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Nipple discharge/headaches
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cfrazier909 posted:
Hi I am a 35 year old female with nipple discharge and headaches that seem to be getting more intense. My first visit to the doctor about this problem was in 2007. I was told that it was normal and would clear up on its own. At the time the headaches hadn't started and I didnt have any breast pain. The nipple discharge never stopped from the time I had my daughter in 1999 to this present day. I have noticed it has slowed down and I have to manual express the nipple for for the discharge to come out. In 2009 I stated having having headaches and as time went by they have been more intense but only on my right temporal area. Now I have nipple discharge, headaches everyday , and breast pain, fatigue and drowiness. I had a mammaogram done it showed fibroticyst breast. My current doctor put me on propranolol to prevent the migraines, but id didnt help after being on the medication for 2 weeks, it made my blood pressure drop so he took me off the medicine and referred me to a neurologist. Im hoping someone can help me with this. The headaches i have dont allow me to do daily activities, my right eye is sensitive to light. The pain i feel is described as pressure and a pulsating feeling in my right temple.
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Jane Harrison Hohner, RN, RNP responded:
Dear cfrazier: My first thought in reading your subject line was a pituitary mass (adenoma) as these can produce bilateral nipple discharge and, if large enough, headaches/visual changes. Yet the nipple discharge is usually spontaneous (ie stimulation or manual expression not really needed). Also I would suspect that your GYN would have drawn a prolactin level (hormone elevated with this type of pituitary lesion).

It's good that you got a mammogram to evalaute the breast pain. It is true that fibrocystic breast changes can be linked to breast pain, too.

Alas, I am not a neurologist so I cannot even posit what the origin of your daily headaches might be. Your symptoms (unilateral, light sensitivity, and marked pain) do sound like a migraine, but only a neurologist can give you the most "for sure" diagnosis.

Bottom line, if your prolactin level is normal a pituitary tumor as a cause for nipple discharge and headaches is unlikely. If the prolactin level is low then your GYN would probably suggest that you not do manual expression. Even that amount of nipple stimulation (or prolonged foreplay with breasts) can increase nipple discharge.

Hopefully a neurologist can find a medication which will control the headaches. There are so many diferent classes of medications from which to choose. Like birth control pills, sometimes one has to try several different options to find the best.

In Support,
Jane
 
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cfrazier909 replied to Jane Harrison Hohner, RN, RNP's response:
Thank you for you advice. As of present day my doctor has not checked my prolactin level. I did have a hysterectomy at age 23, although one ovary was left. If I didn't have the nipple discharge I would say agree with you that it is a migraine. If the headaches had started before the nipple discharge that would had made me think different as well. I have a had the nipple discharge every since my last pregnancy in 1999. The only thing that changed since the birth of my last pregnancy is I have to manual express the fluid. Everythin I have read makes me think its putuitary tumor. I have every symptom. But once I go to the doctor I will know after the MRI and or prolactin level. I have to trust my instinct. This is why in 2010 I woke up with sharp chest pain, and when I took a breath it hurt very bad. I took asprin and got ready for work. I worked through my whole shift knowing something very bad was going on. But because I thought I was too young, and had been told by doctors and nurses on more then one occasion I was too young for this or that. I waited went home and when I couldnt take the pain anymore or get a good breath, I went to the emergency room. I checked myself in I told them what was wrong. My O2 stat was okay in the high 90's. So they had me wait in the waiting room and when they were ready to the diagnostic test they cam and got me and sat me right back in the waiting room. Upon the results coming back from CT, a tech came and took me to a room, thats when the doctor told me I had a blood clot in my right lower lobe. I asked the doctor why did you wait so long to get me a room, when i already told the nurse what i thought was wrong? He told me because they didnt suspect a clot because of my age. So I thank you for your advice.
 
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Jane Harrison Hohner, RN, RNP replied to cfrazier909's response:
Dear cfrazier: Gosh, a pulmonary embolism at age 23! Very unusual in a non-birth control pill user, or one without a coagulation disorder. ..Do let us know how your prolactin or scan turns out.

Yours,
Jane
 
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cfrazier909 replied to Jane Harrison Hohner, RN, RNP's response:
I just wanted to correct you. The hysterectomy was age 23 and the PE was age 32. I have had alot of serious medical problems for my age, but living in chronic pain has become a part of my life. I can only hope for the best. My appointment is on the third of December. I'm hoping to get my CT scan the same day. My first surgery was when I was 9 months old. I had
Intussusception. When I was seven I started getting sore throats and strep that wasnt treated and I got rheumatic fever. I didnt find out I had tricuspid regurgitation until 2002, because i went to the hospital complaining of chest pain. thats when they found the pericarditis and the tricuspid regurgitation. When I got my menstrul cycle at 12 years of age, my cramps were terrible as i got older they got worse. In 2002 I had to have a hysterectomy because I had endometriosis, left one ovary. Before the hysterectomy I was getting recurrent ovarian cyst, the biggest one was 9cm. 5 months ago I had a partial bowel obstruction. Im only 35 and sometimes I feel older, throughout my whole life it really hasnt been a time when i wasnt ill. Some people complain about the flu or common cold. I wish I was that lucky to get minor illness like that, but when i get sick its always serious. Thanks for listening this means alot. Wish me luck.

Yours,
Crystal
 
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Jane Harrison Hohner, RN, RNP replied to cfrazier909's response:
Dear Crystal: A hysterectomy at 23 is still way too young and a PE at 32 is not very common. You're right, your health history should make most of us grateful for having relative good health. Your story certainly gives me a big dose of gratitude.

In Support,
Jane
 
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cfrazier909 replied to Jane Harrison Hohner, RN, RNP's response:
I HAVE A NEW SYMPTOM AND I DONT KNOW WHAT IT MEANS. I HAVE WEAKNESS AND PAIN IN MY LEFT ARM IT STARTED YESTERDAY, ITS VERY WEAK FROM THE SHOULDER DOWN MY ARM AND HAND. IM SO TIRED. WHAT DO YOU THINK?

THANK YOU,
CRYSTAL
 
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Jane Harrison Hohner, RN, RNP replied to cfrazier909's response:
Dear Crystal: Weakness and pain down the arm MIGHT suggest a heart attack, a minor stroke, or a neurologic problem. While we usually think of these conditions as being more likely in older women your health history is replete with conditions less common in younger women.

PLEASE contact your primary care MD promptly about this new symptom.

Yours,
Jane
 
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cfrazier909 replied to Jane Harrison Hohner, RN, RNP's response:
Happy New Year Jane,

I am now taking Lopresser 50mg to help with the palpatations. But it seem I still have them off and on. I was in the hospital a few weeks ago for chest pain. The only thing that they found was I was having palpations and thats when they prescribed the Lopresser. My lab work showed a low serum myoglobin and elevated d dimer, low calcium. After looking through my medical records my d dimer seem to be increasing at a steady pace. I also have a constant low grade fever that never goes over 100. I was taking the Midrin for the headaches, and before that Tyelenol. So I didnt even notice a fever. But I have been having a constant fever for over a year or more. I dont know what to do. Its so hard to find a physician who listen. What do I do next? Oh when I was admitted in the hospital the EKG showed anterolateral ischemia, ST changes, T wave inversion???? Please help.
 
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cfrazier909 replied to cfrazier909's response:
My d dimer by dates:

04/19/2011-<150 ng/ml

blood transfusion-07/10/2011

d dimer-07/11/2011----445 ng/ml

d dimer--07/11/2011----0.60mcg/ml

d dimer--12/09/2012----0.70 mcg/ml

myoglobin--12/09/2012---18 ng

What do all this mean? Is my d dimer increases? I used this online conversion calculater and it seems to be increasing. Please let me know if this is correct.
 
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cfrazier909 replied to Jane Harrison Hohner, RN, RNP's response:
My d dimer by dates:

04/19/2011-<150 ng/ml

blood transfusion-07/10/2011

d dimer-07/11/2011----445 ng/ml

d dimer--07/11/2011----0.60mcg/ml

d dimer--12/09/2012----0.70 mcg/ml

myoglobin--12/09/2012---18 ng

What do all this mean? Is my d dimer increases? I used this online conversion calculater and it seems to be increasing. Please let me know if this is correct.
 
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Jane Harrison Hohner, RN, RNP replied to cfrazier909's response:
Dear Crystal: All I know about the d-dimer test is that it is a fibrin degradation product measure (ie after a clot has been formed by activation of factor VII, or a damage to a blood vessel wall--and then the clot breaks down. I do not have any hematology expertise to even do a guess as to the explanation of your labs.

Many years ago I started my nursing life as an ICU/CCU RN so I can give you some basic info on your EKG report terminology:

1. Anterolateral ischemia--this means decreased oxygen (ie decreased blood flow) to the heart muscle in the front section and also to the side (could be right or left). The exact location can sometimes be an indication of a blockage/narrowing in a specific coronary artery. For example left anterior descending artery is a major coronary artery that supplies the left ventricle of the heart.

2. T wave inversion--a lit search at the National Library of Medicine site found this recent study on T wave inversion:

Circulation. 2012 May 29;125(21):2572-7. doi: 10.1161/CIRCULATIONAHA.112.098681. Epub 2012 May 10.
Prevalence and prognostic significance of T-wave inversions in right precordial leads of a 12-lead electrocardiogram in the middle-aged subjects.
Aro AL, Anttonen O, Tikkanen JT, Junttila MJ, Kerola T, Rissanen HA, Reunanen A, Huikuri HV.
Source

Division of Cardiology, Department of Medicine, Helsinki University Central Hospital, Finland. aapo.aro@helsinki.fi
Abstract
BACKGROUND:

T-wave inversion in right precordial leads V(1) to V(3) is a relatively common finding in a 12-lead ECG of children and adolescents and is infrequently found also in healthy adults. However, this ECG pattern can also be the first presentation of arrhythmogenic right ventricular cardiomyopathy. The prevalence and prognostic significance of T-wave inversions in the middle-aged general population are not well known.
METHODS AND RESULTS:

We evaluated 12-lead ECGs of 10 899 Finnish middle-aged subjects (52% men, mean age 44 ? 8.5 years) recorded between 1966 and 1972 for the presence of inverted T waves and followed the subjects for 30 ? 11 years. Primary end points were all-cause mortality, cardiac mortality, and arrhythmic death. T-wave inversions in right precordial leads V(1) to V(3) were present in 54 (0.5%) of the subjects. In addition, 76 (0.7%) of the subjects had inverted T waves present only in leads other than V(1) to V(3). Right precordial T-wave inversions did not predict increased mortality (not significant for all end points). However, inverted T waves in leads other than V(1) to V(3) were associated with an increased risk of cardiac and arrhythmic death (P<0.001 for both).
CONCLUSIONS:

T-wave inversions in right precordial leads are relatively rare in the general population, and are not associated with adverse outcome. Increased mortality risk associated with inverted T waves in other leads may reflect the presence of an underlying structural heart disease.

3. S-T changes--here is a better description with some common causes listed

http://www.uptodate.com/contents/ecg-tutorial-st-and-t-wave-changes

Crystal, the interpretation of your EKG should be given by an internist, as it depends upon in what leads the findings were seen.

I hope the beta blocker will quell your palpitations (?atrial fib?). Wish I had more expertise to give but my specialty is "Pelvis World".

Yours,
Jane
 
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cfrazier909 replied to Jane Harrison Hohner, RN, RNP's response:
Jane,

Thank you so much. You have given me a place to start. As I was reading your email it came to me how many times I have had to go to the hospital for chest pain. Everytime I have had an ECG it has been abnormal and always showed T wave inversion. I have always been told by doctors that its non specific. But after reading the article and seeing what the rhythm strip looks like on an ECG I now know it my be worth looking into. I have tricuspid regurgitation and I was diagnosed in 2002, I just hope and pray I find a cardiologist that will do a right ventricular angiography on me. Thank you once again.

Crystal
I will keep you updated.


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