Everyone with migraine has different experiences, needs and triggers. But for trans people, there can be additional factors to consider. Hormone therapy, surgery and high levels of stress and trauma can all have an impact on migraine. As well as this, the barriers often experienced around accessing healthcare means that living with migraine can be particularly challenging for the trans community.

This blog looks at some of the key challenges involved in living with migraine as a trans person.

Terms we use in this blog

Trans (or transgender) people are people whose gender identity does not correspond with the sex they were assigned at birth. We also use the term trans in this blog to refer to non-binary people, who do not identify as either a man or a woman. It’s important to note that not all trans people with migraine will have the same experiences and needs.

Hormone therapy and migraine

Hormone therapy is a common treatment for trans people. You may take testosterone if you are a trans man and oestrogen if you are a trans woman.

It’s important to note that if you have migraine with aura, you shouldn’t take oral oestrogen (tablets or pills) as hormone therapy. This is because of a very small, but significant increase in the risk of stroke. Your doctor may prescribe topical forms of oestrogen that you apply to your skin, like patches, gel or spray instead.

The aim of hormone therapy is to make you feel more comfortable in how you look and feel. But how might it affect your migraine?

Migraine and hormones are closely linked. In people with a female reproductive system, a drop in oestrogen levels is known to be a migraine trigger. However, taking ‘exogenous’ hormones (hormones from outside the body) can also have a big impact on your migraine.

Although there isn’t much evidence in this area, studies have shown that:

• trans women taking oestrogen may experience an increase in frequency of migraine attacks
• trans women may also start experiencing migraine with aura for the first time
• trans men taking testosterone may experience a decrease in migraine attack frequency.

Every person responds differently to hormone therapy. If you are taking hormone therapy as part of your transition, it’s important to have your hormone levels checked regularly. It’s a good idea to keep a record of your migraine attacks too, so you can talk to your doctor if you notice a change in frequency. You can use our headache diary to help with this.

It’s important that your GP or consultant is aware of any migraine medicines you are taking if you are starting hormone therapy. Check with them before starting any new migraine medicines too. They can make sure that there are no interactions between different medicines.

Surgery and migraine

If you are considering surgery to remove your womb or ovaries as part of your transition, it’s also important to be aware of potential effects on your migraine. When done for reasons other than gender transition, this surgery often leads to migraine getting worse. This is due to the sudden drop in hormones after the surgery.

This may not be the case when you have the surgery as part of your transition, as you will usually be established on testosterone hormone therapy beforehand. This means you are less likely to experience such a dramatic change in hormone levels after surgery. If you are considering surgery as part of your transition, talk to your doctor about the possible effects on your migraine. They can tell you what to expect and help you to plan ahead for this if necessary.

It may be helpful to keep a headache diary to track any changes before and after surgery.

Stress and trauma

If you have migraine, you will likely be all too aware of the impact it can have on your wellbeing. Trying to find a treatment that helps can create more anxiety and stress. This can end up in a vicious cycle, as stress can be a trigger for migraine, making the situation even worse.

On top of this, trans people often have even higher levels of stress and trauma. This can be due to the stigma, discrimination and feelings of discomfort and distress (gender dysphoria) that often come with life as a trans person. It’s possible this may lead to trans people experiencing more frequent and severe migraine attacks.

If this is an issue for you, you may find emotional support such as counselling or Cognitive Behavioural Therapy (CBT) helpful. Some people also find connecting with others in their communities who may have similar experiences helpful as well. GIRES – the Gender Identity Research & Education Society – have a directory where you can find support in your area.

You can also contact our support services here at The Migraine Trust.

Getting support as a trans person

We know that trans people often have negative experiences when it comes to accessing healthcare services. It might make you more hesitant to seek support when it comes to your migraine. Not all healthcare professionals may have experience in treating trans people with migraine. It can help to educate yourself in this area as much as possible. It may also help to talk things over with supportive family members or friends – you may want to bring someone with you as an ally to any appointments.

You may also consider looking for a healthcare provider who is LGBTQ+ friendly. Peer groups and pharmacists may be able to help signpost to LGBTQ+-friendly GPs in your area. You can also ask to check practice policies. If you feel your GP is not helpful or supportive in this area, it’s OK to look for another one.

If you have questions relating to anything in this blog or need support then we are here for you – find out more about how you can get support.

The following organisations offer support with accessing health care as a trans person:

• Switchboard – the national LGBTQIA+ support line
  Helpline – 0800 0119 100
  switchboard.lgbt
• LGBT Foundation – national LGBTQ+ charity
  Helpline – 0345 3 30 30 30
  lgbt.foundation
• The Rainbow project – charity devoted to improving the health and wellbeing of LGBTQIA+ people in Northern Ireland
  rainbow-project.org
• LGBT Health and Wellbeing – Scotland’s health and wellbeing charity for LGBTQ+ adults
  Helpline – 0800 464 7000
  lgbthealth.org.uk
• Umbrella Cymru – improving the lives of LGBTQ+ people and their families in Wales
  umbrellacymru.co.uk