Nipple Vasospasm: Signs, Triggers and How to Get Relief

Your baby comes off the breast, and within seconds your nipple goes white and starts to burn, throb or sting. A few minutes later it may turn purple or red as the color comes back. If that sounds familiar, you may be dealing with nipple vasospasm, also called Raynaud’s phenomenon of the nipple.

It’s more common than many people realize, and it’s often mistaken for thrush. The good news is that it’s treatable, and most of what helps is simple. Here’s how to recognize it, what sets it off and when medicine is worth discussing with your doctor.

What is nipple vasospasm?

A vasospasm is a sudden tightening of small blood vessels. When the vessels in the nipple clamp down, blood flow drops for a while, the skin turns pale and the area hurts. When the vessels relax, blood rushes back and the color and sensation return.

The NHS notes that Raynaud’s most often affects the fingers and toes but can also affect the nipples, and that episodes can last from a few minutes to a few hours.

It isn’t rare in breastfeeding. In an Australian study that followed 360 first-time mothers for 8 weeks after birth, 23% reported vasospasm at some point.

Signs of nipple vasospasm

The Academy of Breastfeeding Medicine (ABM) Protocol #26 describes vasospasm as blanching (whitening) or purple color changes of the nipple with sharp, shooting or burning pain. Common patterns:

• Color changes. The nipple turns white, then often blue or purple, then red as blood flow returns. In a 2024 systematic review of published cases, about 48% of women had all three color phases and about 41% had two.
• Pain after feeds rather than during them. Many people notice it when the warm mouth comes off and the nipple meets cooler air.
• Pain with cold. ABM gives examples such as stepping out of a warm shower or walking through the frozen food section of a grocery store.
• One or both sides. Symptoms may affect both nipples, or only one, especially if that nipple is or was damaged.
• A history of cold hands and feet, such as needing socks to sleep or gloves in mild weather, or a diagnosis of Raynaud’s.

ABM notes that people with connective tissue disorders such as rheumatoid arthritis, or a previous Raynaud’s diagnosis, are at higher risk.

Vasospasm vs. thrush

Burning nipple pain and a pale nipple can look a lot like yeast, so vasospasm is often treated as thrush first. The research shows how often that happens:

• In a 2004 Pediatrics case series of 12 breastfeeding women with nipple Raynaud’s, 8 had taken several courses of antifungal medicine without relief.
• In a 2013 JAMA Dermatology review of 22 breastfeeding mothers, 20 (91%) had been treated for yeast without success before vasospasm was diagnosed.

Clue	More like vasospasm	More like thrush
Color	Nipple turns white, then purple/blue, then red	Pink, shiny or flaky skin; no white-to-red cycle
Timing	Comes and goes in episodes, often after feeds or with cold	Tends to hurt during and after every feed
Cold	Clearly worse with cold, better with warmth	No clear link with temperature
Baby	Baby’s mouth looks normal	Baby may have white patches in the mouth

Thrush and vasospasm can also happen together, and both can follow nipple damage. Our guide to thrush while breastfeeding covers the yeast side in more detail.

What triggers it?

Common triggers, based on ABM, the NHS and the 2024 review:

• Cold, including cool air on a wet nipple after a feed or pumping session
• Temperature changes, such as getting out of a shower
• Stress
• Nipple damage from a shallow latch
• Caffeine and nicotine. The NHS advises people with Raynaud’s to stop smoking and limit caffeine, and the 2024 review lists caffeine, nicotine, alcohol and vasoconstrictor medicines among things to avoid.

If you’re wondering how much coffee is reasonable while nursing, see our guide to caffeine while breastfeeding. For nicotine, read about vaping and smoking while breastfeeding.

What helps

Keep the nipple warm

Warmth is the first-line treatment. ABM Protocol #26 recommends:

• Warmth right after a breastfeed or whenever pain starts, for example a warm compress or heat pad
• Avoiding cold on the breasts and nipples

In practice that can mean covering the breast as soon as your baby unlatches, keeping a warm (not hot) pad within reach, feeding in a warm room and dressing in layers. The 2024 review also mentions breastfeeding in warm conditions and staying as relaxed as you can during feeds.

Fix the latch and any damage

A shallow latch can squeeze and damage the nipple, and ABM notes that vasospasm symptoms can affect one or both sides in the setting of current or past nipple trauma. If your nipple looks flattened, creased or cracked after feeds, ask a lactation consultant to watch a feed. Our guides on how to get a deep latch and on sore and cracked nipples explain the basics.

Cut back on triggers

Limiting caffeine, avoiding nicotine and keeping warm can all reduce episodes, based on the NHS’s general Raynaud’s advice.

When medicine is used

If pain continues despite warmth and latch help, your doctor may suggest a prescription medicine. Nifedipine, a blood pressure medicine that relaxes blood vessels, is the one most often used. ABM Protocol #26 describes an initial two-week course if pain persists, noting that some women need longer. Your doctor decides the dose and type.

How strong is the evidence? Fairly limited:

• In the 2004 case series, all 6 women who chose nifedipine had prompt pain relief.
• In the 2013 review, 10 of 12 mothers who tried nifedipine had less pain or none.
• The 2024 systematic review found only case reports and case series (19 studies in all) and no randomized trials. It names low blood pressure, a fast heart rate and dizziness as possible side effects.

So nifedipine looks helpful in small reports, but it hasn’t been tested in large trials for this use. On breastfeeding, LactMed says nifedipine levels in milk are low and no adverse effects have been reported in exposed infants, and it describes nifedipine as used for painful nipple vasospasm in mothers who don’t respond to measures such as hot compresses and avoiding cold. Talk through the benefits, side effects and your own situation with your doctor or pharmacist before starting.

When to call a doctor or lactation consultant

ABM Protocol #26 defines persistent breastfeeding pain as pain lasting longer than 2 weeks and notes that up to 1 in 5 women still report pain at 2 months. Pain like that deserves a proper look. Contact your provider if:

• Nipple pain lasts beyond the first 2 weeks or keeps getting worse
• Warmth and latch changes don’t help
• You’ve been treated for thrush and it isn’t working
• The nipple is cracked, bleeding or looks infected
• You also have color changes in your fingers or toes, joint pain, skin rashes or muscle weakness (the NHS lists joint pain, skin rashes and muscle weakness as reasons to see a doctor about Raynaud’s, since it can sometimes be a sign of another condition)
• Pain is making you dread feeds or think about stopping

ABM also recommends that people with persistent breastfeeding pain be checked for mood symptoms, because pain and low mood are linked. You don’t have to just push through. Find an IBCLC or local group on our breastfeeding support page, or browse more guides in our Common challenges hub.