Frontiers in pain research (Lausanne, Switzerland)最新文献

{"title":"Exploring predictors of analgesic response in adult women regularly using NSAIDs: insights from a machine learning approach.","authors":"Christopher Huong, Laura C Seidman, Kevin M Hellman, Laura A Payne","doi":"10.3389/fpain.2026.1878751","DOIUrl":"10.3389/fpain.2026.1878751","url":null,"abstract":"<p><strong>Introduction: </strong>Non-steroidal anti-inflammatory drugs (NSAIDs) are considered a first-line treatment for dysmenorrhea (menstrual pain). However, as much as 20% of women fail to achieve sufficient pain relief from NSAIDs, although factors associated with NSAID non-response are not well-known. The purpose of this study was to investigate factors associated with analgesic response to NSAIDs for dysmenorrhea.</p><p><strong>Methods: </strong>Data were from a large survey study of adult women who reported regularly using NSAIDs for dysmenorrhea. Demographic information, menstrual characteristics, comorbid conditions, and psychosocial factors were collected. NSAID non-response was defined as self-reported minimal or no menstrual pain relief from NSAIDs. We repeatedly applied a group least absolute shrinkage and selection operator (LASSO) logistic regression 100 times, and averaged results to account for model uncertainty and to identify variables related to NSAID non-response.</p><p><strong>Results: </strong>Of 512 women (mean age = 34.0 years, SD = 9.4) who met inclusion criteria, 182 (35.5%) were classified as NSAID non-responders. NSAID non-responders reported significantly higher average menstrual pain severity than responders (mean = 7.4 vs. 6.2 on a 0-10 scale, <i>p</i> < 0.001). The strongest factors associated with NSAID non-response included greater menstrual pain severity and more severe menstrual-related symptoms (e.g., bloating and dull pelvic pain), as well as greater sleep disturbance. Higher negative affect was modestly associated with better odds of NSAID response. Classical risk factors such as heavy menstrual bleeding and self-reported endometriosis were not significantly linked to NSAID response in this sample. However, the LASSO models achieved only modest discrimination (mean cross-validated AUC = 0.64), indicating considerable unexplained variability.</p><p><strong>Discussion: </strong>In this large cross-sectional cohort, women reporting inadequate menstrual pain relief from NSAIDs had more severe menstrual pain and related symptoms, along with indicators of pain amplification (sleep disturbance). Most psychosocial factors (e.g., negative mood) did not correlate with NSAID non-response. These findings underscore the heterogeneity of dysmenorrhea and suggest that clinical factors alone may be insufficient to predict NSAID effectiveness. Further prospective studies are needed to confirm these associations and to explore whether interventions (such as optimizing NSAID timing or addressing sleep disturbances) could improve menstrual pain outcomes for those with NSAID non-response.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1878751"},"PeriodicalIF":2.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peak alpha frequency is associated with pain severity in Long COVID patients with new-onset chronic pain.","authors":"Bárbara Silva-Passadouro, Omar Khoja, Alexander J Casson, Ioannis Delis, Christopher Brown, Manoj Sivan","doi":"10.3389/fpain.2026.1893610","DOIUrl":"10.3389/fpain.2026.1893610","url":null,"abstract":"<p><strong>Background: </strong>New-onset chronic pain is a common and debilitating symptom of Long COVID (LC) that remains not fully understood in terms of pathophysiology and therapeutic targets. A growing body of evidence in chronic pain syndromes similar to LC demonstrates an association between EEG alpha oscillatory activity and the experience of pain, with clinical studies showing maladaptive changes, particularly a slowing of alpha activity.</p><p><strong>Aims: </strong>This study aims to investigate the association between EEG alpha oscillatory activity and pain perception in new-onset LC-chronic pain.</p><p><strong>Methods: </strong>We recruited 31 individuals (20 females) with a clinical diagnosis of LC reporting new-onset chronic pain and 31 healthy pain-free age- and sex-matched controls. Participants completed questionnaires regarding symptoms and psychological functioning prior to recording eyes-open resting-state EEG. Peak alpha frequency (PAF) and alpha band (8-13 Hz) spectral power were extracted from EEG signals.</p><p><strong>Results: </strong>Lower PAF over the posterior scalp region was significantly associated with higher LC-chronic pain severity when controlling for age, depression and the use of centrally acting medication. This finding was consistent across PAF estimation methods. No differences in PAF were observed between the LC patient group and the healthy pain-free control group. Alpha power did not differ between groups and was not associated with pain severity.</p><p><strong>Discussion: </strong>Together, these findings suggest that PAF may index individual differences in pain severity within LC-associated chronic pain, although the absence of overall patient-control differences indicates that PAF should not be interpreted as a disease-specific biomarker and warrants further longitudinal research.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1893610"},"PeriodicalIF":2.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Insights into pain mechanisms - 2024/2025.","authors":"Dai-Qiang Liu, Ya-Qun Zhou","doi":"10.3389/fpain.2026.1925507","DOIUrl":"10.3389/fpain.2026.1925507","url":null,"abstract":"","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1925507"},"PeriodicalIF":2.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limited Australian clinical guidelines for pain assessment in hospitalized older adults with cognitive impairment: implications for safe and quality care.","authors":"Rosemary Saunders, Kaoru Nosaka, Seng Giap Marcus Ang, Natasya Raja Azlan, Aaron Alejandro, Rohini Sharma Bhardwaj, Olivia Gallagher, Irene Ngune, Amineh Rashidi, Yan Hui Celestine Wee, Nilufeur McKay","doi":"10.3389/fpain.2026.1895602","DOIUrl":"10.3389/fpain.2026.1895602","url":null,"abstract":"<p><strong>Introduction: </strong>Pain assessment remains challenging in healthcare settings in patients who are unable to self-report their pain. More than 50% of individuals with dementia and other forms of cognitive impairment (CI) experience pain daily. However, pain is frequently overlooked and inadequately assessed by healthcare professionals due to their lack of knowledge and guidelines to inform pain assessment. Pain is also a leading cause of hospital presentation and inappropriate pain assessment can impact on pain management and compromise safe and quality care. Evidence-based guidelines that inform appropriate pain assessment and management are therefore essential. This scoping review aimed to explore pain assessment guidelines for patients with CI in hospital through an Australian focused search to inform pain assessment practice within our local context and subsequent research. The objectives were to identify accessible pain assessment guidelines for hospitalized older adults with CI and summarize and describe their characteristics.</p><p><strong>Methods: </strong>A scoping review was conducted, using the Joanna Briggs Institute methodology and reported in accordance with the PRISMA-ScR reporting framework. The search strategy was guided by the Population, Concept, and Context frameworks, focusing on older adults with CI, pain assessment guidelines, and hospital or acute care setting. The search was conducted in March 2026, using CINHAL, MEDLINE, Embase, Web of Science, Google, Yahoo Search, and Bing.</p><p><strong>Results: </strong>No Australian guidelines were located in the database search. Of 56 guidelines identified through internet searches, nine met the inclusion criteria and were included in data extraction. All nine included pain assessment indication; however, two provided no practical guidance, and the remaining seven offered only brief narrative descriptions of pain assessment steps. The most frequently recommended pain assessment tools in the guidelines for patients with CI were the Pain Assessment in Advanced Dementia and the Abbey Pain Scale. Discussion: By systematically mapping the extent, characteristics, and variability of guidelines for pain assessment of patients with CI guidelines, it is an important first step in driving innovation in pain assessment for older adults in Australia. It provides transferable insights that can inform the development and adaptation of international clinical guidelines. Scoping Review Registration (OSF):https://doi.org/10.17605/OSF.IO/HJSMZ.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1895602"},"PeriodicalIF":2.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond traditional treatments: vagal nerve stimulation for painful temporomandibular disorders.","authors":"Rania Nuwailati, David P Darrow, Donald R Nixdorf","doi":"10.3389/fpain.2026.1860767","DOIUrl":"10.3389/fpain.2026.1860767","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic temporomandibular disorders (TMD) can progress to refractory chronic pain in a subset of patients, for whom standard multimodal treatments often provide limited relief. Emerging neuromodulation therapies-particularly non-invasive vagal nerve stimulation (nVNS)-suggest a potential non-pharmacologic adjunct within multimodal strategies for managing persistent symptoms. This case series explores the use of non-invasive nVNS in conjunction with a multimodal treatment strategy for managing refractory pain in patients with chronic TMD.</p><p><strong>Methods: </strong>A retrospective review at the University of Minnesota TMD, Orofacial Pain and Dental Sleep Medicine Clinic, evaluated patients with chronic TMD pain treated with a multimodal treatment plan which included GammaCore nVNS device, by comparing their baseline data to outcomes at their most recent follow-up.</p><p><strong>Results: </strong>Three patients (mean age 44.3 ± 23.3 years) with refractory TMD pain were identified as having received nVNS therapy using the GammaCore device. Treatment duration ranged from 4.6 to 18.2 months and was self-administered three to four times per day. All three patients reported improvements in pain intensity, pain-related disability, and psychosocial functioning, in the context of a multimodal treatment plan that included nVNS.</p><p><strong>Discussion: </strong>Our limited clinical experience observed improvements across multiple domains relevant to patients with chronic TMD in the context of a multimodal treatment plan that included nVNS.IRB approval status: Approved STUDY00024420.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1860767"},"PeriodicalIF":2.5,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13443317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydrodissection and hydrodilatation for joint pain: a scoping review.","authors":"Benjamin Leahy, Harry McGrath, Dominic Harmon","doi":"10.3389/fpain.2026.1851291","DOIUrl":"10.3389/fpain.2026.1851291","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the current evidence regarding the effectiveness and safety of ultrasound-guided hydrodissection (US-HD) in the management of joint-related pain.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, Cochrane Library, and Google Scholar was conducted for studies published in the past 15 years. Eligible studies included randomised controlled trials (RCTs), cohort studies, and case series investigating hydrodissection for joint pain (e.g., shoulder, hip, knee, sacroiliac joint). Outcomes included pain reduction, functional improvement, and complication rates. Data extraction and qualitative synthesis were performed due to heterogeneity in study design and outcome measures.</p><p><strong>Results: </strong>A total of 138 studies were identified, of which 21 met inclusion criteria. Evidence suggests that US-HD may provide significant pain relief and functional improvement in conditions such as adhesive capsulitis, greater trochanteric pain syndrome, and knee osteoarthritis. Studies consistently reported low complication rates. However, heterogeneity in technique, injectate composition, and outcome measures was noted.</p><p><strong>Conclusion: </strong>Ultrasound-guided hydrodissection appears to be a safe and promising intervention for joint-related pain. While early evidence is encouraging, larger high-quality trials are required to establish standardised protocols and confirm long-term efficacy.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1851291"},"PeriodicalIF":2.5,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13443037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic low back pain as a control failure state: a predictive-rhythm model of motor control impairment and functional rigidity with functional system constraint modulation.","authors":"SeongHyung Cho, DongYeob Baek, MiSuk Jeong, MinHee Kim","doi":"10.3389/fpain.2026.1812201","DOIUrl":"10.3389/fpain.2026.1812201","url":null,"abstract":"<p><p>Motor dysfunction in chronic low back pain (CLBP) is commonly described at the output level-altered movement patterns, reduced variability, and maladaptive behaviors. Yet such output-level descriptions leave recurring clinical questions unresolved: why altered patterns begin, why apparent correction often fails to generalize, why stress and physiological state modulate function, and why performance fluctuates despite stable structure. We hypothesize that a subset of CLBP presentations can be conceptualized as a persistent control failure state when stabilization-dominant regulation, reduced adaptive variability, impaired phase-transition dynamics, and constrained predictive updating become self-maintaining features of motor behavior. In this framework, stabilization does not mean trunk stability alone; it denotes a regulatory strategy that minimizes uncertainty by reducing variability, restricting phase transitions, and prioritizing predictability over adaptability. Functional rigidity is treated as the clinical output expression of this state, characterized by reduced rhythmic variability, autonomic inflexibility, and anticipatory co-contraction, with altered kinematics emerging as a downstream biomechanical expression rather than the primary explanatory level. Respiratory-autonomic dynamics are introduced not as a privileged cause of CLBP but as one clinically accessible example of a broader class of phase-transition interfaces through which constrained regulation can be observed, perturbed, and quantified during task transitions and repetition. Functional System Constraint modulation (FSCm) is therefore not proposed as a universal CLBP theory or a proprietary intervention protocol. Rather, it is a constraint-level validation architecture that aligns three interacting mechanistic features-restricted phase transitions, reduced adaptive variability, and constrained predictive updating-with measurable recovery targets: restoration of phase-transition capacity, re-expansion of adaptive variability, re-enablement of predictive updating, and re-coupling of interacting rhythms. The model yields falsifiable temporal predictions: phase-transition and autonomic changes should precede or co-occur with reductions in stabilization-based motor output, while variability and repetitive-task performance may partially dissociate from pain intensity. By positioning FSCm as a complementary framework that integrates predictive coding, motor control impairment, nociplastic pain, and behavioral models, this hypothesis specifies target populations, boundary conditions, operational markers, and temporal-order falsification criteria for mechanistic CLBP research.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1812201"},"PeriodicalIF":2.5,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13442559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring magical thinking in the context of pain.","authors":"Birgit Heckemann, Lionel Snell, Mark I Johnson","doi":"10.3389/fpain.2026.1753496","DOIUrl":"10.3389/fpain.2026.1753496","url":null,"abstract":"<p><p>This perspectives article explores magical thinking (which is often dismissed as irrational or pathologized) as a potentially valuable personal orientation and resource for people living with chronic pain: as a way to make more sense of their complex and challenging life experience, psychologically as well as socially. <i>Magical thinking</i> entails a broader acceptance of connectivity between phenomena generally considered to be independent, and it includes symbolic <i>meaning-making acts</i> such as rituals. The authors explicitly exclude in their discussion <i>magical superstitions</i> which involve the conviction that magical acts can directly impact physical reality (such as enabling levitation or turning people into frogs). Drawing on a reflective, interpretive, and conversational methodology, a pain scientist, a nurse researcher, and a writer-practitioner of magical thinking explored how magical thinking functions as a personal orientation and resource that enables symbolic meaning-making and supports emotional regulation and relation with self, others and the wider world. As such, it may be potentially valuable for people living with chronic pain. The article shows that traces of magical thinking can be found within psychology and medicine and invites a broader conversation about how the symbolic and imaginative modes of magical thinking might be valuable in pain care.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1753496"},"PeriodicalIF":2.5,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13442387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurodynamic techniques vs. desensitization maneuvers in the manual therapy management of moderate carpal tunnel syndrome among women: randomized clinical trial with 1-year follow-up.","authors":"Mohamed I Mabrouk, Sahar A Abdalbary, Ehab A A El-Shaarawy, Sami Elmahgoub, Aseel Aburub, Mohammad Z Darabseh, Alexandra Makai, Pongrác Ács","doi":"10.3389/fpain.2026.1792933","DOIUrl":"10.3389/fpain.2026.1792933","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare the clinical and electrophysiological effects of neurodynamic techniques vs. desensitization maneuvers in women with moderate carpal tunnel syndrome (CTS).</p><p><strong>Design: </strong>Randomized clinical trial. The study included 380 female participants with moderate carpal tunnel syndrome, aged between 45 and 55 years, who were randomly assigned to a neurodynamic technique group or a desensitization maneuvers group. Neurodynamic techniques in one group and desensitization in the other group were conducted for 3 months.</p><p><strong>Outcome: </strong>Measures were nerve conduction, pain, symptom severity, and functional status using the Boston Carpal Tunnel Questionnaire, and cylindrical and pincer grip strength before treatment and after 3 months of treatment. One-year follow-up for pain, symptom severity, and functional status using the Boston Carpal Tunnel Questionnaire.</p><p><strong>Results: </strong>Both groups demonstrated significant within-group improvements in nerve conduction, pain, symptom severity, and functional status (<i>P</i> < 0.001). Between-group analysis showed greater improvements in sensory and motor nerve conduction, pain, symptom severity, and functional status in the desensitization group (<i>P</i> < 0.001). Improvements in cylindrical and pincer grip strength were significant only in the desensitization group. Clinical gains in pain and function were maintained at 1-year follow-up.</p><p><strong>Conclusion: </strong>Both interventions were effective in women with moderate CTS; however, desensitization maneuvers demonstrated superior improvements in neurophysiological outcomes, pain, and function over 12 weeks, with sustained benefits at 1-year follow-up.<b>Clinical Trial Registration:</b> http://www.clinicaltrials.gov/, NCT05150912.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1792933"},"PeriodicalIF":2.5,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13463407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Episodic cluster headache with suspected giant cell arteritis, sinusitis-related headache, and dietary triggers: a case report.","authors":"Shusheng Jiao, Ning Zhen","doi":"10.3389/fpain.2026.1884385","DOIUrl":"10.3389/fpain.2026.1884385","url":null,"abstract":"<p><strong>Background: </strong>Cluster headache is a primary trigeminal autonomic cephalalgia characterized by severe, strictly unilateral orbital/periorbital pain with ipsilateral autonomic features. It is rare for a patient with cluster headache to have coexisting multiple headache disorders and experience unusual triggers.</p><p><strong>Case presentation: </strong>A 53-year-old male with a 14-year history of episodic cluster headache presented with his third cluster episode. He exhibited strictly unilateral left orbital/periorbital/temporal drilling pain [Visual Analogue Scale (VAS) 9-10/10], ipsilateral conjunctival injection, lacrimation, rhinorrhea, and agitation. Notably, during the second episode (2015), left maxillary sinusitis was identified and surgically treated, leading to immediate and complete headache resolution. During the current episode, physical examination revealed left temporal artery nodularity and tenderness-raising suspicion of giant cell arteritis. However, the erythrocyte sedimentation rate and C-reactive protein levels were within the normal range. Brain MRI/MRA revealed only nonspecific white matter changes, along with suspected wall thickening of the left superficial temporal artery. The patient declined temporal artery ultrasound, high-resolution MRI, and biopsy. In accordance with clinical guidelines, the patient was administered comprehensive treatment for cluster headache. Given the suspicion of giant cell arteritis, empirical prednisone was also initiated at a dose of 1 mg/kg/day. By day 3 of treatment, attack frequency had reduced from daily to 3-4 times per week, pain intensity decreased from VAS 10/10 to 3-6/10, attacks resolved within 30 min either spontaneously or after zolmitriptan, and temporal artery nodules had markedly diminished. Interestingly, during follow-up, the patient reported that ingestion of soy sauce or vinegar consistently triggered an unusual throat discomfort followed by headache within 30 min, whereas avoidance of these substances resulted in no attacks. The patient's strict avoidance of soy sauce and vinegar led to a marked reduction in headache frequency over a short period, ultimately resulting in a complete absence of headache episodes. He remains under follow-up.</p><p><strong>Conclusion: </strong>This case highlights an unusual concurrence of episodic cluster headache with suspected giant cell arteritis and possible sinusitis-related headache in a single patient. The potential role of soy sauce and vinegar as triggers for cluster headache warrants further validation with extended follow-up and a larger case series.</p>","PeriodicalId":73097,"journal":{"name":"Frontiers in pain research (Lausanne, Switzerland)","volume":"7 ","pages":"1884385"},"PeriodicalIF":2.5,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13442384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}