My research interests are primarily focused on the way in which hormones such as estrogen and testosterone influence the development of headache in puberty as well as the changes in brain structure and function that show us how this development happens. A particular group of patients in which I study this is transgender youth, with my primary research technique involving imaging of the brain using magnetic resonance imaging (MRI).
For Referring Providers:
My primary clinical interest is in the neuroimaging of sex differences in brain development. The nexus with headache comes with the fact that the overall prevalence of headache in women is about twice that in men. This difference in prevalence starts in adolescence when estrogen rises significantly in girls, and many think that estrogen plays a role in this sex difference in headache, particularly migraine. Evidence from prior studies suggests that the rise in average estrogen levels at puberty guides the development of brain structure and function, including areas key to headache. Challenges in studying this clinically are that estrogen is one of several hormones that change at puberty and that estrogen is released cyclically. Clinical studies have shown that in adult women the monthly drop in estrogen level often triggers migraine. Thus, separating the overall effect of estrogen on brain development and headache from the effect of cycling estrogen is difficult. A unique and increasing population in which change in estrogen at puberty is isolated from other hormones and in which estrogen is given in a steady state rather than cycling is the transfemale patient population. Treatment for transfemale adolescent girls includes suppression of testosterone at puberty and initiation of estrogen. My research seeks to support the hypothesis that exposure to estrogen at puberty increases the risk for incidence of headache. Thus transfemale male-to-female youth who receive estrogen will have a higher incidence of headache than cis-gender boys who do not receive estrogen. I am engaged in study of this hypothesis by evaluating headache incidence and brain structure and function in male-to-female transfemale youth and by comparing this to matched cis-gender boys who do not receive estrogen. My goal is to increase our understanding of how and when estrogen changes risk of developing headache in puberty.