This presentation will review terminology and nomenclature use to describe sex and gender identity, including the use of chosen names and pronouns in clinical practice. We will discuss health disparities that affect the LGBTQIA2S+ population, reviewing comorbid chronic conditions and disability related to those conditions. We will explore barriers to care for these patients and discuss how various psychosocial factors may lead to poorer healthcare outcomes in these individuals, especially as they relate to headache and chronic pain. This presentation will also address key clinical practice topics including: maintaining a welcoming and affirming office environment, using gender neutral language, how to competently discuss pregnancy planning when prescribing teratogenic medications in gender and sexual minorities,
integration of sexual orientation and gender identity data in EMR, and describing the benefits of partnering with local LGBTQ clinic providers.

An overview of gender affirming hormone therapy (GAHT) in adolescents and adults and how this can interact with headache and its treatment. Includes discussion of the role of hormones in primary headache disorders and potential effects of GAHT, review of potential adverse effects of GAHT that can present as secondary headache disorders (e.g. cerebral venous sinus thrombosis, meningiomas) or stroke, review of drug-drug interactions between GAHT and commonly prescribed headache medications, and future avenues of research.

Learners will receive an overview psychiatric comorbidities in headache and higher rates of psychiatric disorders in LGBTQ patients, sexual and gender minority stress and the influence of trauma, discrimination, and stigma in LGBTQIA+ patients, and integrating behavioral health into the management of headache disorders.

There is a severe knowledge gap on managing headache disorders in sexual and gender minorities, which impacts providing care for this disadvantaged population. This patient population has either been excluded from clinic studies or failed to be characterized when included. Furthermore, topics relevant to patients who identify as LGBTQIA+ have not been examined in headache clinical studies. Here, we discuss what key research gaps in the literature currently exist and how we may address these gaps moving forward. This includes how to recruit LGBTQ research participants and conduct clinical research with gender-affirming practices. Also, we discussed how to collect and report sexual orientation, sex, and gender identity data based on guidelines set by Headache.