Macromastia in Headache Medicine: A Survey of American Headache Society Members
Kristyn Spera Pocock1, Aubrey Heath2, Alexa Hirshman2, Joseph Rigdon3, Elizabeth Laikhter4, Lisa R. David4, Richard B. Lipton5, Jamy Ard6, Rebecca Erwin Wells1
1Atrium Health Wake Forest Baptist, Department of Neurology, Comprehensive Headache Program, Winston-Salem, NC; Wake Forest University School of Medicine, Winston-Salem, NC, 2Wake Forest University School of Medicine, Winston-Salem, NC, 3Wake Forest University School of Medicine, Winston-Salem, NC; Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, 4Wake Forest University School of Medicine, Winston-Salem, NC; Atrium Health Wake Forest Baptist, Department of Plastic Surgery, Winston-Salem, NC, 5Department of Neurology, Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, 6Wake Forest University School of Medicine, Winston-Salem, NC; Department of Neurology, Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY
Objective:
To assess awareness, attitudes, and clinical perceptions of headache specialists regarding macromastia as a contributor to headache and neck pain.
Background:
Headache disorders disproportionately affect women, yet biological contributors to this disparity remain poorly understood. Breast hypertrophy (macromastia) has been linked to musculoskeletal and neurological symptoms, including headache, which is cited by insurers as an indication for breast reduction—despite limited evidence. Although macromastia is common (average US bra size is 34DD), its role in craniocervical pain disorders has received little attention in neurology and pain research.
Design/Methods:
A 21-item online survey via Survey Monkey was distributed to American Headache Society (AHS) members by email (Sept 4–Oct 22, 2024). Additional responses were collected in person at the AHS Scottsdale Headache Symposium (Nov 14–17, 2024).
Results:
Among 121 respondents, most identified as women (64%), White (66%), aged 30–39 (46%), and specialized in neurology (86%). While 58% were familiar with “macromastia,” only 4% had training in evaluating it in headache patients. Half (51%) considered breast size moderately to extremely important in headache management; 43% had suspected macromastia as a contributing factor. Yet, 79% never asked about breast or bra size. Forty-five percent had been asked by patients about macromastia’s role, and 38% had referred patients to plastic surgery. Neck pain was perceived as significantly more associated with macromastia than tension-type headache (TTH) (p=0.013) or migraine (p=0.001), and cervicogenic headache more than migraine (p=0.041), but not TTH (p=0.134). Respondents viewed macromastia’s influence on neck pain and cervicogenic headache similarly (p=0.480); migraine and TTH were perceived similarly (p=1.00). Most (55%) disagreed that macromastia is primarily due to obesity.
Conclusions:
Half of surveyed headache specialists felt breast size is an important factor in managing craniocervical pain, with cervicogenic headache and neck pain perceived as most strongly associated with macromastia. More research is needed to clarify macromastia’s role in craniocervical pain.
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