It's an isekai manga, and not a reincarnation manga. There are elements of romance but I wouldn't call it a romance manga.
I distinctly remember it starts with the main character in a school setting. There was a girl that was interested in him, and was about to confess to him but got interrupted as he was experiencing severe headaches. He then got transported to a new world.
There was a scene where he was on an operation table and was possibly being experimented on. This may have been how he got his powers from whoever summoned him.
I forget at which point, but he met a tiny fairy/pixie who he befriends, who is later suggested to become the main heroine and love interest for the MC. She can change sizes and I remember she was shown to be very proficient in magic when she is in her larger form.
I don't remember much else other than the MC having to do guild quests with his magic powers in this fantasy land filled with other monsters.