Patterns of head and neck pain and obstructive sleep apnea in women with macromastia: A cross‐sectional analysis

Abstract Objectives/Background Symptomatic macromastia, or breast hypertrophy, is associated with musculoskeletal and neurological symptoms, including headache and neck pain. Though insurers list headache as an indication for breast reduction surgery, its relationship to specific headache phenotypes, neck pain disorders, and sleep‐related disorders remains poorly understood. Our objectives were to evaluate the potential relationship between macromastia and chronic migraine, neck pain, cervical radiculopathy, occipital neuralgia, and obstructive sleep apnea (OSA), and to assess factors that influence the likelihood of treatment with reduction mammoplasty in an academic neurology practice. Methods We conducted a retrospective cross‐sectional study of women with and without macromastia by reviewing the charts of women with and without diagnosed macromastia (using the International Classification of Diseases, Tenth Revision code N62, hypertrophy of the breast) treated at an academic neurology practice from January 1, 2017, to December 31, 2024. Groups were matched on age, race‐ethnicity, and body mass index (BMI) using propensity matching. In both groups, we analyzed diagnostic codes for chronic migraine, neck pain, cervical radiculopathy, occipital neuralgia, and OSA. The primary outcome was the prevalence of queried craniocervical pain disorders (e.g., chronic migraine, neck pain, occipital neuralgia, and cervical radiculopathy) in women with macromastia versus controls. For our secondary outcome, we examined the prevalence of OSA and rates of reduction mammoplasty in women with macromastia by type of craniocervical diagnostic code. Results We identified 347 women with macromastia and 340 matched controls. Postmatch differences remained for mean BMI (28.0 [SD = 6.7] vs. 26.5 [SD = 6.5] kg/m 2 , standardized mean difference = 0.194), depression (48.4% vs. 29.7%, p < 0.001), and anxiety (57.3% vs. 32.9%, p < 0.001). After adjusting for BMI, demographics, and comorbid mood disorders, women with macromastia had significantly higher adjusted prevalence ratios (aPRs) for chronic migraine (aPR = 1.40; 95% CI = 1.16–1.68, p = 0.003), neck pain (aPR = 2.04; 95% CI = 1.65–2.53, p = 0.003), cervical radiculopathy (aPR = 2.38; 95% CI = 1.39–4.06, p = 0.026), and OSA (aPR = 1.54; 95% CI = 1.23–1.95, p = 0.003), but not occipital neuralgia (aPR = 1.54; 95% CI = 0.98–2.39, p = 0.054), compared to controls. Among women with macromastia, only those with neck pain were more likely to undergo reduction mammoplasty. Conclusion In our retrospective, cross‐sectional study, compared to women without macromastia, women with macromastia had a higher prevalence of chronic migraine, neck pain, cervical radiculopathy, and OSA. Women with macromastia and neck pain were more likely to have breast reduction surgery compared to women with macromastia without neck pain. 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.