Research Summary

Study Links Higher Migraine and Neck Pain Prevalence to Macromastia

Edited by:
Brian McCurdy

Key Highlights

  • Researchers compared 347 women with macromastia with 340 matched controls in an academic neurology practice.
  • Macromastia was associated with a higher prevalence of chronic migraine, neck pain, cervical radiculopathy, and obstructive sleep apnea after adjustment.
  • Among women with macromastia, only neck pain was associated with a greater likelihood of reduction mammoplasty.

Women with macromastia had a higher prevalence of chronic migraine, neck pain, cervical radiculopathy, and obstructive sleep apnea (OSA) than matched controls, according to a retrospective cross-sectional study published in Headache. These associations persisted after adjustment for BMI, demographics, and comorbid mood disorders.

Investigators examined the relationship between breast hypertrophy and specific headache, neck pain, and sleep-related diagnoses. They also evaluated factors associated with reduction mammoplasty, noting that although insurers list headache as an indication for breast reduction, its relationship to particular headache phenotypes remains poorly understood.

Researchers reviewed records of women treated at an academic neurology practice from January 1, 2017, through December 31, 2024. Macromastia was identified using ICD-10 code N62 for breast hypertrophy. Women with and without the diagnosis were propensity-matched on age, race-ethnicity, and BMI.

The primary outcome was the prevalence of chronic migraine, neck pain, occipital neuralgia, and cervical radiculopathy. Secondary outcomes included OSA prevalence and rates of reduction mammoplasty among women with macromastia, assessed by craniocervical diagnosis.

Study Findings

The analysis included 347 women with macromastia and 340 controls. Differences remained after matching: mean BMI was 28 versus 26.5 kg/m2, depression prevalence was 48.4% versus 29.7%, and anxiety prevalence was 57.3% versus 32.9%. Both mood-disorder comparisons had P values < .001.

After adjustment, macromastia was associated with higher prevalence of chronic migraine (adjusted prevalence ratio [aPR], 1.40; 95% CI, 1.16–1.68; P = .003), neck pain (aPR, 2.04; 95% CI, 1.65–2.53; P = .003), cervical radiculopathy (aPR, 2.38; 95% CI, 1.39–4.06; P = .026), and OSA (aPR, 1.54; 95% CI, 1.23–1.95; P = .003). The association with occipital neuralgia was not statistically significant (aPR, 1.54; 95% CI, 0.98–2.39; P = .054). Among women with macromastia, only those with neck pain were more likely to undergo reduction mammoplasty.

Clinical Implications

According to the authors, the findings identify a higher prevalence of several craniocervical pain disorders and OSA in women with macromastia. They called for prospective, longitudinal research to clarify potential mechanisms and determine how macromastia treatment affects headache outcomes.

Expert Commentary

“Prospective, longitudinal studies are needed to clarify potential mechanisms driving macromastia's impact on migraine and other disorders and to assess the impact of macromastia treatment on headache outcomes,” the researchers concluded.

Reference

Pocock KS, Rigdon J, Smirnoff L, et al. Patterns of head and neck pain and obstructive sleep apnea in women with macromastia: a cross-sectional analysis. Headache. Published online September 22, 2026. doi:10.1111/head.70226