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Gender Minority Stress, Psychiatric Comorbidities, and the Experience of Migraine in Transgender and Gender-Diverse Individuals: a Narrative Review

  • Psychological and Behavioral Aspects of Headache and Pain (D Buse, Section Editor)
  • Published:
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Abstract

Purpose of Review

This review aims to discuss the experience of migraine in transgender and gender-diverse individuals as it relates to other psychiatric comorbidities such as anxiety, depression, PTSD, and others. As this population faces stigma and discrimination, literature posits that gender minority stress can also contribute to the experience of pain in these individuals.

Recent Findings

Though there is little explicit data on these topics, more recent studies have explored the concept of gender minority stress and how stigma and discrimination can affect health outcomes and overall perception of health. These findings, as well as data on psychiatric comorbidities in cisgender individuals with migraine, can be extrapolated to understand how gender minority individuals may experience migraine.

Summary

Research has demonstrated that stigma and discrimination can affect health outcomes in the transgender and gender-diverse community. A recent study has shown that sexual minority stress associated with stigma, discrimination, and barriers to care can exacerbate migraine. It is known that psychiatric comorbidities such as anxiety, depression, and PTSD can affect migraine frequency and severity in cisgender individuals. Though there are no specific studies in the transgender and gender-diverse patient population, these highly prevalent mental health conditions could potentially contribute to their migraine experience. Hormones, as well, may affect mood in those on gender-affirming hormone therapy, with some studies exploring how this may have both a direct and indirect relationship with migraine. There are clear knowledge gaps that can be addressed by future research in these areas to better understand the migraine experience in transgender and gender-diverse individuals and improve overall care.

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      Authors and Affiliations

      1. Division of Headache and Facial Pain, Department of Neurology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 7th Floor, New York, NY, 10029, USA

        Anna Pace

      2. Department of Neurology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, NY, USA

        Mark Barber

      3. Children’s Hospital of Philadelphia, Philadelphia, PA, USA

        Jason Ziplow

      4. Division of Neurology, Department of Pediatrics, School of Medicine, University of Colorado, Children’s Hospital Colorado, Aurora, CO, USA

        Jennifer A. Hranilovich

      5. Department of Neurology, University of Pennsylvania, Philadelphia, USA

        Eric A. Kaiser

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      1. Anna Pace
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      Correspondence to Anna Pace.

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      Conflict of Interest

      JH, AP, MB, JZ: no conflict. EAK has received royalties from patents in association with Alder Biopharmaceuticals related to anti-CGRP monoclonal antibodies for the treatment of migraine and photophobia. EAK has received investigator-driven grant funding from Amgen, which manufactures an anti-CGRP monoclonal antibody for the treatment of migraine.

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      Appendix. Glossary of terminology and nomenclature (adapted from Hranilovich et al. [5••])

      Appendix. Glossary of terminology and nomenclature (adapted from Hranilovich et al. [5••])

      Gender identity

      The gender an individual sees themselves as having, e.g., male or female, no gender, or something else.

      Sex assigned at birth

      Examples are male or female, and are typically designated based on an infant’s external genitalia.

      Sexual orientation

      Describes a person’s sexual, romantic, or emotional attraction to another person

      Cisgender

      Describes a person whose gender identity is consistent with their sex assigned at birth

      Transgender

      Describes a person whose gender identity is different than the person’s sex assigned at birth

      Trans-masculine

      Describes a person who was assigned female sex at birth and identifies with masculinity more than femininity

      Trans-feminine

      Describes a person who was assigned male sex at birth and identifies with femininity more than masculinity

      Gender nonbinary

      Describes a person whose gender identity falls outside of the traditional gender binary structure

      Gender queer

      An umbrella term that describes a person whose gender identity falls outside the traditional gender binary of male and female. Some people use the term gender expansive.

      Gender fluid

      Describes a person whose gender identity is not fixed, a person may feel like a mix of more than one gender, or may feel more aligned with a certain gender some of the time, another gender at other times, both genders sometimes, and sometimes no gender at all.

      Pangender

      Describes a person whose gender identity is comprised of many genders

      Agender

      Describes a person who identifies as having no gender

      Intersex

      Describes a group of congenital conditions in which the reproductive organs, genitals, and/or other sexual anatomy do not develop according to traditional expectations for females or males. Intersex can also be used as an identity term for someone with one of these conditions.

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      Pace, A., Barber, M., Ziplow, J. et al. Gender Minority Stress, Psychiatric Comorbidities, and the Experience of Migraine in Transgender and Gender-Diverse Individuals: a Narrative Review. Curr Pain Headache Rep 25, 82 (2021). https://doi.org/10.1007/s11916-021-00996-7

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