Recognizing Macromastia in Women as a Potential Risk Factor for Headache: Kristyn Pocock, MD

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"If [macromastia is] really impacting [the patient’s] life, I often refer them to plastic surgery to have that conversation. If it doesn't have a huge impact on their life and there are a lot of conservative options left like migraine therapies, physical therapy, supportive bras—I recommend trying those first.”

Symptomatic macromastia, known as enlarged breasts, is characterized by persistent headache, neck and shoulder pain, thoracic kyphosis, painful shoulder grooving from bra straps, inframammary rash, backache, and upper extremity paresthesias. Among 100,000 women in the United States who underwent breast reduction surgery, up to 89% reported headache before surgery, and many noted improvements afterward.¹ Research has shown that headache can even be recognized as an insurance indication for surgical reduction, and that the peak prevalence of migraine can align closely with the average age of women who undergo this procedure.

Despite these associations, the neurological aspects of macromastia seem to remain underrecognized in research. In a recent literature review, researchers did not find any studies published in Neurology that examined macromastia-associated headache or the effects of reduction mammoplasty.¹ This gap may highlight how the condition, although well documented in plastic surgery, has received little attention in neurology. Researchers emphasized the need for answers to key questions, including which headache types affect women with macromastia and which are most likely to improve following surgical intervention.

Headache neurologist Kristyn Pocock, MD, an assistant professor of neurology at Wake Forest Baptist Atrium Health, addressed these concerns during her presentation at the 2025 American Headache Society (AHS) Annual Meeting, held June 19-22, in Minneapolis, Minnesota. Her talk at the meeting explored potential mechanisms linking macromastia and headache, encouraging neurologists to consider breast size as a contributing factor in chronic head and neck pain.

In a conversation with NeurologyLive^® at AHS 2025, Pocock expanded on these clinical insights. She stressed the importance of careful patient evaluation, recommending that clinicians ask about bra size and functional limitations as part of the assessment. Before surgery, she advised prioritizing conservative strategies such as migraine therapy, physical therapy, and properly fitted or medical-grade bras. Although acknowledging that breast reduction surgery can provide significant relief in severe cases, Pocock underscored that it should remain a last-line option, given its surgical risks and the potential impact on future breastfeeding.

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REFERENCES
1. Pocock KS, Laikhter E, Hardy BW, et al. Enlarged Breast Size (Macromastia) and Associated Neurologic Risks: A Scoping Review. Neurology. 2025;104(11):e213633. doi:10.1212/WNL.0000000000213633
2. Pocock K. Understanding the Headache of Enlarged Breast Tissue (Macromastia) and Impact of Surgery: A Prospective Cohort Study. Presented at: 2025 AHS Annual Meeting; June 19-22; Minneapolis, MN. Scientific Abstracts 1 OR-06.