Vasospasm describes a situation when blood vessels contract abnormally resulting in impaired blood flow to an area. People with Raynaud’s phenomenon (often associated with “auto-immune” illnesses such as lupus erythematosus and rheumatoid arthritis) may have vasospasm that will occur in the fingers when going outside from a warm house on a cool day. The fingers will turn white and the lack of blood getting to the tips of the fingers will cause pain.

Vasospasm of the nipples can occur occasionally during pregnancy and not infrequently with breastfeeding and can cause pain in the nipples and/or breasts. See also the information sheet “Sore Nipples”. Note, vasospasm pain in the breast is sometimes referred to as Mammary Constriction Syndrome (MCS), a related condition that is treated similarly.

Symptoms of vasospasm in breastfeeding:

Burning, stabbing, throbbing, and/or “pins and needles” pain in the nipple and/or in the breast usually once the baby is off the breast.

• Pain may also occur when stepping out of a warm shower or when going outside on a cold day.

• There may or may not be pain during breastfeeding.

• Nipples may change colour (red, white, or purple) and go back and forth between colours (e.g. white to pink, back to white) for several minutes or even an hour or two.

• • See this video of colour changes in the nipple.

• • Note: colour changes on their own (without pain) are not a concern.

• Because of a lack of blood flow to the nipple, healing of nipple damage/wounds may be delayed

Causes of vasospasm:

• Any cause of nipple pain, like a less than adequate latch or pulling at the breast (as in decreased milk flow), can be associated with vasospasm.

Treatment of vasospasm:

Note: vasospasm is often diagnosed as a Candida infection (yeast, fungus) because some of the symptoms are said to be similar. We recommend trying the suggestions below before trying treatments for yeast. Candida infections of the nipples are over-diagnosed.

1. Improve the latch. Almost all nipple soreness is due to a less than adequate latch, or made worse by a less than adequate latch. See information sheet “Latching and Feeding Management”. Try the latch quiz.

2. Air-drying the nipples, often recommended for other causes of sore nipples, may actually increase vasospasm because of the cool air. We see more cases of vasospasm in summer than in winter, presumably because of air conditioning.

3. Keep your nipples/breasts warm. Exposing the nipple to cooler air after it has been inside the baby’s warm mouth often triggers vasospasm. When baby comes off the breast, immediately cover the nipple with your warm hand while you get your bra done up. After taking a shower, wrap a towel around your breasts before stepping out of the shower enclosure. Wool breast pads keep the nipples warmer than regular cotton or disposable pads. You can also apply dry heat to nipples/breasts by using a heating pad or hot water bottle over your clothes.

4. All Purpose Nipple Ointment or olive oil. If using the All Purpose Nipple Ointment, warm a small amount between your fingers, reach inside your bra and squeeze and massage the areola. The same can be done with plain olive oil as an alternative.

5. Pectoral muscle massage. Massage the chest muscles below the collarbone and above the breasts after the feedings or at the onset of nipple or breast pain. The massage should be very vigorous and firm and should be done for 60 seconds on each side. You can also massage under or between the breasts or in her armpits, but this massage should be done gently.

6. Stretching. If there is pain in the breast, stretching the muscles around the breast throughout the day can help keep blood flowing more easily. Lift one arm to shoulder height or slightly lower and press it back/behind you. Hold the stretch while taking a couple of deep breaths. Do the stretch twice with each arm – once with your palm facing forward and once with it facing back. Use the photos below as a guide.

If there is little or no improvement: (skip to point 9 below as we have generally stopped using the treatments in point 7 and 8). Though 7 and 8 do seem to work, we recommend these only if the mother cannot take nifedipine for some reason. Though nifedipine is often used for high blood pressure, having a normal blood pressure does not mean you cannot take it.

7. Vitamin B6 in a B vitamin complex. Vitamin B6 seems to work best for vasospasm when it is taken as part of a B complex of vitamins that includes niacin. Take 100 mg of B6, in the complex, twice a day. The amount of B6 in each capsule will be listed on the bottle’s label. So, for example, if the overall capsule is 125 mg of B complex and there is only 50 mg of B6 in that capsule, then you would need to take two capsules, two times a day. If there is no significant improvement within one week, stop the B complex. If the B complex decreases the pain, continue taking it until your pain has been stable (or you have been pain-free) for 2 weeks, and then stop.

8. Magnesium can help relax muscles and blood vessels. A magnesium supplement can be especially helpful if there is vasospasm pain in the breasts. Take 250 to 300 mg of magnesium, twice a day. There are different forms of magnesium available as supplements – look for magnesium bisglycinate or magnesium citrate, as they are better absorbed and less likely to cause loose stool than others. If there is no significant improvement within 3 to 4 weeks, stop the magnesium supplement. If the magnesium decreases the pain, continue taking it until your pain has been stable (or you have been pain-free) for 2 weeks, and then stop.

9. Nifedipine (or other medication which causes relaxation of blood vessels). Nifedipine is a prescription drug used for high blood pressure. One 30 mg tablet of the slow release formulation once a day often almost always takes away the pain of vasospasm completely. After two weeks, we recommend you stop the medication. If pain returns (about 10% of the time), start it again. After two more weeks, stop the medication.  If pain returns (which is uncommon), start it again.

In resistant cases, we have prescribed nifedipine 30 mg of the slow release twice a day.

If necessary nifedipine can be used long term.  Side effects are uncommon, but headache is not rare. The dose can be increased if 1 tablet is insufficient (contact us for more information). Nifedipine may be used in conjunction with all of the other treatments listed above.

The information presented here is general and not a substitute for personalized treatment from an International Board Certified Lactation Consultant (IBCLC) or other qualified medical professionals.

This information sheet may be copied and distributed without further permission on the condition that it is not used in any context that violates the WHO International Code on the Marketing of Breastmilk Substitutes (1981) and subsequent World Health Assembly resolutions. If you don’t know what this means, please email us to ask!

©IBC, updated November 2016, 2021

Questions or concerns?  Email Dr. Jack Newman (read the page carefully, and answer the listed questions).

Make an appointment at the Newman Breastfeeding Clinic.