Can Mastitis Cause Headaches in Postpartum Breastfeeding Women?
Mastitis itself does not directly cause headaches, but the systemic inflammatory response and fever that accompany mastitis commonly produce headache as a constitutional symptom. 1, 2
Understanding the Connection
Systemic Symptoms of Mastitis
- Fever, malaise, and headache occur together as part of the systemic inflammatory response when mastitis progresses beyond localized breast inflammation. 1, 2
- The American Academy of Pediatrics recognizes that patients with mastitis present with focal breast tenderness accompanied by fever and malaise, which are systemic manifestations. 3
- Fever and chills in a postpartum patient with mastitis indicate systemic involvement and warrant close monitoring, with hospitalization considered for worsening symptoms or concern for sepsis. 1
Clinical Presentation Pattern
- Focal breast tenderness typically precedes visible skin changes, followed by systemic symptoms including fever, malaise, and associated headache. 4, 2
- Mastitis represents a spectrum of inflammatory conditions, with diagnosis made clinically based on fever, malaise, and focal breast symptoms. 2
- Most cases occur in the first 3 months postpartum, particularly within the first 6 weeks of breastfeeding. 2, 3
When to Escalate Care
Warning Signs Requiring Hospitalization
- Persistent fever and chills despite outpatient antibiotics indicate systemic involvement requiring IV antibiotics and hospital admission. 5
- Worsening symptoms or concern for sepsis necessitate intravenous antibiotics and hospitalization. 1, 2
- The presence of severe headache with high fever, altered mental status, or signs of sepsis should prompt immediate evaluation for septic complications. 1
Critical Pitfall to Avoid
- Never discontinue breastfeeding during mastitis treatment, as this worsens the condition and increases abscess risk. 5
- Regular feeding or milk expression is an essential component of treatment and should continue even during hospitalization. 1
Management Approach
Initial Conservative Management (1-2 days)
- NSAIDs for pain and fever control (which will also address headache). 2
- Ice application to affected breast. 2
- Continued breastfeeding from the affected side. 1, 2
- Minimize pumping to avoid overstimulation. 2
Antibiotic Therapy if No Improvement
- Dicloxacillin or cephalexin as first-line antibiotics targeting Staphylococcus aureus. 5, 3
- Clindamycin or azithromycin as alternatives if needed. 5
- Most patients respond to oral antibiotics as outpatients. 2
The headache associated with mastitis is a secondary symptom of the systemic inflammatory response and fever, not a direct effect of the breast inflammation itself. Treatment of the underlying mastitis with appropriate antibiotics and supportive care will resolve the headache as the systemic symptoms improve. 1, 2