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
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.
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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."
