Journal of Headache and Pain最新文献

{"title":"Interictal eye movement alterations in migraine with aura: impact of perceptual and cognitive load during reading.","authors":"Vojislav Jovanović, Vanja Ković, Andrej M Savić, Igor Petrušić","doi":"10.1186/s10194-025-02171-4","DOIUrl":"https://doi.org/10.1186/s10194-025-02171-4","url":null,"abstract":"","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"207"},"PeriodicalIF":7.9,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence status and influencing factors of acute and preventive pharmacotherapy among migraine patients in China.","authors":"Cancan Chen, Zizi He, Jing Zhang, Longteng Ma, Li Kang, Hui Su, Zhenjie Ma, Shuqing Wang, Yunyun Huo, Shengyuan Yu, Ye Ran, Zhao Dong","doi":"10.1186/s10194-025-02156-3","DOIUrl":"https://doi.org/10.1186/s10194-025-02156-3","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the current adherence status and influencing factors for acute and preventive pharmacotherapy among migraine patients in China.</p><p><strong>Methods: </strong>Utilizing a prospective cohort design with retrospective identification, migraine patients first attending the Headache Clinic (Chinese PLA General Hospital, May-November 2024) were prospectively assessed for treatment adherence and influencing factors via structured telephone follow-ups.</p><p><strong>Results: </strong>Among 456 enrolled patients (75.9% female, 24.1% male), migraine subtypes included probable migraine (14.9%), migraine without aura (72.6%), migraine with aura (4.2%), and chronic migraine (8.3%). Good adherence rates were 30.5% for acute and 53.3% for preventive pharmacotherapy. Key non-adherence behaviors for acute medication: Abstinence from medication during attacks (63.1%) and administration after pain progression to moderate/severe intensity (35.0%). Primary reasons: mild headache deemed non-requiring medication (43.3%) and fear of potential adverse effects (36.0%). Key non-adherence behaviors for preventive medication: incomplete treatment course duration (76.4%), failure to obtain prescribed medications (15.3%), and non-adherence to prescribed medication schedule (11.1%). Primary reasons given for nonadherence to preventive medication included perceived prescription inappropriateness (43.1%) and adverse effects that occurred (19.4%). Multivariate regression analysis revealed that adherence to acute pharmacotherapy increased with higher educational level, medical insurance coverage, satisfaction with pain relief, and enhanced patient valuation of pharmacotherapy (all p < 0.05). For preventive medication, adherence was associated with adverse effects, satisfaction with treatment efficacy, and enhanced patient valuation of pharmacotherapy (all p < 0.05). Good adherence independently predicted fewer monthly headache days (MHD: 3.4 ± 3.9 days vs. 7.7 ± 6.1 days, p < 0.01).</p><p><strong>Conclusion: </strong>Suboptimal medication adherence persists among Chinese migraine patients, with patient valuation of pharmacotherapy being the strongest modifiable factor. Interventions should prioritize patient education, personalized treatment plans, and tailored adherence strategies to improve outcomes.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"208"},"PeriodicalIF":7.9,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional crosstalk between the vanilloid and endocannabinoid systems in modulating vascular tone: implications for (neuro)vascular disorder therapy.","authors":"Eduardo Rivera-Mancilla, Antoon van den Bogaerdt, A H Jan Danser, Antoinette MaassenVanDenBrink","doi":"10.1186/s10194-025-02085-1","DOIUrl":"10.1186/s10194-025-02085-1","url":null,"abstract":"","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"203"},"PeriodicalIF":7.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244572","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":"Use of glucagon-like peptide-1 receptor agonists in idiopathic intracranial hypertension : a systematic review.","authors":"Julien Ognard, Sevda Alipour Khabir, Sherief Ghozy, Gerard El Hajj, Kevin M Kallmes, John J Chen, Ramanathan Kadirvel, David F Kallmes, Waleed Brinjikji","doi":"10.1186/s10194-025-02148-3","DOIUrl":"10.1186/s10194-025-02148-3","url":null,"abstract":"","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"202"},"PeriodicalIF":7.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244585","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":"Prevalence of migraine in Iceland.","authors":"Larus S Gudmundsson, Sunna D Arnardottir, Dawn C Buse, Ann I Scher, Lenore J Launer, Gretchen E Tietjen, Richard B Lipton, Jon H Eliasson","doi":"10.1186/s10194-025-02092-2","DOIUrl":"10.1186/s10194-025-02092-2","url":null,"abstract":"<p><strong>Background: </strong>There are few studies assessing the prevalence and characteristics of migraine in the Icelandic population. Previous Icelandic studies have methodological limitations and no study has been performed using full ICHD-3 criteria.</p><p><strong>Methods: </strong>The study is based on data from a pilot for the SAGA (Stress-And-Gene-Analysis) cohort study conducted in 2014. The participants were women invited to cancer screening and men randomly sampled from the National Registry of Iceland. Participants answered an online health questionnaire including standardized, validated questions, used to identify migraine as defined by the ICHD-3 criteria. Estimates are provided for the one-year period prevalence of migraine overall, and the migraine subgroups migraine with aura, migraine without aura, and probable migraine.</p><p><strong>Results: </strong>Of 1390 individuals invited to participate, 916 responded (65.9%). There were 402 men (44.0%) and 514 women (56.0%), 21 to 75 years of age with a median age of 50 years. The 1-year period prevalence of migraine was 14.4% overall, 19.3% in women and 8.2% in men with a female-to-male ratio of 2.3:1. The prevalence of subjects with migraine without aura (MO) but not migraine with aura (MA) was 6.3%, Conversely, the prevalence of subjects with MA who did not meet the criteria for MO was 4.9%. A total of 3.2% of the participants met the criteria for both migraine with and without aura (MA + MO). The prevalence of probable migraine was 2.6% overall, 2.7% in women and 2.5% in men.</p><p><strong>Conclusions: </strong>The 1-year prevalence of migraine in Iceland was 14.4% overall, 19.3% in women and 8.2% in men. These rates are in line with European prevalence estimates and are slightly higher than United States estimates. The 1-year prevalence of probable migraine was 2.6%, 2.7% in women and 2.5% in men.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"205"},"PeriodicalIF":7.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244621","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":"Introduction of a classification interview for post-traumatic headache after concussion.","authors":"Hannah S Lyons, Matilde Sassani, Helen Brunger, Abigail Lake, Benjamin Jefferies, Mark Thaller, Andreas Yiangou, Victoria Homer, Shreshth Dharm-Datta, Henrietta Ellis, Manjit Matharu, Lisa J Hill, James L Mitchell, Alexandra J Sinclair","doi":"10.1186/s10194-025-02149-2","DOIUrl":"10.1186/s10194-025-02149-2","url":null,"abstract":"","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"206"},"PeriodicalIF":7.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12505653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244604","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":"The global prevalence of headache disorders of public-health importance: a meta-analysis of population-based individual participant data from 41,614 adults from 17 countries.","authors":"Andreas Kattem Husøy, Shengyuan Yu, Ruozhuo Liu, Akbar A Herekar, Bilal Ahmed, Arif D Herekar, Callixte Kuate Tegueu, Anastase Dzudie Tamdja, Annick Mélanie Magnerou, Najib Kissani, Latifa Adarmouch, Thierry Adoukonou, Mendinatou Agbetou, Oyéné Kossi, Mehila Zebenigus, Redda Teckle-Haimanot, Dawit K Worku, Girish N Rao, Girish B Kulkarni, Gopalkrishna Gururaj, Mohammed Al Jumah, Ali M Al Khathaami, Guiovanna Quispe, Carlos Palomino-Diaz, Mattias Linde, Ajay Risal, Krishnan Anand, Debashish Chowdhury, Ashish Duggal, Otgonbayar Luvsannorov, Selenge Enkhtuya, Dorjkhand Baldorj, Ilya Ayzenberg, Zaza Katsarava, Colette Andrée, Gretchen L Birbeck, Elena Ruiz De la Torre, Daiva Rastenytė, Hallie Thomas, Lars Jacob Stovner, Timothy J Steiner","doi":"10.1186/s10194-025-02142-9","DOIUrl":"10.1186/s10194-025-02142-9","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Recent studies indicate that migraine affects 14-15% of the global population, tension-type headache (TTH) around 26%, and medication-overuse headache (MOH) 1-2%. While these estimates highlight the impact of these conditions on population health, their reliability is compromised by the variable quality of contributing studies. In response, the Global Campaign against Headache has supported epidemiological studies in all parts of the world, using standardized methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a meta-analysis of individual participant data from these studies, accepting only population-representative data (17 countries from all world regions). All included studies were cross-sectional surveys of adults aged 18-65 years using the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire. Algorithmic diagnosis applying modified International Classification of Headache Disorders (ICHD) criteria identified the headache disorders of public-health importance: migraine, TTH and probable MOH (pMOH: the association of headache on ≥ 15 days/month [H15+] and reported medication overuse). Two sets of estimates were made for migraine and TTH, one excluding those with H15+ (standard process), the other including these (extended process). We analysed associations with demographical variables, and, accordingly, adjusted prevalence estimates for age, gender and country income level.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We included 41,614 individuals, with over-representations of females (22,278 [53.5%]) and of participants from lower-middle income countries (59.7%; global 37.8%). Age-distribution was similar to that of the world. Overall, 65.5% (95% CI: 65.0-66.0) reported headache during the previous year, females (72.1% [71.5-72.7]) more than males (57.9% [57.2-58.6]). Migraine was more common among females (standard process: 29.5% [28.9-30.1]; extended process: 33.1% [32.5-33.7]) than males (18.6% [18.1-19.2]; 20.1% [19.6-20.7]), as was pMOH (5.6% [5.3-5.9] vs. 2.3% [2.1-2.5]). TTH was similarly prevalent among males (33.4% [32.8-34.1]; 34.9% [34.2-35.5]) and females (31.2% [30.6-31.8]; 33.2% [32.6-33.8]). Headache was more prevalent in high/upper-middle income countries (71.4% [70.6-72.2]) than in low/lower-middle income (63.0% [62.5-63.6]). Prevalence estimates adjusted for age, gender and income level were 65.0% (64.6-65.5) for any headache, 23.5% (23.1-23.9; standard process) and 25.9% (25.4-26.3; extended process) for migraine, 33.2% (32.7-33.6) and 34.7% (34.3-35.2) for TTH, and 4.1% (3.9-4.3) for pMOH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;About 65% of the world's population aged 18-65, likely to include most of the world's workforce, will have headache during the coming year, about 25% migraine and 4% pMOH. Both these estimates are higher than previous comparable estimates, and we believe them to be the best currently available for this population. Our est","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"204"},"PeriodicalIF":7.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244626","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":"Direct cost of headache treatment in Benin, a West African country, in 2023.","authors":"Mendinatou Agbetou, Toussaint Avolonto, Corine Houehanou, Oyéné Kossi, Thierry Adoukonou","doi":"10.1186/s10194-025-02163-4","DOIUrl":"10.1186/s10194-025-02163-4","url":null,"abstract":"<p><strong>Background: </strong>Headache is a public health problem in Africa and is a significant cause of neurological consultations, imposing a heavy burden. Data on its actual economic burden are scarce in Africa. This study aims to evaluate the direct cost of headache management in 2023 and to identify factors associated with the high direct cost of headache management.</p><p><strong>Methods: </strong>This cohort study with descriptive and analytical aims was conducted from June 15 to October 15, 2023, in the neurology unit of the teaching hospital of Borgou in Parakou, on 91 subjects with headaches, including migraine, tension type headache, trigeminal neuralgia, cluster headache, paroxysmal hemicrania and secondary headache. Any patient who had experienced headaches in the past 12 months, who was aged at least 18 years and who provided informed consent was included. The direct cost of headache management was defined as the sum of costs by consumption level category (consultation, diagnostic tests, treatments, transport, hospitalization costs, other nonmedical costs) and the monetary value of the main companion. This cost was expressed in Benin's local currency (West African francs XOF), with a corresponding amount in euros. The direct cost of headache care was considered high when the mean monthly direct cost was more than 10% of the guaranteed minimum wage in Benin. Consumption level data were collected through an individual interview, supplemented by a review of medical records, notebooks, and receipts for headache management. Data entry was carried out via the KoboCollect application. Data analysis was performed using EpiInfo 7.2 software.</p><p><strong>Results: </strong>A total of 91 participants were included, with 51 women (56.04%). The mean age was 38.91 ± 14.52 years. The monthly direct cost estimated one month after inclusion was high, calculated at XOF1,599,400 (€2,438.26), with an average of XOF17,575.82 ± 10,290.68 (€26.79 ± 15.69), representing 33.80% of the minimum wage in Benin. The global annual direct cost of headaches was XOF15,537,875 (€23,687.23) with a higher cost for tension type headaches at XOF6,077,530 (€9,265.09), whereas that of migraine was calculated at XOF4,603,970 (€7,018.67). The factors associated with high costs of headache management were a history of anxiety (p = 0.02), the presence of comorbidities (p = 0.005), the frequency of attacks (p = 0.048), and consumption related to psychiatric consultation (p = 0.02).</p><p><strong>Conclusion: </strong>The direct cost of managing headaches is high, with multiple associated factors. Strategies aimed at reducing this cost are urgently needed to optimize management and influence national public health policy for headache patients in Benin.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"201"},"PeriodicalIF":7.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244645","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":"Ergotamine and triptans induced medication-overuse headache: a real-world population-based comparative study from the Northern Thai headache registry.","authors":"Surat Tanprawate, Kitti Thiankhaw, Watthikorn Chusilthong, Vipanee Muangchean, Sirinada Ma-Imjai, Noratham Chalapati, Kanokkarn Teekaput, Chutithep Teekaput","doi":"10.1186/s10194-025-02161-6","DOIUrl":"10.1186/s10194-025-02161-6","url":null,"abstract":"<p><strong>Background: </strong>Medication-overuse headache (MOH) remains a leading cause of chronic daily headache globally. Although triptans are the predominant implicated in high-income countries, ergotamine continues to be widely used in many low- and middle-income settings. Comparative data on ergotamine- versus triptan-induced MOH remain limited.</p><p><strong>Methods: </strong>We analyzed prospective data from the Northern Thai Headache Registry, enrolling patients with ergotamine-MOH, triptan-MOH, or dual-MOH. Demographic and clinical characteristics, treatment outcomes, recurrence rates, and withdrawal symptoms were evaluated over 12 months. Outcomes included changes in Headache Impact Test (HIT-6) scores, recurrence-free survival, and adverse events during withdrawal.</p><p><strong>Results: </strong>A total of 117 MOH patients were included: 61 (52.1%) with ergotamine-MOH, 44 (37.6%) with triptan-MOH, and 12 (10.3%) with dual-MOH. Patients with ergotamine-MOH experienced significantly more withdrawal symptoms compared to those with triptan-MOH (P < 0.01). In contrast, recurrence rates were highest among dual-MOH patients (P < 0.01). Improvement in HIT-6 scores was observed across all groups, though ergotamine-MOH patients showed slower recovery trajectories. Kaplan-Meier analysis demonstrated a higher risk of recurrence in dual-MOH compared to single-agent MOH.</p><p><strong>Conclusions: </strong>Ergotamine-induced MOH is linked to more severe withdrawal symptoms, whereas dual-MOH carries the greatest risk of recurrence. These findings highlight the importance of tailored withdrawal strategies and close monitoring, particularly in resource-limited settings where ergotamine remains widely available. They also support policy initiatives aimed at restricting over-the-counter ergotamine and expanding access to safer acute treatment options.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"198"},"PeriodicalIF":7.9,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212874","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":"Hallmarks of primary headache: part 3 - cluster headache.","authors":"Gianluca Coppola, Marco Antônio Arruda, Messoud Ashina, Mads Barloese, Andrea Carmine Belin, Sara Bottiroli, Debashish Chowdhury, Roberto De Icco, Cherubino Di Lorenzo, Giulia Di Stefano, Jacob C A Edvinsson, Stefan Evers, Stefania Ferraro, Rolf Fronczek, David García-Azorín, Peter J Goadsby, Licia Grazzi, Dagny Holle, Julia J Jansen, Raquel Gil-Gouveia, Giorgio Lambru, Michel Lanteri-Minet, Marco Lisicki, Dimos D Mitsikostas, Teshamae Monteith, Danilo Antonio Montisano, Mark Obermann, Li-Ling Hope Pan, Kuan-Po Peng, Mario Peres, Igor Petrušić, Alberto Proietti Cecchini, Marta Vila-Pueyo, Alberto Raggi, Innocenzo Rainero, Giorgio Sandrini, Gabriele Sebastianelli, Tsubasa Takizawa, Surat Tanprawate, Cristina Tassorelli, Andrea Truini, Massimiliano Valeriani, Doga Vuralli, Marta Waliszewska-Prosół, Shuu-Jiun Wang, Yonggang Wang, Tissa Wijeratne, Paolo Martelletti","doi":"10.1186/s10194-025-02145-6","DOIUrl":"10.1186/s10194-025-02145-6","url":null,"abstract":"<p><strong>Background: </strong>Cluster headache (CH) is a rare primary headache disorder characterized by recurrent episodes of strictly unilateral excruciating pain accompanied by trigemino-autonomic signs, which significantly impacts the quality of life, social interactions, and occupational functioning of those who are affected. To promote a better understanding of this disabling condition and to foster research on the topic, this review provides a comprehensive description of the hallmarks of CH, including its clinical presentation, diagnostic challenges, pathophysiology, and current and novel therapeutic targets. It concludes by describing the disease burden and advocating for significant improvements in healthcare systems, and promoting health equity, as well as reducing stigma.</p><p><strong>Principal findings: </strong>Despite its distinctive clinical and chronobiological features, CH may be mistaken for other primary headache disorders or different types of orofacial pain. Key pathogenic characteristics include the activation of the trigeminal-autonomic system with the release of several neuropeptides, the involvement of the hypothalamus in regulating the circadian rhythm, genetic variants, and the mesolimbic system. Both invasive and non-invasive neuromodulation treatments have been used to target the trigemino-cervical, parasympathetic, and hypothalamic systems. Additionally, novel therapeutic targets are currently being study. Alongside canonical therapies, several complementary approaches have been explored over the years, with most evidence deriving from uncontrolled research involving individuals who do not respond to standard pharmacological treatments. Despite advancements in our understanding of this complex disease, CH continues to pose considerable social, economic, and psychological challenges. Advocacy is essential and should prioritize early diagnosis, alleviate stigma, provide specialized training for healthcare professionals, and offer support to and through patient associations.</p><p><strong>Conclusions: </strong>CH is characterised by a complex, multifactorial, pathophysiology that is still not fully understood. Precise diagnosis, additional research studies, and robust psychosocial and institutional support are necessary to improve the quality of life for individuals affected by this debilitating condition.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"196"},"PeriodicalIF":7.9,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12490097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212876","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}