To:  Christine Choong and Lactnetters
Dear Christine,
     I wonder if the mother has an epidural headache?  Other
possibilities - *before* we consider if this is one of those difficult
cases where the headache is severe and continues during lactation (and
only time will tell that) - include the fairly common postnatal
headache, commonly on or about days 3-6, from falling hormonal levels.
Do take a careful case history, which may help point up specific
factors. It is good if the mother is willing to keep a headache diary,
indicating also the intensity of the headaches on a scale of 1-10 (10 =
very severe).
    You mentioned that the pain eases if the baby comes off the breast.
This may be a *positive* factor you can use, i.e. it may make it
bearable if the mother can take the baby off for a few minutes, before
reattaching.  She may be better able to cope.  If she is motivated about
breastfeeding (espec. for the IQ and future educational benefits, so
valued in a Chinese community), she may be willing to keep going with BF
on a week by week basis, or even half a week at a time.  (Women
sometimes can cope with planning half a week or a week, and then
reviewing about continuing for another week.)
    The Mum is going to need appropriate pain relief, including
pharmaceutical. Time the medications so that they are acting by the time
the feed starts, at least for some feeds.  Some mothers also find neck
massage, by a physical therapist, helpful - but in recent months I had a
call from a mother whose severe headaches were linked to deep neck
massage by a hospital physical therapist.  So, though it can be helpful,
it depends on how it's done and the particular client.  Biofeedback,
taught by a physical therapist, may help in pain relief, too.  I don't
have case histories where Chinese pain relief, such as acupuncture, were
used, but it might be something to consider.
    One final point:  this Mum has enough pain to cope with.  So it is
very important that she have good "latch" to prevent any nipple pain.
Two lots of severe pain are too much for lany woman to be asked to cope
with!
    Keep us posted on what eventuates.
     Cheers,
          Virginia
          Virginia Thorley
          Lactation consultant (private practice)
          Brisbane, Queensland, Australia


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