Assistant professor, pediatrics and neurology, Headache Program, University of Colorado School of Medicine/Children’s Hospital Colorado

Jennifer Hranilovich, MD

“Transgender individuals want to know more about the effects of gender-affirming hormone therapy—which is relatively new, especially in the US—on their own health, so putting some more study into this understudied population is important. I think it's important to understand that transgender individuals have been stigmatized, and so even their clinical interaction with the medical profession has been somewhat limited by that, it's been disincentivized.”

As a historically stigmatized and underserved population, transgender and gender-diverse patients with headache have not had access to data pertaining to their health, particularly with the effects of gender-affirming hormone therapy (GAHT). Jennifer Hranilovich, MD, assistant professor, pediatrics and neurology, Headache Program, University of Colorado School of Medicine/Children's Hospital Colorado, spoke with 

 on the importance of research for gender minorities, and the next steps for those in the headache and migraine space. 

Hranilovich provided additional comment on the general importance of research, in that studying the effect of GAHT on headache can also inform studies about the effect of hormones in all patients’ brains. Recent steps have been taken she said, including the establishment of the Sexual & Gender Minority Research Office by the National Institutes of Health in 2015. 

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The assistant professor of pediatrics and neurology at the University of Colorado School of Medicine discussed the importance of headache research in gender minorities.  

Expanding Research for Transgender and Gender-Diverse Patients: Jennifer Hranilovich, MD

“I think the key takeaway for clinicians is that they should become knowledgeable about this stuff—and by ‘this stuff,’ I mean caring for the transgender population. One part of that would be to make a welcoming practice. For example, asking your patients what name you should use when speaking or communicating with them, and asking them, ‘Hey, what are your pronouns?’”

Creating a respectful and welcoming environment is vital for all patients in the clinical care setting, but for transgender and gender-diverse patients—a historically stigmatized population—feeling supported can help bridge gaps in care and improve patient-provider communication. 

According to Jennifer Hranilovich, MD, assistant professor, pediatrics and neurology, Headache Program, University of Colorado School of Medicine/Children's Hospital Colorado, this can be accomplished by simply affirming patients’ gender identity, and directly asking patients for their preferred pronouns and name in conversation. Offices can also opt to use of electronic medical record systems that feature sexual and gender identity prominently, making it easier for clinicians and staff to interact with patients. 

Discussing a recent narrative review conducted to investigate headache in transgender and gender-diverse patients, Hranilovich also commented on the importance of identifying drug-drug interactions in patients who may be receiving gender affirming hormone therapy (GAHT). Areas in need of further research include epidemiology of headache in this population, understanding the difference between people who do and do not receive GAHT, as well as the effects of pubertal suppression. 

Discussing the key takeaways for clinicians when it comes to treating this patient population, the assistant professor of pediatrics and neurology at the University of Colorado School of Medicine emphasized the need to improve communication.  

Caring for Transgender and Gender-Diverse Patients With Migraine: Jennifer Hranilovich, MD

“We decided there's not really enough [research] out there to do a formal systematic review; we did what's called a narrative review, where we took our expertise and created a guide for individuals who aren't as familiar with transgender care, but who were familiar with neurology and headache, in particular, on good resources [and] best practices for caring for this population.”

The lack of research within the transgender and gender-diverse population has persisted due to ongoing stigma and barriers to health care and insurance. Jennifer Hranilovich, MD, assistant professor, pediatrics and neurology, Headache Program, University of Colorado School of Medicine/Children’s Hospital Colorado, sat down with NeurologyLive to discuss a recently conducted narrative review, in which she and colleagues reviewed best practices for treating transgender and gender-diverse patients with headache, focusing specifically on how gender-affirming hormone therapy (GAHT) may affect patients’ conditions.

Hranilovich outlined the study, discussing surprising findings about the epidemiology of headache in this patient population, and the general lack of prospective population studies on headache prevalence. This gap was highlighted by a Patient-Centered Outcomes Research Institute funded study, which asked transgender patients about the research they were looking to see within their own population. Responses reflected interest in understanding new migraine onset during GAHT, further speaking to the demand for additional investigation in this area. 

Hranilovich, JA, Kaiser, EA, Pace, A, Barber, M, Ziplow, J. Headache in transgender and gender-diverse patients: A narrative review.

. 2021;61:1040-1050. doi:10.1111/head.14171

The assistant professor of pediatrics and neurology at the University of Colorado School of Medicine spoke on a recent narrative review investigating headache in gender minorities.  

Jennifer Hranilovich, MD

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Expanding Research for Transgender and Gender-Diverse Patients: Jennifer Hranilovich, MD

Caring for Transgender and Gender-Diverse Patients With Migraine: Jennifer Hranilovich, MD

Studying Headache in Transgender and Gender-Diverse Patients: Jennifer Hranilovich, MD

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