Headache in transgender and gender‐diverse patients: A narrative review

Abstract

Objective: To summarize the unique aspects of managing headache in gender minorities and current research in this area including the potential relationship between gender-affirming hormone therapy (GAHT) and headache. Background:The study of headache in gender minorities is intrinsically important.Gender minorities are medically underserved, and their medical care to date has been limited by socioeconomic disadvantages including stigma and an unsupportive clinical environment. Despite the rising population of transgender and gender-diverse adults and youth, headache research has also been limited. Knowledge of hormonal effects on headache in cisgender patients raises the question of possible effects of GAHT on transgender patients. Methods/Results:The manuscript is a narrative review of current best practices in treating transgender patients, including the use of appropriate terminology and ways to create a supportive environment. It also contains current guidelines on GAHT and reviews drug-drug interactions and secondary headache related to hormone therapy.We also review transgender headache research and related research on hormonal effects on headache in cisgender individuals. Conclusion:Creating a supportive environment for transgender and gender-diverse patients and being knowledgeable about GAHT are key to providing quality headache care. This review identifies further research needs for this population including the epidemiology of headache disorders in sexual minorities and the potential effects of GAHT on headache disorders in transgender patients.

Inclusion of Historically Oppressed Genders in Neurologic Practice Research

“…4 There are other considerations when treating patients on gender-affirming hormone therapy, including potential changes in the frequency of migraine headaches and serum levels of seizure medications. 5 We applaud the authors for the manuscript's use of affirming language in the case description. This is particularly noteworthy in comparison with the broader literature, which often uses culturally insensitive terminology, even at the date of publication (Table ).…”

“…4 There are other considerations when treating patients on gender-affirming hormone therapy, including potential changes in the frequency of migraine headaches and serum levels of seizure medications. 5…”

Virtual issue: Diversity, equity, and inclusion

“…Physical activity had a fluctuating impact on migraine odds that varied with type and intensity 6 7 . In this work, the authors share guideline principles on gender‐affirming hormone therapy, provide insight into potential drug–drug interactions in transgender headache care, and review secondary headaches related to hormone therapy 7 …”

“…7 In this work, the authors share guideline principles on gender-affirming hormone therapy, provide insight into potential drug-drug interactions in transgender headache care, and review secondary headaches related to hormone therapy. 7 The final papers in our collection brought forth an advocacy and community awareness perspective to DEI. In a comprehensive piece, Shapiro addresses the inequity of headache medicine (particularly cluster headache and migraine) with regards to the disease impact, societal burden, and lack of NIH funding.…”

“…6 Just prior to the publication of this editorial, Hranilovich and colleagues published a narrative review on headache in transgender and gender-diverse patients. 7 In this work, the authors share guideline principles on gender-affirming hormone therapy, provide insight into potential drug-drug interactions in transgender headache care, and review secondary headaches related to hormone therapy. 7 The final papers in our collection brought forth an advocacy and community awareness perspective to DEI.…”