Transgender and Migraine

Migraine is known to be affected by sex hormones, with the higher prevalence in women during the reproductive years considered to be due to the effects of oestrogen. Hence, migraine is likely to be affected by hormones used for transgender treatment. Of the very limited data available, the prevalence of migraine increases in transgender women using oestrogen and reduces in transgender men using testosterone. The increased prevalence of migraine aura in transgender women may be associated with high oestrogen dosing, particularly of oral oestrogen. Risks can be reduced by using transdermal hormones, which result in stable physiologic levels. In patients with aura, modifiable risk factors for stroke should be managed, particularly smoking cessation. Otherwise migraine management should follow national guidelines.