Transgender and Migraine: Impact of Hormone Therapy

    January 2019 in “ Headache ”
    E. Anne MacGregor, Alec Maassen van den Brink
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    TLDR Hormone therapy may increase migraines in transgender women and decrease them in transgender men; more research is needed on migraine management in transgender individuals.
    The document from 2019 examines the impact of hormone therapy on migraine prevalence and characteristics in transgender individuals. It highlights that transgender women may experience an increase in migraine prevalence post-sex reassignment surgery and after feminizing hormone therapy, similar to cisgender women, while transgender men may see a reduction in headache frequency and severity following testosterone therapy. The document underscores the need for clinicians to consider the effects of hormone treatment on migraines and to provide appropriate management advice. It also discusses the potential mechanisms by which hormones affect migraines, such as changes in pain thresholds and susceptibility to cortical spreading depression. Additionally, the document notes the importance of contraception in transgender men and non-binary individuals on hormone therapy and the need for correct headache diagnosis and management according to national guidelines. The conclusion emphasizes the scarcity of high-quality research on the care of transgender individuals with migraine and the necessity for more studies to inform management guidelines. It also advises transgender individuals about the risks of hormone therapy, including the increased risk of ischaemic stroke associated with migraine aura, and the importance of managing cardiovascular risk factors and smoking cessation.
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