How migraine impacts the transgender community
Before our webinar on migraine in transgender people, we polled the migraine community to see what questions people had. Host Dr. Anna Pace, director of the Transgender Headache Medicine Program at Mount Sinai, discussed the latest in research and treatment and answered questions from the community. Read on for her responses:
Can testosterone cause migraine?
Testosterone is a hormone that tends to be anti-pain, says Dr. Pace. According to studies in both animals and in humans on primarily cisgender patients (meaning they identify with the same gender assigned at birth), researchers used testosterone to help reduce the severity of pain. Any change of hormones, either an increase or decrease, could potentially affect migraine, says Dr. Pace. There hasn’t been enough research to say for certain that testosterone is a trigger of migraine in an individual. But some patients on testosterone may experience fewer attacks. Changes in testosterone levels may affect how frequently migraine attacks occur.
How do transition surgeries affect migraine frequency and severity?
In women whose gender identity matches their biological sex, removal of the uterus and ovaries can increase migraine attack frequency. This is because the removals cause estrogen levels to quickly decrease. That sudden drop in hormones can be a trigger, says Dr. Pace. In any case, keeping a headache diary before and after surgery will show how the frequency changes. Dr. Pace says the surgeries themselves are not something a person should be concerned about in terms of causing migraine or leading to migraine. A transgender person can use migraine treatments to reduce the chance attacks will increase while taking hormone therapy.
What is the stroke risk in transgender people taking estrogen who have migraine with aura?
While there is no specific data about stroke risk in transgender people, data on women whose gender identify matches their biological sex show aura can be worsened by estrogen, and women with aura are at a slightly higher risk of stroke compared to the general population. Preventive therapy, lifestyle modifications and complementary treatments may minimize aura, but the effect on stroke risk is unknown.