Journal of Headache and Pain最新文献

{"title":"Interpreting the S1BF-ACC-LHb pathway in trigeminal neuralgia-associated affective behavior.","authors":"Donghai Chen, Jian Jiang","doi":"10.1186/s10194-026-02537-2","DOIUrl":"10.1186/s10194-026-02537-2","url":null,"abstract":"<p><p>The study by Wang and colleagues proposes that three connected brain areas link facial nerve injury to pain and depression-like behavior in mice. The experiments are ambitious and potentially important. However, the nerve-injury model differs from the defining pattern of human trigeminal neuralgia, several behavioral and drug controls leave alternative explanations open, and measurements from many cells were not clearly separated from the animals that supplied them. Clarifying these issues, and distinguishing results from whole tissue from results specific to neurons, would make the causal and clinical implications more secure.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"27 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal convergence is needed before inferring neuroaxonal injury in migraine.","authors":"Yuhao Zhang, Jian Jiang","doi":"10.1186/s10194-026-02533-6","DOIUrl":"10.1186/s10194-026-02533-6","url":null,"abstract":"<p><p>Gallardo and colleagues reported higher serum neurofilament light (sNf-L), greater susceptibility-weighted imaging signal in the left rostral anterior cingulate cortex, and lower fractional anisotropy in the right cuneus in patients with high-frequency migraine. Their prospective phenotyping and multimodal approach are valuable. However, these modality-specific findings do not necessarily indicate a shared neuroaxonal-injury process. Serum Nf-L is anatomically non-specific, susceptibility-weighted signal is an indirect marker of iron-related changes, and fractional anisotropy reflects several aspects of tissue architecture. In addition, the imaging findings were focal, cross-modal associations were not reported, and the classification model had a small held-out test set with a wide confidence interval. We therefore suggest describing the results as independent candidate markers associated with high-frequency migraine. Evidence of multimodal convergence would require replicated cross-modal relationships or related longitudinal changes. This distinction preserves the value of the study while avoiding a mechanistic interpretation that extends beyond the available data.Clinical trial number Not applicable.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"27 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Migraine 1-2-3-4-5: a candidate communication aid for adult migraine without aura.","authors":"Yongxiang Zhang, Zhi Guo, Cunxin Lin, Geyu Liu, Xin Liu, Yonggang Wang","doi":"10.1186/s10194-026-02524-7","DOIUrl":"https://doi.org/10.1186/s10194-026-02524-7","url":null,"abstract":"<p><p>Migraine remains under-recognised despite its substantial global burden. This Correspondence presents Migraine 1-2-3-4-5 as a candidate communication aid for adults aged 18 years or older with recurrent headache. It reorganises selected positive clinical features of migraine without aura from the International Classification of Headache Disorders, third edition (ICHD-3), into five numerical anchors spanning four clinical domains: one associated-symptom category, at least two headache features, one 4-72-hour duration condition jointly encoded by 3 days and 4 h, and at least five attacks. Its proposed value is a compact, visible structure for discussing clinically relevant history before or during a clinical encounter; whether it improves comprehension, recall, or reporting is unknown. It is not a questionnaire, score, diagnostic rule, or exclusion rule. Interpretation requires several caveats: successfully treated attacks may be shorter than 4 h; fewer than five otherwise typical attacks may meet criteria for probable migraine without aura; and new, sudden, progressive, atypical, or concerning headache requires clinical assessment. This is a conceptual article; no participants were enrolled and no outcomes were measured. Validation should proceed hierarchically from comprehension, recall, and accurate symptom reporting to communication outcomes, followed by diagnostic-concordance and safety outcomes. Comparative usability testing against an information-matched plain-language presentation is required before routine public use can be recommended.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"27 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In the heat of the moment: prevalence and clinical characteristics of headache associated with sexual activity (head HEATS study).","authors":"Simon Heintz, Florian Giese, Stefan Watzke, Dietrich Stoevesandt, Steffen Naegel, Torsten Kraya","doi":"10.1186/s10194-026-02516-7","DOIUrl":"https://doi.org/10.1186/s10194-026-02516-7","url":null,"abstract":"<p><strong>Background: </strong>Headache associated with sexual activity (HAS) is an uncommon and understudied primary headache disorder. Previous epidemiological studies have estimated a lifetime prevalence of approximately 1.0-1.6%, although the true prevalence remains uncertain because symptoms related to sexual activity may be underreported.</p><p><strong>Objective: </strong>This study aimed to assess the prevalence and clinical characteristics of HAS and its co-occurrence with other primary headache disorders in a university-based cohort.</p><p><strong>Methods: </strong>A cross-sectional questionnaire study was conducted among students and employees at Martin- Luther-University Halle-Wittenberg, Germany. Of 1213 distributed questionnaires, 606 with complete age and sex information were included in the final analysis. Continuous variables were assessed for normality and compared using non-parametric methods when appropriate. Categorical variables were compared using two-sided Fisher's exact tests. Associations with HAS were explored using parsimonious Firth penalized logistic regression models.</p><p><strong>Results: </strong>Twenty-three of 606 participants reported HAS, corresponding to a lifetime prevalence of 3.8% (95% CI, 2.6-5.6%). Participants with HAS were older than those without HAS (median [IQR], 25 [21-34.5] vs. 21 [19-26] years; p = 0.005). Although 82.6% of participants with HAS were female, the proportion did not differ significantly between groups (82.6% vs. 68.6%; p = 0.175). Among participants with available timing data, headache occurred during sexual arousal or the buildup to orgasm in 57.9% and at orgasm in 42.1%. Clinical characteristics were heterogeneous with respect to pain quality and localization, and symptoms compatible with migraine aura were reported by 34.7%. Migraine and tension-type headache were not significantly associated with HAS. In age- and sex-adjusted Firth penalized logistic regression, primary exercise headache was associated with higher odds of HAS (aOR 4.06, 95% CI 1.41-11.72; p = 0.010).</p><p><strong>Conclusions: </strong>In this university-based questionnaire study, 3.8% of participants reported symptoms compatible with HAS. The clinical presentation was heterogeneous, and primary exercise headache was associated with higher odds of HAS after adjustment for age and sex. Given the small number of HAS cases, questionnaire-based case ascertainment, and potential selection and response bias, these findings should be considered exploratory and should not be interpreted as population-representative prevalence estimates. Larger studies using clinician-confirmed diagnoses are needed to validate these findings.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"27 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trigeminal nociceptive somatotopy across brainstem and cortex and their functional interactions.","authors":"Adrian Scutelnic, Kuan-Po Peng, Kristina Kokian, Arne May, Jan Mehnert","doi":"10.1186/s10194-026-02476-y","DOIUrl":"10.1186/s10194-026-02476-y","url":null,"abstract":"<p><strong>Background: </strong>The trigeminal nerve innervates the face and the meninges via its three branches, with central relay neurons located in the brainstem's spinal trigeminal nucleus. We have shown a somatotopic organization on human brainstem level and aimed, using an independent new sample, to characterize the functional somatotopy with a focus on within-brainstem and brainstem-cortical connectivity.</p><p><strong>Methods: </strong>Electrical stimulation was applied to the three branches of the trigeminal nerve at two intensities (high and low) to examine the somatotopic organization in healthy participants during fMRI. Neuroimaging was preregistered (NCT06534880) and covered the upper spinal cord, brainstem, thalamus, insula, primary somatosensory cortex (S1), S2/parietal operculum, and cingulate cortex. Activation patterns following stimulation of each trigeminal branch were analyzed. Branch-specific functional connectivity was estimated within the brainstem as well as between brainstem and cortical targets.</p><p><strong>Results: </strong>In a cohort of 30 healthy participants (mean age 32.1 ± 8.8 years, 18 female (60%)), spatially distinct brainstem representations of the trigeminal branches were identified, replicating previous reports. Activation at the cortical level was largely bilateral and symmetric, except in the primary somatosensory cortex and the insula, where it was predominantly contralateral. Within the brainstem, functional connectivity was strongest between the left and right subnuclei at the same level and was independent of the stimulated branch (all F(2,116) ≤ 5.67, threshold F = 8.00, α = 0.05/90). Brainstem-cortex connectivity showed a robust rostrocaudal gradient that was modulated by the stimulated branch across insular, somatosensory, and opercular regions (significant in 37/48 ROIs, F-Range 2.46-5.19, P_FWE<0.05).</p><p><strong>Conclusion: </strong>We replicated somatotopic representation of the three trigeminal branches in the brainstem and revealed distinct bilateral activation and branch-specific functional connectivity across multiple levels of the afferent neuraxis.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"27 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resting-state local brain functional synchronization after a single trigger-zone stimulation: with versus without evoked pain in classical trigeminal neuralgia patients.","authors":"Xiuhong Ge, Luoyu Wang, Juncheng Yan, Lei Pan, Haiqi Ye, Yuting Zhang, Lidan Fang, Huan Chen, Wenhua Yu, Quan Du, Zhongxiang Ding","doi":"10.1186/s10194-026-02492-y","DOIUrl":"https://doi.org/10.1186/s10194-026-02492-y","url":null,"abstract":"<p><strong>Background: </strong>Classical trigeminal neuralgia (CTN) is characterized by transient, stimulus-evoked pain attacks, but post-stimulation changes in local brain synchronization remain unclear. We characterized static and dynamic local functional synchronization at baseline and during resting-state scans initiated after a single trigger-zone stimulation.</p><p><strong>Methods: </strong>Baseline analyses included 44 healthy controls (HC), 80 CTN patients with stimulation-evoked pain (CTN_{_pain}), and 68 CTN patients without evoked pain (CTN_{_no_pain}). Longitudinal analyses included 39 HC, 75 CTN_{_pain} patients, and 64 CTN_{_no_pain} patients completed all the three resting-state fMRI sessions: baseline, a scan initiated within 5 seconds after stimulation, and a scan initiated 30 minutes later. The first 20 seconds of each time series were discarded. Regional homogeneity, coherence-based regional homogeneity, and their dynamic measures (ReHo, CoReHo, dReHo, and dCoReHo) were assessed using voxel-wise group/time analyses; exploratory region of interest (ROI)-level mixed-effects models tested group × time interactions.</p><p><strong>Results: </strong>At baseline, group differences were observed in Frontal_Med_Orb_R, Insula_L/R, and Hippocampus_R/L. Insula_R dReHo and Frontal_Med_Orb_R ReHo differed between CTN_{_pain} and CTN_{_no_pain} patients. Within-group post-stimulation changes were limited in HC and broader in both CTN subgroups. Exploratory ROI-level sensitivity analyses identified seven group × time interactions that remained significant after metric-specific Bonferroni correction. Exploratory imaging-clinical analyses indicated that imaging measures associations with pain scores in CTN_{_pain} patients and quality of life, anxiety and depression scores in CTN_{_no_pain} patients.</p><p><strong>Conclusions: </strong>CTN subgroups defined by the observed pain-evocation outcome differed in baseline and temporal measures of resting-state local synchronization. Baseline Insula_R dReHo was the subgroup-associated measure but should not be interpreted as causal or predictive. Exploratory group × time interactions and imaging-clinical correlations provide preliminary evidence that requires independent replication. These findings reflect post-stimulation resting-state alterations rather than acute activation.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"27 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Headache disorders and the Global Burden of Disease study: deficiencies, challenges and opportunities for betterment.","authors":"Andreas Kattem Husøy, Latifa Adarmouch, Amalie Berring-Uldum, Raquel Gil-Gouveia, Rigmor Jensen, Risako Shirane, Timothy J Steiner","doi":"10.1186/s10194-026-02490-0","DOIUrl":"10.1186/s10194-026-02490-0","url":null,"abstract":"","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"27 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain in Parkinson's disease: bridging pathophysiology, clinical features, and personalized management.","authors":"Thalis Asimakopoulos, Iliana Psychari, Martina Rekatsina, Zinovia Kefalopoulou","doi":"10.1186/s10194-026-02416-w","DOIUrl":"10.1186/s10194-026-02416-w","url":null,"abstract":"<p><p>Pain is a highly prevalent and disabling non-motor symptom of Parkinson's disease (PD), yet it remains underrecognized and frequently undertreated in clinical practice. Although long considered a secondary consequence of motor dysfunction, pain in PD is now increasingly understood as a manifestation of disease-related alterations in nociceptive processing. These changes extend beyond dopaminergic deficiency and involve broader neurotransmitter imbalances and impaired descending inhibitory control across different neuroanatomical regions, providing a framework for understanding pain as an intrinsic feature of PD rather than a purely peripheral or motor-related phenomenon. We also summarize the main categories of pain experienced in PD, each with distinct clinical features and underlying pathophysiological mechanisms, and link them with current management strategies. A multimodal, mechanism-informed approach that integrates optimization of dopaminergic therapy with non-dopaminergic pharmacological treatments, neuromodulation, rehabilitation, and complementary interventions is key to a personalized treatment plan for pain in patients with PD. Finally, we highlight emerging translational directions, including candidate biomarkers that may help objectify pain and its related dysfunction in the PD population. Focusing on the neurobiological basis of pain in PD, this review aims to support a shift toward mechanism-based assessment and management, with an ultimate goal of improving pain outcomes and quality of life for individuals living with the disease.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"27 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Botulinum toxin type A attenuates trigeminal neuralgia-like pain by suppressing CGRP release and modulating NaV1.7-associated signaling.","authors":"Min-Hua Yao, Hai-Chao Chen, Xiao-Yu Zhang, Si-Wei Zhou, Chuan-Xiong Li, Yan-Yu Lu, Zi-Rui Liao, Lei Wang, Ruo-Hui Zhang, Yu-Hong Jing","doi":"10.1186/s10194-026-02454-4","DOIUrl":"10.1186/s10194-026-02454-4","url":null,"abstract":"<p><strong>Background: </strong>Trigeminal neuralgia (TN) is a disabling facial pain disorder, and current treatments remain insufficient for a substantial proportion of patients. Botulinum toxin type A (BoNT/A) has shown therapeutic benefit in TN, but its peripheral analgesic mechanisms remain incompletely understood. We aimed to determine whether BoNT/A alleviates TN-like pain by modulating the calcitonin gene-related peptide (CGRP)-extracellular signal-regulated kinase (ERK)-NaV1.7 pathway in trigeminal ganglion neurons.</p><p><strong>Methods: </strong>TN-like pain was induced in mice by chronic constriction injury of the infraorbital nerve (CCI-ION). On postoperative day 14, BoNT/A (10 U) or saline was injected intradermally into the whisker pad. Evoked and spontaneous pain-like behaviors were assessed using von Frey testing, the Ugo Basile facial pain test, and spontaneous scratching recordings; anxiety-like behavior was evaluated using the elevated plus maze. Myelin pathology was examined by Luxol fast blue staining and transmission electron microscopy. CGRP, NaV1.7/NaV1.8, and ERK/MAPK signaling were examined in trigeminal ganglion neurons using immunofluorescence, Western blotting, RT-qPCR, ELISA, calcium-influx assays, and whole-cell patch-clamp recordings. Olcegepant and PD98059 were used to interrogate CGRP receptor- and ERK-dependent mechanisms.</p><p><strong>Results: </strong>BoNT/A significantly attenuated CCI-ION-induced mechanical allodynia, increasing the facial withdrawal threshold from 0.11 to 1.29 g, and reducing spontaneous pain-like behaviors. BoNT/A also improved anxiety-like behavioral measures in CCI-ION mice. Histological and ultrastructural analyses shown partial amelioration of myelin pathology, accompanied by increased myelin basic protein expression and a lower g-ratio. Mechanistically, BoNT/A reduced CGRP-associated activity in TRPV1-positive trigeminal ganglion neurons, accompanied by lower serum CGRP levels and attenuated capsaicin-evoked calcium influx. These changes were associated with a preferential reduction in NaV1.7 membrane localization, without a comparable reduction in NaV1.8, and with a marked decrease in sodium current density, with peak sodium current reduced by 78.6%. Pharmacological inhibition of CGRP receptors or ERK phosphorylation reproduced the effects of BoNT/A on NaV1.7 membrane localization.</p><p><strong>Conclusions: </strong>These findings suggest that BoNT/A alleviates CCI-ION-induced TN-like pain, at least in part, by suppressing CGRP-dependent ERK activation and subsequent NaV1.7 membrane recruitment in trigeminal ganglion neurons. The CGRP-ERK-NaV1.7 pathway may represent a peripheral mechanism of BoNT/A-mediated analgesia and a potential target for neuropathic facial pain.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"27 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating clinical associations of immediate post-traumatic headache: a prospective multicenter study.","authors":"Mansoureh Togha, Maryam Bahreini, Sepideh Aarabi, Elham Jafari, Soroor Advani, Nahid Beladi-Moghadam, Narges Yazdi, Muhammad Hussain Ahmadvand","doi":"10.1186/s10194-026-02478-w","DOIUrl":"10.1186/s10194-026-02478-w","url":null,"abstract":"<p><strong>Background: </strong>Post-traumatic headache (PTH) is a frequent early consequence of head traumatic injury, yet emergency departments (EDs) lack practical tools to identify high-risk patients. Whether routinely documented trauma characteristics are associated with immediate PTH beyond established clinical factors remains uncertain.</p><p><strong>Methods: </strong>This prospective, multicenter observational study evaluated patients aged ≥ 18 years presenting with head and/or neck trauma to the ED between 2022 and 2025. To adhere strictly to ICHD-3 criteria and prevent severity measurement bias, the primary analysis was restricted exclusively to a homogeneous cohort of 495 patients with mild traumatic head injury (GCS 13-15, no traumatic brain CT abnormalities). The primary outcome was immediate PTH occurring directly following the traumatic event. To prevent overfitting, candidate variables were restricted a priori to 9 core features. We utilized multivariable logistic regression and evaluated internal validity via 500 bootstrap resamples.</p><p><strong>Results: </strong>Immediate PTH occurred in 62.8% of patients with mild head trauma. Prior headache history showed the strongest association with PTH. Several trauma-related characteristics, including posterior, frontal, and temporal impact locations, scalp hematoma, and traffic accident mechanism, were independently associated with higher odds of PTH. Variance Inflation Factor (VIF) confirmed no significant multicollinearity (< 1.85). The parsimonious 9-variable model demonstrated robust discrimination and stability, with an apparent AUC of 0.855 and an optimism-corrected AUC of 0.843.</p><p><strong>Conclusions: </strong>An association model based on 9 routine ED variables identified several clinical and specific trauma features strongly associated with immediate PTH in mild head trauma patients. These findings highlight important early prognostic factors and maintain statistical stability; however, external validation is required before widespread clinical application.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"27 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148684809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}