Conduct a scoping review of current evidence in headache disparities and treatment within the LGBTQ+ population.
Although sexual and gender minority (SGM) identity is a key health determinant, there remains a paucity of data concerning the care of LGBTQ+ patients within neurology. Despite evidence of disparities in headache disorders among SGM individuals, there has not been a scoping review focused on this population. We aim to summarize the current available evidence of disparities in primary and secondary headache disorders among LGBTQ+ patients, their mechanisms and risk factors associated with these disparities, as well as current treatment considerations.
A systematic search of articles published in MEDLINE, Embase, and Web of Science was conducted using descriptors of SGM and primary/secondary headache disorders. A total of 1064 articles were identified, of which 918 were submitted for review after duplicates were removed. Observational studies, reviews, and case reports/series discussing an LGBTQ+ adult population addressing a primary/secondary disorder were included. Title and abstract followed by full-text review was conducted by two independent reviewers with conflicts settled by consensus discussion.
65 articles were identified for final data extraction. 43 were case reports or series (66.2%). 34 (52.3%) articles included transgender persons. 16 (24.6%) articles focused on primary headache including migraine and other headache syndromes. Secondary headache syndromes included infectious-associated headache (syphilis/HIV) (22), idiopathic intracranial hypertension (13), meningiomas/tumors (7), cerebral venous thrombosis (3), behavioral health (2), fibromuscular dysplasia (1), and TBI (1). 8 articles reported statistically higher prevalence of headache/migraine among cisgender sexual minorities although at variable rates between genders. There were few observational studies discussing headache prevalence among transgender persons and case reports of hormone-related effects were most prevalent. 1 article discussed LGBTQ+ informed treatment for pain syndromes.