Women with enlarged breast tissue who experience frequent headaches are often told they have “tension headaches,” but new research from Wake Forest University School of Medicine suggests many have migraine, a neurologic condition that requires different evaluation and treatment.
The findings were recently published in Cephalalgia Reports.
In a small observational study, most women who sought breast reduction surgery and reported headaches screened positive for migraine rather than tension-type headache, as is commonly assumed. Many participants also reported fewer and less severe headaches after surgery, with improvements lasting more than a year.
“Headache is a common complaint in women with macromastia, or enlarged breast tissue, pursuing breast reduction surgery, yet it’s often not evaluated in depth,” said Kristyn Pocock, M.D., assistant professor of neurology at Wake Forest University School of Medicine and corresponding author of the study. “Our findings suggest we may be missing migraine in this population, and that matters for diagnosis, treatment and quality of life.”
Migraine is a neurologic disorder that can cause severe pain, light sensitivity, sound sensitivity, nausea and disability. It requires different management than tension‑type headache, which is typically much milder and often assumed to be linked to muscle strain or stress.
Women are disproportionately affected by migraine, particularly during the same years many seek breast reduction surgery. Despite this overlap, headache symptoms in women with large breasts are not routinely studied using established headache criteria.
“This is an important gap,” Pocock said. “If migraine is being overlooked, patients may not be getting appropriate migraine-specific care or may be living with headaches longer than they need to.”
For the study, researchers followed 34 adult women with enlarged breast tissue who experienced at least four headache days per month and were scheduled for breast reduction surgery. Before surgery, participants completed validated headache and health questionnaires and took part in an interview with a headache specialist.
Participants completed follow-up surveys three to four months after surgery and again up to two years later. Researchers looked at headache frequency, pain intensity, disability, skin sensitivity and risk for sleep apnea.
Key findings before surgery:
- 91% of participants screened positive for migraine
- Headaches were frequent and disabling, averaging about 10 headache days per month
- Many participants reported atypical headache symptoms that warranted further neurologic evaluation
After surgery, participants reported:
- Fewer headache days, less pain and less disruption to daily life
- Improvements within months that persisted for up to 28 months
- Better sleep and improved neck pain
While the study was not designed to prove that surgery treats migraine, the results suggest a possible connection that deserves closer attention, Pocock said.
Because this was a small pilot study, the researchers emphasize the need for larger studies to better understand why headaches improve and how breast size and structure, posture, sleep, weight and nerve or muscle strain may play a role.
“We’re not saying breast reduction surgery is a migraine treatment. To determine this, we need to conduct a large randomized controlled trial,” Pocock said. “But these findings tell us we need to ask better questions, involve headache specialists earlier and study the underlying biology more carefully.”
Pocock said future research will explore whether some headaches associated with enlarged breasts represent a previously unrecognized headache condition, or whether breast size may precipitate or worsen underlying migraine in some patients.
“Our goal is simple,” Pocock added. “We want women’s symptoms to be taken seriously, and assessed accurately, so they can receive the care they deserve.”