Vasospasm is a real nuisance and we have been wrestling with it at the
Edmonton Breastfeeding Clinic.  Here is what I have concluded to date.

1.  Vasospasm is not infrequent.  While there are only two or three reported
cases in the literature, we have seen about twenty cases at the clinc.

2.  Vasospasm symptoms are very similar to yeast.  Mothers complain of a
burning, searing pain of the nipple with radiation to the breast.  If you
have diagnosed yeast and yet it doesn't respond to topical and oral
antifungals, think of vasospasm.

3.  Vasospasm has been referred to as Raynaud's of the nipple.  There is
nothing to substantiate that this is a connective tissue disease.  I have
seen one patient who also had true Raynaud's of the fingers but it was
quiescent at the time she had her nipple vasospasm.  No other patients had a
personal or family history of Raynauds or of other connective tissue
disease.   I have also work up several patients for connective tissue
diseases and all have been negative.

4.  Vasospasm seems to be associated with other nipple pathology including
cracks, mastitis and yeast.  Treating these other problems can sometimes
help the symptoms.

5.  The vasospasm we have seen, has not responded to tea bags, heat or
topical nitroglycerine.  It has responded wonderfully to nifedipine 5 mg
three times per day for one week only.  The patients are either cleared up
or significantly improved and did not need or want more medication.

I generally try to avoid medication in patients.  The dosage of nifedipine
is a very low one and I do not use the sustained preparations.  Mothers can
get a headache with the medication or might feel a little lightheaded.  If
they are having any side effects I usually tell them to stop.  The babies
also have to be watched closely.  ( Dr. Hale recently reviewed nifedipine on
Lactnet.)

I would love to study this in more depth and publish a proper article on it.
So much pathology, so little time!

Hope this helps,

from the Great Canadian North,
M. Shirley Gross M.D.,C.M., C.C.F.P.
I.B.C.L.C
Director of the Edmonton Breastfeeding Clinic