Journal of Clinical Medicine

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Headache: Updates on the Assessment, Diagnosis and Treatment

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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

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13 pages, 886 KiB

Open AccessArticle

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

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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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Open AccessSystematic 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

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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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