While gender-affirming surgery (GAS) can be life-changing for transgender women, it's important to understand its potential impact on pre-existing conditions like migraine. Although research on the direct link between GAS and migraine is limited, there are several factors to consider:

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Hormonal changes:

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Many feminizing surgeries involve altering hormone levels, which can influence migraine patterns.
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For instance, orchiectomy (removal of testicles) can lead to a decrease in testosterone, potentially impacting migraine frequency and severity.
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Additionally, some individuals may choose to start or adjust hormone replacement therapy (HRT) after surgery, which can further influence migraine as discussed earlier.

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Stress and recovery:

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Surgery is a major stressor for the body, and stress is a well-known migraine trigger.
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The recovery period after GAS can involve pain, sleep disturbances, and emotional adjustments, all of which can contribute to migraine attacks.

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Anesthesia and medications

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Anesthesia and pain medications used during and after surgery can also trigger migraine attacks in some individuals.
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It's important to discuss your migraine history with your surgeon and anesthesiologist to choose medications that are less likely to cause problems.

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Individual differences

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The impact of GAS on migraine will vary for each individual. Some may experience an improvement in migraine attacks due to reduced stress or hormone fluctuations, while others may face temporary worsening during the recovery period.

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Pre- and post-operative considerations

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• Discuss your migraine history with your surgeon and healthcare team.
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• Develop a plan for managing migraine attacks before, during, and after surgery.
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• Optimize your migraine preventive medications before surgery if possible.
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• Have rescue medications readily available for breakthrough migraine attacks.
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• Manage stress and pain effectively during recovery.
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• Communicate any changes in migraine patterns to your healthcare providers.

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Talk to your Neura care team about how to best manage your migraine before, during, and after surgery for a smoother transition.

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