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Headache: Updates on the Assessment, Diagnosis and Treatment
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Headache: Updates on the Assessment, Diagnosis and Treatment

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: 25 December 2025 | Viewed by 2834

Special Issue Editors

Dr. Ernesto Anarte-Lazo

E-Mail Website
Guest Editor
Department of Physiotherapy and Nursing, UNIE University, 28015 Madrid, Spain
Interests: headache; migraine; tension-type headache; cervicogenic headache; therapeutic exercise
Special Issues, Collections and Topics in MDPI journals
Dr. Carlos Bernal-Utrera

E-Mail Website
Guest Editor
Department of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain
Interests: neck pain; headache; therapeutic exercise
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Headache is one of the most prevalent and disabling pain conditions, affecting millions of people worldwide. Despite significant advances in its assessment, diagnosis, and treatment, managing headaches remains challenging due to the wide range of etiologies and clinical presentations. Furthermore, it is crucial to consider the cognitive and emotional consequences that often accompany this condition. This Special Issue seeks to provide a comprehensive update on the latest findings, with a focus not only on the biomedical aspects but also on the broader impact that headaches have on individuals' lives. We encourage authors to submit papers on the latest clinical advancements in the assessment, diagnosis, and treatment of various headache disorders, with a particular emphasis on the importance of person-centered interventions.

Dr. Ernesto Anarte-Lazo
Dr. Carlos Bernal-Utrera
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • headache
  • migraine
  • tension-type headache
  • cervicogenic headache
  • therapeutic exercise

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Published Papers (5 papers)

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Research

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13 pages, 582 KiB  
Article
Strength Training and Posture Correction of the Neck and Shoulder for Patients with Chronic Primary Headache: A Prospective Single-Arm Pilot Study
by Jordi Padrós-Augé, Henrik Winther Schytz, Karen Søgaard, Rafel Donat-Roca, Gemma Victoria Espí-López and Bjarne Kjeldgaard Madsen
J. Clin. Med. 2025, 14(15), 5359; https://doi.org/10.3390/jcm14155359 - 29 Jul 2025
Viewed by 677
Abstract
Background: Few studies have examined exercise-based treatments for migraine and tension-type headache (TTH), and even fewer have focused on strength training and chronic headache, as these present greater challenges. Objectives: This study aimed to evaluate the effectiveness of a group-based neck and [...] Read more.
Background: Few studies have examined exercise-based treatments for migraine and tension-type headache (TTH), and even fewer have focused on strength training and chronic headache, as these present greater challenges. Objectives: This study aimed to evaluate the effectiveness of a group-based neck and shoulder strength training intervention combined with postural correction for patients with chronic headache. Methods: This prospective, single-arm, uncontrolled pilot study with a pre–post design included patients with chronic migraine (n = 10) and TTH (n = 12) who participated in an 8-week group-based program consisting of neck and shoulder strength training three times per week, along with instructions for postural correction. The primary outcome was change in headache frequency. Secondary outcomes included changes in the intensity and duration of headache, number of days of analgesic use, and functionality. Results: In total, 22 patients completed the intervention and were included in the analysis. Headache frequency decreased at follow-up for the overall group (r = 0.531; p = 0.014). In-depth analysis showed that 45% of participants experienced an average reduction of 38% in headache frequency. Additionally, large to moderate effect sizes were observed for the secondary outcomes. Conclusions: This is the first study to introduce a group-based exercise program targeting the neck and shoulder muscles, combined with postural correction and standard pharmacological treatment, for patients with chronic primary headache. It was found to be a safe, well-tolerated, useful, and promising intervention for improving headache frequency, duration, and functionality. Full article
(This article belongs to the Special Issue Headache: Updates on the Assessment, Diagnosis and Treatment)
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18 pages, 953 KiB  
Article
Efficacy of Greater Occipital Nerve Blockade in Craniofacial Neuralgia and Facial Pain Syndromes: A Retrospective Chart Review with Prospectively Collected Follow-Up Data
by Turan Poyraz and Aynur Ozge
J. Clin. Med. 2025, 14(14), 5034; https://doi.org/10.3390/jcm14145034 - 16 Jul 2025
Viewed by 474
Abstract
Background/Objectives: Greater occipital nerve blockade (GONB) is a minimally invasive intervention used to treat primary headaches. However, the evidence regarding its role in craniofacial pain syndromes and its potential impact on analgesic use remains limited. Previous studies have reported that GONB is [...] Read more.
Background/Objectives: Greater occipital nerve blockade (GONB) is a minimally invasive intervention used to treat primary headaches. However, the evidence regarding its role in craniofacial pain syndromes and its potential impact on analgesic use remains limited. Previous studies have reported that GONB is an effective method in patients with cranial neuralgia, but its efficacy is limited in persistent idiopathic facial pain (PIFP). Methods: This study was a retrospective cohort trial examining the medical records of 26 patients who applied to our Headache Clinic due to facial pain and cranial neuralgia between April 2023 and April 2025. Of these patients, 12 were trigeminal neuralgia (46%), 6 were occipital neuralgia (23%), 4 were trigeminal neuropathic pain (15%), and 4 were PIFP (15%) patients. In our study, the landmark-based GONB technique was used to determine the greatest tenderness to palpation (TTP) area. A standard 2.5 mL mixture of 30 mg 2% lidocaine and 4 mg dexamethasone was injected bilaterally as a single dose into the nerve region of all patients. After GONB, all patients were routinely contacted by phone or addressed face to face once a week for the first month and monthly thereafter, and medical changes were recorded with a standard-case follow-up form file. The case follow-up form allowed regular monitoring of parameters, such as the Visual Analog Scale (VAS), self-assessment scales for patients’ clinical responses, sensitivity to triggers, possible side effects, duration of effect, and the number of analgesics used. Results: A positive response with at least 50% overall improvement compared to the patient’s baseline level was found in 22 of 26 patients. Response to treatment was observed in 10 patients in the trigeminal neuralgia group (83%), 3 patients in the trigeminal neuropathic pain (75%) and PIFP groups (75%), and all in the occipital neuralgia group (100%). There was no statistically significant difference in response rates between the diagnostic groups. A significant difference was found in terms of response rates according to gender (p = 0.022). Accordingly, while response was observed in all 15 female patients, response was observed in 7 of 11 male patients (64%). Pre-GONB VAS values of those responding to treatment were found to be higher. Patients with positive responses to GONB had a significantly higher median value of the VAS total score (5; 95% CI: 1.83–4.52) in comparison to those with negative responses (8.32; 95% CI: 8.17–12.12) (p < 0.001). Post-GONB Intensity (VAS) and Post-GONB sensitivity to triggers decreased significantly (p < 0.001, p < 0.001). In those who responded, the decrease in analgesic use after GONB compared to before was statistically significant in the first and second months (p < 0.001, p < 0.003, respectively). Although the decrease continued in the third month, this difference did not reach statistical significance (p = 0.551). Conclusions: GONB reduces the duration, frequency, and intensity of headaches, and the need for acute analgesic use in CN and PIFP patients. Full article
(This article belongs to the Special Issue Headache: Updates on the Assessment, Diagnosis and Treatment)
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13 pages, 886 KiB  
Article
Headache Management in Military Primary Care: Findings from a Nationwide Cross-Sectional Study
by Carl H. Göbel, Ursula Müller, Hanno Witte, Katja Heinze-Kuhn, Axel Heinze, Anna Cirkel and Hartmut Göbel
J. Clin. Med. 2025, 14(13), 4497; https://doi.org/10.3390/jcm14134497 - 25 Jun 2025
Viewed by 506
Abstract
Background: Headache disorders, particularly migraine, are a leading cause of disability among active-duty military personnel, significantly affecting operational readiness and fitness for duty. Despite their high prevalence, limited data exist on how headache disorders are managed within military primary care systems. This [...] Read more.
Background: Headache disorders, particularly migraine, are a leading cause of disability among active-duty military personnel, significantly affecting operational readiness and fitness for duty. Despite their high prevalence, limited data exist on how headache disorders are managed within military primary care systems. This study aimed to evaluate diagnostic confidence, treatment strategies, and structural challenges in the management of headache disorders from the perspective of military primary care physicians. Methods: A prospective, nationwide cross-sectional survey was conducted between May and July 2023 among all active-duty military physicians in primary care roles. An anonymous 15-item questionnaire assessed diagnostic practices, therapeutic approaches, referral pathways, perceived knowledge gaps, and suggestions for system improvements. The survey was distributed across military medical centers and outpatient clinics in Germany. Results: Ninety military physicians participated. Migraine and tension-type headache were commonly encountered, with 70% having treated at least one headache patient in the week prior to the survey. Diagnostic confidence was high for migraine (83.4%) and tension-type headache (77.8%) but lower for medication-overuse headache (65.5%) and cluster headache (47.8%). Acute treatment was widely implemented, but only 27.8% of respondents regularly initiated preventive therapies. Awareness of clinical guidelines was limited: only 23.3% were familiar with the ICHD-3, and just 58.9% with national headache treatment guidelines. Respondents expressed strong demand for targeted education, practical diagnostic tools, and improved interdisciplinary coordination. Conclusions: Headache disorders are a prevalent and clinically significant issue in military primary care. While military physicians show high engagement, important gaps exist in preventive treatment, guideline familiarity, and access to specialist care. Structured training, standardized treatment protocols, and system-level improvements are essential to optimize headache care and maintain operational readiness. Full article
(This article belongs to the Special Issue Headache: Updates on the Assessment, Diagnosis and Treatment)
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Review

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20 pages, 783 KiB  
Review
A Scoping Review of Clinical Features and Mechanisms of Orofacial Pain and Headache in Patients with Head and Neck Cancer
by Ernesto Anarte-Lazo and Carlos Bernal-Utrera
J. Clin. Med. 2025, 14(16), 5722; https://doi.org/10.3390/jcm14165722 - 13 Aug 2025
Abstract
Background: Orofacial pain (OFP) and headache are common and disabling conditions in people with head and neck cancer (HNC), although their clinical characteristics and underlying pain mechanisms remain poorly studied, leading to worse diagnosis and, thus, management. Therefore, this review aims to synthesize [...] Read more.
Background: Orofacial pain (OFP) and headache are common and disabling conditions in people with head and neck cancer (HNC), although their clinical characteristics and underlying pain mechanisms remain poorly studied, leading to worse diagnosis and, thus, management. Therefore, this review aims to synthesize the literature regarding clinical features, pain descriptors, mechanisms, and assessment tools of OFP and/or headache in adults with HNC. Methods: A scoping review was conducted following the Arksey and O’Malley framework and reported using PRISMA-ScR guidelines. We searched PubMed, Embase, Scopus, and Web of Science. Quantitative and qualitative original studies were included. Data were charted and summarized using narrative synthesis. Results: Of 3647 records initially retrieved, 32 studies met the inclusion criteria. Most studies were observational and heterogeneous in design, population, and pain assessment methods. OFP was highly prevalent, with neuropathic descriptors (e.g., burning, electric shocks, tingling) reported in 13.1% to 64.5% of patients, although heterogeneity in study design and tools used to assess this potential pain mechanism was high. Pain was frequently localized at the tumor site, although pain in other regions beyond the head and neck was also reported. Pain intensity was generally moderate, although varied across studies. OFP and headache in HNC patients were often neuropathic in nature and contributed significantly to disability and reduced quality of life. Most articles lacked mechanistic classifications of pain, although some suggested that central sensitization may be involved in some patients. Conclusions: Orofacial pain and headache are prevalent, under-characterized symptoms in HNC patients. There is an urgent need for standardized assessments using validated tools to improve phenotyping and inform targeted treatment strategies. Full article
(This article belongs to the Special Issue Headache: Updates on the Assessment, Diagnosis and Treatment)
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Other

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17 pages, 1164 KiB  
Systematic Review
What Is the Link Between Migraine and Hypothyroidism? A Systematic Literature Review
by Martyna Michalik, Justyna Łapicka, Marcin Sota, Julia Zawieska, Olga Grodzka and Katarzyna Kępczyńska
J. Clin. Med. 2025, 14(13), 4645; https://doi.org/10.3390/jcm14134645 - 1 Jul 2025
Viewed by 756
Abstract
Background: Hypothyroidism is defined as a deficiency of thyroid hormones and is further classified into primary, secondary, and tertiary types, based on the root cause of the deficiency. Migraine is a primary headache disorder, characterized by unilateral, pulsating pain, lasting from 4 [...] Read more.
Background: Hypothyroidism is defined as a deficiency of thyroid hormones and is further classified into primary, secondary, and tertiary types, based on the root cause of the deficiency. Migraine is a primary headache disorder, characterized by unilateral, pulsating pain, lasting from 4 to 72 h, accompanied by symptoms such as photophobia, phonophobia, nausea, and emesis and sometimes preceded by specific aura phenomena. Both diseases are more prevalent in women than in men. While the primary focus of this systematic review was on the relationship between hypothyroidism and migraine, we also included relevant data on headaches in general when they provided valuable context or mechanistic insight. Methods: This systematic review aimed to summarize the current knowledge about the relationship between migraine and hypothyroidism. The Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines were applied. Screening of two databases led to including 29 relevant studies in the review. Results: Studies demonstrated that migraine and disturbed thyroid function may influence one another. The positive correlation between migraine and hypothyroidism, mainly Hashimoto’s disease, was presented in several studies. Moreover, some research identified this correlation in pediatric populations. Finally, the effects of levothyroxine use, a treatment applied in hypothyroidism, on migraine course were presented. Conclusions: A better understanding of the correlation between migraine and hypothyroidism may lead to an increase in the understanding of the pathogenesis of both disorders and positively impact clinical practice. Full article
(This article belongs to the Special Issue Headache: Updates on the Assessment, Diagnosis and Treatment)
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