush.
Nipple vasospasm can be very painful and is often misdiagnosed. Here’s how to recognize it.
What It Is
Vasospasm means blood vessels suddenly narrow, reducing blood flow. When it affects the nipple, it may be called Raynaud’s phenomenon of the nipple, especially if it happens to someone who also gets cold, color-changing fingers or toes.
Signs
- Color changes: the nipple turns white (blanches), then may turn blue or purple, then red as blood returns.
- Pain: burning, stabbing, or throbbing, often after a feed or when exposed to cold.
- Pain can last minutes to an hour or more.
Common Causes and Triggers
- Nipple compression from a shallow latch. When a nipple comes out of the baby’s mouth flattened or white, the latch is often the trigger.
- Cold exposure, such as air after a feed or a cold room.
- Raynaud’s phenomenon history.
- Nicotine and caffeine may contribute for some people.
- Nipple damage or infection.
Why It’s Confused With Thrush
Burning nipple pain is often blamed on thrush. A 2004 study by Anderson and colleagues described mothers who had been treated for thrush without relief and actually had vasospasm. Color change is a key clue.
What Helps
- Get latch help. An IBCLC can help deepen the latch.
- Keep warm: cover the nipple right after feeds and apply dry warmth (a warm, dry cloth or a heat pack wrapped in cloth).
- Avoid cold: dress warmly and keep rooms warm.
- Limit caffeine and avoid nicotine.
- Gentle massage of the nipple and areola with warm hands after feeds may ease spasm.
Medical Treatment
For persistent or severe vasospasm, a doctor may prescribe nifedipine, a blood pressure medication that relaxes blood vessels. It’s considered compatible with breastfeeding. Some clinicians also suggest magnesium or vitamin B6, though evidence for these is limited. Discuss options with your doctor.
See your doctor or IBCLC if: you have ongoing nipple pain, color changes, or pain that hasn’t improved with latch changes.
The Bottom Line
Nipple vasospasm causes color changes and burning pain. Improve latch, keep nipples warm, and ask about treatment if it persists.
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Sources
- Anderson JE, Held N, Wright K. Raynaud’s phenomenon of the nipple: a treatable cause of painful breastfeeding. Pediatrics. 2004;113(4):e360-e364.
- Berens P, Eglash A, Malloy M, Steube AM; Academy of Breastfeeding Medicine. ABM Clinical Protocol #26: Persistent pain with breastfeeding. Breastfeed Med. 2016;11(2):46-53.
- National Library of Medicine. Nifedipine. Drugs and Lactation Database (LactMed). https://www.ncbi.nlm.nih.gov/books/NBK501922/
This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.
