{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:18:30Z","timestamp":1790983110453,"version":"4.1.0"},"reference-count":19,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,8,10]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>\n                    Oestrogen-containing oral contraceptives (OCPs) are associated with increased cerebrovascular risk, particularly in individuals with migraine and vascular risk factors.\n                    <jats:sup>1\u20133<\/jats:sup>\n                    Evidence regarding neurological complications of oestrogen use in transgender women remains limited.\n                    <jats:sup>4 5<\/jats:sup>\n                    We report a transgender woman with a history of migraine who presented with acute-onset severe retro-orbital headache followed by a generalised tonic-clonic seizure after initiating an ethinylestradiol-containing OCP for gender-affirming therapy. Initial neuroimaging demonstrated a left parietotemporal hypodensity interpreted as a possible cortical infarct. Following cessation of oestrogen therapy, the patient experienced complete clinical recovery, with resolution of the previously described imaging abnormality. This case illustrates the complex interplay between migraine, exogenous oestrogen and cerebrovascular risk. The presentation and disease course were most consistent with suspected reversible cerebral vasoconstriction syndrome associated with recent OCP exposure, although the diagnosis was not angiographically confirmed. Using the Naranjo adverse drug reaction probability scale, the association between the OCP and the neurological event was classified as possible rather than definite.\n                    <jats:sup>6<\/jats:sup>\n                    This case highlights the importance of careful risk assessment before oestrogen initiation and reinforces the need for safer hormone formulations in transgender healthcare.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2026-273249","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T03:02:26Z","timestamp":1787194946000},"page":"e273249","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Suspected reversible cerebral vasoconstriction syndrome following ethinylestradiol-containing oral contraceptive use in a patient with migraine"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8113-6115","authenticated-orcid":false,"given":"Ungku Nasreen","family":"Ungku Mohsin","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nurul Huda","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine Universiti Teknologi MARA & Hospital Al-Sultan Abdullah UiTM, Sungai Buloh, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safreeda SF","family":"Salim","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine Universiti Teknologi MARA & Hospital Al-Sultan Abdullah UiTM, Sungai Buloh, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sin Hong","family":"Chew","sequence":"additional","affiliation":[{"name":"Neurology Unit, Department of Internal Medicine, Hospital Sultanah Aminah, Johor Bahru, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"2026081907001346000_19.8.e273249.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(11)70266-6"},{"key":"2026081907001346000_19.8.e273249.2","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-017-0815-1"},{"key":"2026081907001346000_19.8.e273249.3","first-page":"389","article-title":"Headache in users of oral contraceptives","volume":"11","author":"MacGregor","year":"2007","journal-title":"Curr Pain Headache 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syndromes","volume":"28","author":"Chen","year":"2008","journal-title":"Cephalalgia"},{"key":"2026081907001346000_19.8.e273249.13","first-page":"365","article-title":"Reversible cerebral vasoconstriction syndrome and oral contraceptives: case report","volume":"54","author":"Silva","year":"2014","journal-title":"Headache"},{"key":"2026081907001346000_19.8.e273249.14","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1212\/01.WNL.0000130338.62037.CC","article-title":"Migraine prevalence in male to female transsexuals on hormone 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