Women with very large breasts who often suffer from headaches are frequently told they have “tension headaches.”
But new research from Wake Forest University School of Medicine suggests that many of these women may actually have migraine, a neurological condition that needs different diagnosis and treatment.
The findings, published in the journal Cephalalgia Reports, come from a small observational study of women seeking breast reduction surgery.
Researchers found that most of the participants who reported frequent headaches met screening criteria for migraine rather than tension-type headache, which is usually considered milder and linked to stress or muscle strain.
Migraine is more than just a bad headache.
It is a neurological disorder that can cause severe throbbing pain, sensitivity to light and sound, nausea, and significant disruption to daily life.
Women are affected by migraine far more often than men, especially during the same years when many seek breast reduction surgery. Despite this overlap, headache symptoms in women with enlarged breast tissue are not routinely assessed using formal migraine criteria.
Dr. Kristyn Pocock, assistant professor of neurology at Wake Forest and the study’s lead author, said headache is a common complaint among women with macromastia, the medical term for enlarged breast tissue.
However, these headaches are often not carefully evaluated. As a result, migraine may be overlooked, and patients may not receive migraine-specific care that could improve their quality of life.
The study followed 34 adult women who had enlarged breasts and experienced at least four headache days per month. All were scheduled for breast reduction surgery. Before surgery, participants completed detailed headache questionnaires and were interviewed by a headache specialist.
Before surgery, 91 percent of the women screened positive for migraine. On average, they reported about 10 headache days per month, and many described symptoms that suggested more complex neurological involvement than simple muscle tension. These headaches were often disabling.
After surgery, many participants reported meaningful improvements. Within three to four months, they experienced fewer headache days, lower pain intensity, and less interference with daily activities. Improvements were still reported up to two years later. Many also said their sleep quality improved and neck pain decreased.
The researchers emphasize that the study does not prove breast reduction surgery treats migraine. It was a small pilot study and not designed to establish cause and effect. However, the results suggest there may be an important link that deserves further investigation.
Future research will explore whether large breast size may trigger or worsen migraine in some women, possibly through posture changes, muscle strain, nerve pressure, sleep disruption, or other biological mechanisms. Larger studies, including randomized controlled trials, will be needed to better understand the connection.
For now, the researchers say the key message is simple: women with enlarged breasts and frequent headaches should be evaluated carefully. Their symptoms should not automatically be labeled as tension headaches. Accurate diagnosis can lead to more appropriate treatment and potentially better quality of life.
