Macromastia Linked to Risk for Chronic Migraine, Neck Pain

Risk for chronic migraine, pain, and sleep problems is significantly higher in women with enlarged breast tissue due to macromastia than in women without the condition, a new study showed.Macromastia, also called breast hypertrophy, is marked by the abnormal, excessive enlargement of one or both breasts that is disproportionate to an individual’s body frame.In a cross-sectional analysis of nearly 700 women, those with macromastia were 40% more likely to have chronic migraine, 54% more likely to have obstructive sleep apnea (OSA), and roughly twice as likely to have neck pain and cervical radiculopathy — even after controlling for BMI.“Many people think of enlarged breast tissue primarily as a cosmetic issue, but our findings suggest it may be associated with a broader range of women’s health concerns, including chronic migraine, neck pain and sleep-related breathing disorders,” lead investigator Kristyn Pocock, MD, assistant professor of neurology at Wake Forest University School of Medicine in Winston-Salem, North Carolina, said in a statement.The study was published online on September 22 in Headache.Tracking Neurologic SymptomsPrevious research has linked macromastia to musculoskeletal and neurologic symptoms, including headache and neck pain. However, its relationship with specific headache disorders, cervical radiculopathy, and sleep-related disorders is not well understood.Investigators reviewed electronic health records for 23,288 women treated at headache and neurology clinics affiliated with Stanford Medical Center between 2017 and 2024.The analysis included 347 women (mean age, 58.1 years) with an International Classification of Diseases, 10th Revision, diagnosis of macromastia and 340 matched women without macromastia (mean age, 57.0 years).Analyses were adjusted for age, BMI, race and ethnicity, marital status, depression, and anxiety. Depression and anxiety were more common among women with macromastia (48.4% vs 29.7% and 57.3% vs 32.9%, respectively; P < .001 for both).Neck Pain Stands OutChronic migraine was more common among women with macromastia (adjusted prevalence ratio [aPR], 1.40; P = .003). Women with macromastia were about twice as likely to have neck pain (aPR, 2.04; P = .003) and more than twice as likely to have cervical radiculopathy (aPR, 2.38; P = .026). There was no significant association with occipital neuralgia.One possible explanation for the higher odds of headache and other symptoms is that the additional weight of enlarged breast tissue may place greater mechanical strain on the cervical spine, which could contribute to neck and nerve pain, the investigators noted. However, the study’s cross-sectional design cannot determine whether macromastia contributes to these conditions or whether other factors explain the associations.OSA was also more common among women with macromastia (aPR, 1.54; P = .003). Potential explanations include that enlarged breast tissue may affect breathing or be associated with lower physical activity, but the study could not determine why.The analysis also examined breast reduction surgery. Neck pain was the only condition significantly associated with undergoing the procedure (aPR, 2.33; adjusted P = .037). Chronic migraine, cervical radiculopathy, occipital neuralgia, and OSA were not significantly associated with breast reduction.What Comes NextThe investigators cautioned that the cross-sectional design prevents causal inference and that reliance on diagnostic codes limits information on symptom severity, duration, and functional impact.“Taken together, our study underscores the need for greater understanding of the relationship between macromastia and craniocervical pain disorders and whether treatment of macromastia has the potential to improve headache in a specific cohort of patients,” the investigators wrote.“These data suggest that clinicians evaluating women with macromastia and headache should consider formal headache phenotyping and screening for OSA as part of comprehensive assessment,” they added.The investigators call for prospective, longitudinal studies to determine whether macromastia contributes to migraine, OSA, and broader pain symptom burden and whether treatment affects these outcomes.Disclosure information for study authors is available in the original study publication.