Tag: hair

The Facts About Cold Capping



I was diagnosed with breast cancer in 2015, right around the same time the first FDA-approved cold cap came out. I’d heard about the potential hair-saving helmet on the news, and I crossed all my follicles that it could work for me as I prepared to start chemotherapy.

Unfortunately, I wasn’t a candidate for scalp cooling therapy. Back then, the cooling devices were only approved for early-stage breast cancer and less potent types of chemo. I was stage 3 and taking doxorubicin, also known as the “red devil.” So, yeah, pretty potent stuff.

Although I was disappointed that I couldn’t try cold capping to reduce hair loss during chemo, just knowing it was out there made me hopeful for advancements in cancer treatments. Hair loss may seem like a small thing when talking about disease, but it can be really devastating. One recent report cited up to 14% of women won’t consider chemotherapy because of hair loss.

Cold caps don’t work for everyone, and results vary from person to person depending on a lot of different factors. But new research shows using cold caps can help some people keep a good amount of hair during chemo — even people getting the red devil: In one study, 71.4% of people on doxorubicin saw successful hair retention. That’s a hair flip in the right direction.

If you or someone you know is interested in cold caps for chemo-induced hair loss, here’s what you need to know.

What is cold capping?

Cold capping involves wearing a helmet-like device to lower the temperature of the scalp during chemotherapy. The cold temperature decreases blood flow, which can reduce the amount of chemo that reaches the hair follicles and may reduce hair loss for some people.

What are the types of cold caps?

Scalp cooling therapy includes two types of devices:

  • Automated: The insulated cold cap is hooked up to a machine that circulates cooling liquid or gel inside the cap. Once the device is hooked up, the cooling system will keep the temperature where it needs to be. Automated cold caps are regulated by the FDA.
  • Manual: The frozen gel caps are stored in a freezer or with dry ice. Because the gel will start to warm once it’s on the scalp, a new frozen cap will have to be replaced about every 30 minutes. Manual cold caps are not regulated by the FDA.

How do cold caps work?

Both types of cold caps work by reducing the temperature of the scalp before, during and after chemo.

Typically, the person administering the chemo will help set up the automated cold cap machine and make sure the temperature is correct and that the cap is secured tightly around your head.

People using manual caps also need an outside pair of hands to help with the caps, although it doesn’t have to be a nurse — family or friends can help during treatment.

Who can use cold caps?

People with solid tumors (breast, colon, lung, gynecological) can use cold caps to help reduce hair loss during chemo.

Who shouldn’t use cold caps?

Cooling caps are relatively safe overall, but some people with certain health conditions shouldn’t use cold caps.

For example, people with blood cancers like leukemia or lymphoma shouldn’t use cold caps because the restricted blood flow may stop the chemo from getting to where it needs to go.

You also shouldn’t use cold caps if you:

  • Have central nervous system cancer
  • Are getting chemo for a bone marrow transplant
  • Had radiation to the head or will have radiation to the scalp

Cold capping is not recommended for people who have cold-agglutinin disease, cryoglobulinemia and post-traumatic cold dystrophy.

What are the side effects of cold caps?

Cold caps live up to the name, so if you’re sensitive to cold temperatures, you may feel uncomfortable during the sessions. Other side effects of cold capping can include:

  • Dry skin
  • Feelings of claustrophobia when wearing the cap
  • Headache attacks
  • Nausea
  • Cold thermal injury (burn) from manual caps

Do I need a prescription for scalp cooling therapy?

Whether you need a prescription depends on which type of cold cap you want to try. The automated systems require a prescription, and the manual systems do not. Always be sure to ask your healthcare provider before using any type of scalp cooling device.

Is cold capping covered by insurance?

Manual frozen caps are not covered by insurance, but automated cold caps are covered by Medicare and may be covered by other insurance plans.

If you need help paying for the cooling therapy, nonprofit organizations such as HairToStay and The Rapunzel Project may be able to help cover the cost of cold capping.

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The Facts About Redheads and Pain


Rebecca Sager, senior vice president of development for HealthyWomen, was in the prep room at the hospital getting ready to deliver her first child when the nurse came in and asked her an odd question. “Are you a real redhead?”

“You’re going to find out in a minute,” Sager quipped, knowing the nurse was there to see how dilated she was. Sager is, in fact, a real redhead. Or as she put it, the carpet matches the drapes.

Natural redheads are rare — less than 2% of the population. Was the nurse so taken by Sager’s firey mane that she had to know if it was real? Probably. But she also asked because, if Sager’s hair color was natural, it meant she may need more pain management during labor.

“I’d never heard that before,” Sager said.

Do redheads have a higher pain tolerance?

There’s a growing body of research that shows that people with red hair experience pain differently compared to people of other hair colors. The jury’s still out as to why this may be, but one theory has to do with the melanocortin-1 receptor (MC1R) gene.

All people with red hair are born with a mutation of the MC1R gene. That’s not only what gives them flaming locks of auburn hair, but, according to a 2021 study, it also reduces the function of the gene. And those changes affect the balance between pain sensitivity and tolerance.

Overall, research on redheads supports the seeming contradiction that they have a higher tolerance for pain in general, but they have increased sensitivity to certain types of pain.

For example, one study found women with red hair were more sensitive to temperature-related pain compared to women with dark hair. But another study found that people with red hair were less sensitive to pain by electric shocks.

The differences don’t stop at the way redheads perceive pain. They also respond to pain medication differently. Given the range of pain sensitivity and different types of pain, pain management can present challenges for people with red hair. Studies show redheads may require higher doses of some types of non-opioid pain relievers. But, the 2021 study mentioned above found that redheads may be more sensitive to opioids and need less medication to stop pain.

The sensitivity to opioids may be even more pronounced in women. One study found that women with two parents who have read hair — meaning they have two variant MC1R genes — had significantly higher pain tolerance and significantly higher sensitivity to opioids.

Rebecca Sager, rocking her red locks, 2023

Rebecca Sager, rocking her red locks, 2023

Do redheads need more anesthesia?

The research on whether redheads need more anesthesia is limited, but if you talk to women with red hair, you may hear anecdotal evidence that they require more anesthesia. Why? The theory is back to the MC1R gene mutation, which leads to a reduced response to anesthesia, so more is needed. One study found that women with red hair required almost 20% more anesthesia for sedation compared to women with dark hair.

Della Lin, M.D., an anesthesiologist and secretary of the Anesthesia Patient Safety Foundation, noted that the research regarding redheads and more anesthesia comes from smaller studies, so it may not be something your healthcare provider (HCP) thinks about right away.

Lin encourages people with red hair — and everyone else — to bring up any concerns about anesthesia or pain management before the procedure. “I might keep that thought in the way back of my mind [that you have red hair], but I’m not going to increase anything by default,” Lin said. “So it’s nice to know if you’ve noticed that you’re sensitive to opioids … because everyone is a little bit different.”

Jackie Wexler, a middle school teacher with curly scarlet-red hair, said she had no clue her hair color was tied to her reaction to medicine. But looking back, regular OTC pain medications haven’t done much for her menstrual cramps or her headache attacks. “Now I have the worst migraine attacks and nothing helps,” she said.

Read: 8 Types of Migraine Attacks >>

It makes sense to her that the high pain tolerance and high tolerance to certain painkillers is genetic. She said her sister, who also has red hair, needed more pain medication than they would give her when she gave birth.

Sager is now mindful of her real redhead status and tries to get her HCPs on the same page regarding any pain medication or anesthesia she may need. Still, some providers don’t think the connection between redheads and pain is true. When Sager went in for a colonoscopy, she told her anesthesiologist that she needed a higher dose. She pointed to her head. He said she didn’t. So when the nurse came in and asked why she was still coherent and sitting up, Sager didn’t mince words. “I’m a redhead. I’m different.”

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