Abstract Details

Title Macromastia in Headache Medicine: A Survey of American Headache Society Members

Topic Headache

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 15-009

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 141 respondents, most were female (68%), White (71%), aged 30–39 (47%), and specialized in neurology (84%). 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; 68% 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 also 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.

Authors/Disclosures
Kristyn Pocock, MD PRESENTER	Dr. Pocock has nothing to disclose.
Aubrey Heath	No disclosure on file
Alexa Hirshman	No disclosure on file
Joseph Rigdon, PhD	No disclosure on file
Elizabeth Laikhter, MD	No disclosure on file
Lisa R. David, MD	No disclosure on file
Richard B. Lipton, MD, FAAN (Albert Einstein College of Medicine)	Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Allergan/Abbvie. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Amgen. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biohaven. Dr. Lipton has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Eli Lilly. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lundbeck. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for GlaxoSmithKline. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Teva. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Vedanta. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Grifols. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Pfizer. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Axon. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Satsuma. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cool Tech. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BDSI. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Linpharma. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Axsome. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Clexio. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shiratronics. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Allergan/Abbvie. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biohaven. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lundbeck. Dr. Lipton has or had stock in Biohaven.Dr. Lipton has or had stock in Manistee.Dr. Lipton has or had stock in Axon.Dr. Lipton has or had stock in CoolTech. The institution of Dr. Lipton has received research support from Teva. The institution of Dr. Lipton has received research support from Amgen. The institution of Dr. Lipton has received research support from Allergan/Abbvie. The institution of Dr. Lipton has received research support from Gammacore. The institution of Dr. Lipton has received research support from Axsome. The institution of Dr. Lipton has received research support from Charleston Labs. The institution of Dr. Lipton has received research support from Eli Lilly. The institution of Dr. Lipton has received research support from Satsuma. The institution of Dr. Lipton has received research support from NIH . The institution of Dr. Lipton has received research support from Veterans Administration. Dr. Lipton has received publishing royalties from a publication relating to health care.
Jamy Ard, MD	No disclosure on file
Rebecca E. Wells, MD, FAAN (Wake Forest Bapttist Medical Center)	The institution of Dr. Wells has received research support from NIH. Dr. Wells has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Southern Headache Society. Dr. Wells has a non-compensated relationship as a Board member with Southern Headache Society that is relevant to AAN interests or activities. Dr. Wells has a non-compensated relationship as a Board member with American Headache Society that is relevant to AAN interests or activities.

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