Migraine prevalence in transgender and gender-diverse individuals: A single-center retrospective study

Editor’s note: The research described below comes from a recipient of a 2026 MSC Travel Grant supporting travel to the 68th Annual Scientific Meeting of the American Headache Society. These grants reimburse travel expenses for those who have had their abstract for a presentation or poster accepted at a meeting. 

By Alyxandra Ramsay, clinical research coordinator, Mount Sinai Hospital.

What is the research gap that your study addresses?

There is limited and conflicting evidence regarding the relationship between gender-affirming hormone therapy (GAHT) and migraine risk in transgender and gender-diverse (TGD) populations. Existing studies are small, heterogeneous, and often do not account for confounding factors such as mental health conditions or BMI. This gap limits clinicians’ ability to counsel TGD patients on potential neurologic effects of GAHT. Our study addresses this gap by evaluating the association between hormone-related variables and migraine diagnosis while accounting for demographic and clinical factors in a relatively large single-center TGD cohort.

What is your research hypothesis?

We hypothesized that exposure to gender-affirming hormone therapy would be associated with an increased likelihood of migraine diagnosis among transgender and gender-diverse individuals.

What methodology did you use to address your research hypothesis?

We conducted a single-center retrospective chart review of 1,340 transgender and gender-diverse patients. Migraine diagnoses were identified using ICD-10 codes (G43.xx, G44.xx). Clinical variables extracted included hormone therapy type, hormone levels (e.g., estradiol, testosterone, LH), BMI, and psychiatric comorbidities. Data were merged to account for multiple migraine diagnoses per patient, resulting in a final analytic sample of 67 individuals with migraine data.

Logistic regression models were used to evaluate associations between hormone-related variables, demographic factors, and migraine diagnosis. Due to small subgroup sizes and sparse data in certain strata, Firth penalized logistic regression was applied where appropriate to reduce bias in parameter estimates. Statistical significance was defined as p < 0.05. Subgroup analyses were performed for transgender women and transgender men to assess hormone-specific effects. This approach allowed for adjustment of key confounders and more robust estimation of associations in a clinically complex population.

What are the main results of your study?

Among transgender women, estradiol, testosterone, and LH levels were not significantly associated with migraine diagnosis, nor was progesterone use. Among transgender men, testosterone levels were also not associated with migraine. In contrast, higher BMI was significantly associated with increased odds of migraine (OR = 1.48, p < 0.001). Additionally, individuals with anxiety had approximately fourfold higher odds of migraine diagnosis (OR = 4.06, p = 0.003). Depression, ADHD, and PTSD were not significantly associated with migraine.

What conclusions did you reach based on your results?

Gender-affirming hormone therapy was not associated with increased migraine risk. Instead, migraine in TGD individuals appears more strongly linked to non-hormonal factors, particularly higher BMI and comorbid anxiety

What are the limitations of your study?

This study is limited by its retrospective, single-center design, which may reduce generalizability. The final analytic sample size was small after data merging, limiting statistical power and subgroup analyses. Missing or incomplete gender identity data may introduce bias. Reliance on ICD-10 codes may result in misclassification of migraine diagnoses.

What is the relevance of your study to migraine?

This study provides clinically relevant evidence that gender-affirming hormone therapy does not appear to increase migraine risk in transgender and gender-diverse individuals. These findings help inform safer, evidence-based counseling for patients considering or receiving GAHT. Additionally, the identification of BMI and anxiety as significant correlates highlights modifiable and comorbid factors that may better explain migraine burden in this population, supporting more targeted and holistic approaches to migraine management in TGD patients.