[Transgender health, migraine and headache-Underestimated associations, limited data situation]

Migraine and other headache disorders are highly relevant in the care of transgender patients. Gender-affirming hormone therapies lead to adaptive changes in physiological systems that are typically sexually dimorphic, aligning them with an endocrine milieu corresponding to the affirmed gender. This can substantially influence hormone-dependent components of migraine, such as frequency, intensity and triggering mechanisms. In addition, psychosocial factors play an important role: transgender individuals are often exposed to specific stressors which, within the biopsychosocial model, can directly affect the experience of pain and migraine. The available data are currently very limited and their interpretation is further constrained by small cohorts, predominantly from uncontrolled studies as well as heterogeneous definitions of both headache disorders and the studied populations. Therefore, this article does not claim to be comprehensive but rather provides an overview of the challenges in transgender patients with migraine and other headache disorders.