Chronic headaches/migraines: extending indications for breast reduction

In patients with macromastia, the currently accepted indications for reduction mammaplasty are back pain, neck pain, shoulder grooving, and intertrigo in the inframammary fold. Occipital neuralgia and chronic headaches/migraines are not indications, but the authors noted anecdotally that numerous patients with macromastia complained of chronic headaches/migraines, and many of them reported headache improvement following surgery. Therefore, the authors conducted a retrospective review of their cases to evaluate this association.

A retrospective chart review of all patients undergoing reduction mammaplasty between 2003 and 2008 performed by the senior author (I.D.) was conducted. Patients were followed with clinic visits and telephone interviews. Collected data included preoperative symptoms, pain scores, and postoperative findings. Statistical analysis was conducted using the paired t test.

Of the 84 patients who underwent reduction mammaplasty for macromastia between 2003 and 2008, 58 (69 percent) had chronic headaches preoperatively. Of these 58 patients, 31 (53 percent) reported a greater than 50 percent reduction in headache frequency and severity, with 12 (21 percent) stating that their headaches resolved completely after surgery. These patients reported a mean pain score of 7.2 (of 10) before surgery that dropped to 3.2 after reduction mammaplasty. Of all patients, 90 percent reported an improvement in their quality of life.

The authors' data show that patients with macromastia who have occipital neuralgia and/or chronic headaches/migraines can experience headache relief following reduction mammaplasty. Future research should evaluate headaches as indications for reduction mammaplasty. Those patients whose headaches do not improve following breast reduction should consider further specialized evaluation and treatment.