Impact and care gaps of headache disorders in active-duty military personnel: A cross-sectional study from a European armed forces population.

The frequency of probable migraine (PM) remains elusive; some of the published literature estimate PM to be at least as prevalent as definite migraine (DM) while others report PM to affect about 5% of the population or less. We conducted a cross sectional survey of female high school students using a validated questionnaire which covered the diagnostic features of DM, PM and tension type headaches as specified by the international classification of headache disorders. The survey also inquired about subjects' treatment history and analgesic use. Headache related disability was ascertained using headache impact test 6 (HIT-6). The participants included 309 girls with a mean age of 16.0 yr. The prevalence of DM and PM in our cohort were 18% and 25% respectively. Overall, headaches were more frequent in the DM group although this did not reach statistical significance (P < 0.06). There was no statistical significance between DM and PM in respect to seeking medical care (P < 0.30). The individuals with tension type headaches however, were less likely to seek medical care compared to the ones with PM or DM (P < 0.001). The preventative medications were under-utilized in all three groups. Moreover, individuals in the DM group reported higher frequencies of analgesic use (P < 0.001). The girls with DM experienced higher degrees of headache related disability as measured by HIT-6 (P < 0.0001). PM appears to be at least as prevalent of DM in our cohort of teenage girls. We propose that PM may produce a milder phenotype indicated by significantly lower HIT-6 scores.

Post-traumatic headache (PTH) is among the most prevalent of the secondary headache disorders. As currently classified by the International Classification of Headache Disorders, 2nd edition (ICHD-2), PTH must start within 7 days of a mild, moderate, or severe traumatic brain injury (TBI). PTH transitions from an acute subtype to a chronic subtype 3 months after the injury (1). No other defining clinical characteristics set PTH apart from other primary or secondary headache disorders. In fact, most PTHs appear to have a phenotype indistinguishable from primary headache disorders and may respond to the same treatments as primary headache disorders (2,3). It seems altogether intuitive that headaches would occur acutely in the majority of individuals after a mild TBI (or concussion). More vexing, and controversial, is the link between head trauma and the subsequent development of chronic headaches (4,5). PTHs persist beyond the acute period in a significant proportion of patients. Up to 60% of TBI patients have chronic headaches persisting for up to 12 months (4,6). That chronic PTHs develop more often in mild versus moderate to severe TBI, in cases with impending litigation or in the setting of analgesic medication overuse, suggests a role for factors independent of trauma in the process of headache chronification (4,7,8). While each (or all) of these factors may be important in the genesis of chronic headaches in individual cases, there is a lack of evidence supporting them as unifying hypotheses to explain the spectrum of chronic PTHs in civilian and military patient populations. A better understanding of the processes leading to headache chronification after brain trauma is needed. Over the past 3 years, large epidemiological studies of headaches in military, civilian, and veteran populations with head trauma have been completed (9–11), providing a valuable opportunity to better understand and classify PTHs. In this issue, Lucas et al. (10) report the findings of a multi-center, longitudinal study of headaches in a population of 378 patients with moderate to severe TBI. The subjects underwent a baseline headache evaluation shortly after TBI and were then followed by telephone interview at 3, 6, and 12 months after injury to longitudinally assess headache incidence and headache characteristics. To our knowledge, this is one of the largest longitudinal studies of headaches in TBI patients. Many interesting findings emerge from this study, parts of which have been published previously (10, 11). The cumulative headache incidence in the study cohort was 71% over 12 months. Forty-three percent of patients had headaches at the baseline assessment shortly after TBI and this proportion was stable over the next 12 months. There were no differences in headache incidence between mild, moderate, and severe TBI patients. Eighteen percent of all patients had a history of headaches prior to TBI with 57% of these being migraine or probable migraine. Similar to previous studies, pre-traumatic headache and female sex were risk factors for reporting headaches after TBI. Migraine and probable migraine were the most common headache types after trauma, accounting for 52% of headaches at baseline and 60% of headaches 6 months after injury. Migrainous headaches were 2–3fold more common than tension-type headaches (TTHs; 7–21%) at all time points. The high prevalence of migraine observed by Lucas et al. (10) sharply contrasts with older studies which suggested a higher prevalence of TTH after TBI, but are similar to the findings of recent studies in military and veteran populations which found migraine in 60 to over 90% of cases (2,3,9,12). Comparing PTH studies and study populations can be difficult, but the accumulation of

Osmophobia is an under-investigated associated symptom in migraine. To evaluate the clinical correlates and diagnostic utility of osmophobia. Adult patients with migraine (with or without aura), probable migraine (PM), tension-type headache (TTH), and cluster headache (CH) were recruited retrospectively from our headache registration system. Migraine patients with and without osmophobia were compared. The newly proposed criteria for migraine requiring at least two of photo-, phono-, or osmophobia instead of both photo- and phonophobia were validated. In total, 2883 patients were included: 1809 migraine, 792 PM, 138 TTH, and 144 CH. Osmophobia was more common in migraine (62.2%) than in PM (33.8%), TTH (14.5%), and CH (31.3%) (all p < 0.001). Migraine patients with osmophobia scored higher on the Hospital Anxiety and Depression Scale (HADS) than those without (15.6 ± 7.6 vs. 13.3 ± 7.8, p < 0.001). The concordance in headache diagnoses between ICHD-2 (International Classification of Headache Disorders, Second Edition) and the newly proposed criteria was "almost perfect" (κ = 0.886, p < 0.001). Additionally, 16.9% of ICHD-2 PM patients were reclassified as migraine using the newly proposed criteria. Osmophobia was prevalent in migraineurs, and was associated with higher HADS scores. The newly proposed criteria appear comparable to the ICHD-2 criteria, and may increase the diagnostic yield for Asian migraineurs, among whom photophobia was less common.

To determine the extent to which variation in the Migraine Disability Assessment (MIDAS) score is associated with headache frequency, pain intensity, headache symptoms, gender, and employment status. The MIDAS questionnaire is a 7-item questionnaire (with 5 scored items) designed to measure headache-related disability, to improve physician-patient communication, and to identify patients with high treatment needs. Data from 3 population-based studies (total sample, n = 397) conducted in the United States and the United Kingdom were used to evaluate the relationship between headache features (attack frequency, pain intensity, pain quality, and associated symptoms) and MIDAS score. Data on headache features were collected by telephone using a standardized interview. The MIDAS questionnaire was completed shortly after the telephone interview. General linear models were used to determine the extent to which population variation in the MIDAS score was explained by headache features. Using linear regression, variables for all headache features (ie, headache frequency, pain intensity, pain quality, and associated symptoms) and demographic characteristics explained only 22% of the variation in MIDAS scores. Almost all (19.9%) the explained variance was accounted for by average pain intensity (12.0%), number of headache days (6.1%), and exacerbation of pain with movement (1.8%). When pain intensity and headache frequency were included in the model, no statistically significant differences in MIDAS scores were observed by gender or employment status. Although explaining only 2.1% of the variance, age was significantly associated with MIDAS scores, with those under 25 years demonstrating higher MIDAS scores than other age groups. No other variables (ie, frequency of occurrence of associated symptoms and other measures of quality of pain) were associated with MIDAS scores. Challenges to the utility of the MIDAS as a measure include whether headache-related disability is largely a function of other routine headache features and whether MIDAS is inherently biased based on work status and gender. While the MIDAS score was associated with headache frequency and average pain score, these two headache features explain only a modest proportion of the variation in MIDAS scores. Additionally, gender and work status were not related to MIDAS scores. These findings suggest that the MIDAS score captures information about disability that is not inherent to other headache features and is independent of gender and work status.

Background and PurposeHeadache disorders are a leading cause of disability globally. However, there is inadequate information available about these disorders and the related economic loss in the workplace in Asian countries. Information technology (IT) jobs are intellectually and cognitively challenging, and hence IT workers are a suitable population for assessing headache disorders and related economic loss.MethodsWe sent invitation emails to all employees of selected IT companies. A comprehensive Web-based questionnaire regarding headache characteristics, disability, quality of life, and economic loss was completed by 522 participants from 8 companies.ResultsThe participants included 450 (86.2%) who had experienced headache more than once during the previous year. The frequencies of migraine, probable migraine (PM), and tension-type headache (TTH) were 18.2%, 21.1%, and 37.0%, respectively. The Migraine Disability Assessment score was higher for participants with migraine [median and interquartile range, 3.0 (0.0–6.0)] than for those with PM [0.0 (0.0–2.0), p<0.001] and TTH [0.0 (0.0–1.0), p<0.001]. The estimated annual economic losses caused by migraine per person associated with absenteeism and presenteeism were USD 197.5±686.1 and USD 837.7±22.04 (mean±standard deviation), respectively. The total annual economic loss per person caused by migraine (USD 1,023.3±1,972.7) was higher than those caused by PM (USD 424.8±1,209.1, p<0.001) and TTH (USD 197.6±636.4, p<0.001).ConclusionsMigraine, PM, and TTH were found to be prevalent among IT workers in Korea. Disability and economic loss were significantly greater in participants with migraine than in those with PM or TTH.

In the absence of a biological marker and expert consensus on the best approach to classify chronic migraine (CM), recent revised criteria for this disease has been proposed by the Headache Classification Committee of the International Headache Society. This revised criteria for CM is now presented in the Appendix. Herein we field test the revised criteria for CM. We included individuals with transformed migraine with or without medication overuse (TM+ and TM–), according to the criteria proposed by Silberstein and Lipton, since this criterion has been largely used before the Second Edition of the International Classification of the Headache Disorders (ICHD-2). We assessed the proportion of subjects that fulfilled ICHD-2 criteria for CM or probable chronic migraine with probable medication overuse (CM+), as well as the revised ICHD-2 (ICHD-2R) criteria for CM (15 days of headache, 8 days of migraine or migraine-specific acute medication use—ergotamine or triptans). We also tested the ICHD-2R vs. three proposals. In proposal 1, CM/CM+ would require at least 15 days of migraine or probable migraine per month. Proposal 2 required 15 days of headache per month and at least 50% of these days were migraine or probable migraine. Proposal 3 required 15 days of headache and at least 8 days of migraine or probable migraine per month. Of the 158 patients with TM–, just 5.6% met ICHD-2 criteria for CM. According to the ICHD-2R, a total of 92.4% met criteria for CM (P < 0.001 vs. ICHD-2). The ICHD-2R criterion performed better than proposal 1 (47.8% of agreement, P < 0.01) and was not statistically different from proposals 2 (87.9%) and 3 (94.9%). Subjects with TM+ should be classified as medication overuse headache (MOH), and not CM+, according to the ICHD-2R. Nonetheless, we assessed the proportion of them who had 8 days of migraine per month. Of the 399 individuals with TM+, just 10.2% could be classified as CM+ in the ICHD-2. However, most (349, 86.9%) had 8 days of migraine per month and could be classified as MOH and probable CM in the ICHD-2R(P < 0.001 vs. ICHD-2). We conclude that the ICHD-2R addresses most of the criticism towards the ICHD-2 and should be adopted in clinical practice and research. In the population where use of specific acute migraine medications is less common, the agreement between ICHD-2R CM and TM may be less robust.

BackgroundAccording to the third beta edition of the International Classification of Headache Disorder (ICHD-3 beta), the diagnostic criteria for tension-type headache (TTH) might lead to the inclusion of individuals with headaches showing migrainous features. To better define TTH, the alternative diagnostic criteria were proposed in the appendix of ICHD-3 beta. This study attempted to test the alternative criteria for diagnosis of TTH proposed in ICHD-3 beta in a population-based sample from Korea.MethodsWe selected participants from the Korean population aged 19–69 years using stratified random sampling and evaluated them by interview using a questionnaire designed to identify headache type, headache characteristics, and psychiatric comorbidities.ResultsOf the 2,762 participants, 586 (21.3%) were diagnosed as having TTH using the standard criteria. Among these, 238 (40.6%) were also classified as having TTH using the alternative criteria. All 238 TTH subjects first diagnosed as having TTH by the alternative criteria were also classified as having TTH by the standard criteria. If the standard criteria were not applied, the remaining 348 patients were subclassified as having probable migraine (115, 19.6%) and unclassified headache (233, 39.7%). Compared with subjects diagnosed with TTH using the standard criteria, those diagnosed using the alternative criteria were less likely to demonstrate unilateral, pulsating headache, which is aggravated by movement, photophobia, phonophobia, and osmophobia.ConclusionUsing the alternative criteria, less than half of the subjects with TTH according to the standard criteria were classified as having TTH. All the subjects with TTH by the alternative criteria were classified as having TTH by the standard criteria. This study also demonstrated that subjects diagnosed with TTH using the standard criteria could include people with headaches showing migrainous features.

BackgroundRecent studies have shown a significant association between restless legs syndrome (RLS) and primary headache disorders. Nevertheless, information regarding the association between tension-type headache (TTH) and RLS is limited. This study aimed to investigate the association between RLS and TTH in a population-based sample.MethodsWe selected a stratified random population sample of Koreans aged 19–69 years and assessed them using a semi-structured interview designed to identify RLS, headache type, and clinical characteristics of TTH. We determined the prevalence and clinical impact of RLS in participants with TTH.ResultsOf the 2695 participants, 570 (21.2%) and 142 (5.3%) were classified as having TTH and RLS, respectively. Among the 570 individuals with TTH, 113 (19.8%) also met the criteria for probable migraine (PM). The prevalence of RLS was significantly higher among individuals with TTH than among those with non-headache (6.0% vs 3.6%, p = 0.018). The prevalence of RLS was significantly higher in subjects with TTH who fulfilled PM criteria than in those with non-headache participants (8.0% vs. 3.6%, p = 0.018). However, RLS prevalence in individuals with TTH who did not fulfil PM criteria did not differ from that of participants with non-headache (5.5% vs. 3.6%, p = 0.063). TTH participants with RLS had higher visual analogue scale scores for headache intensity (5.1 ± 2.0 vs. 4.3 ± 1.8, p = 0.038), and higher prevalence of anxiety (20.6% vs. 8.8%, p = 0.022) and depression (14.7% vs. 3.5%, p = 0.002) than TTH participants without RLS. Multivariable analyses revealed that headache aggravation by movement (odds ratio [OR] = 2.4, 95% confidence interval [CI] = 1.1–5.2) and depression (OR = 3.5, 95% CI = 1.1–11.4) were significant indicators of RLS among individuals with TTH.ConclusionsThe prevalence of RLS was higher among individuals with TTH than among those with non-headache. Some clinical presentations varied in accordance with the presence of RLS among participants with TTH.

It is estimated that 30–80% of the population in Europe and the United States experience frequent and recurrent headaches, the most common of which are tension-type, migraine and cluster headaches. Migraine can also overlap with tension-type headache, which is referred to as vasomotor or mixed headache. According to the 3rd edition of the International Classification of Headache Disorders (ICHD-3 beta), these entities are classified as idiopathic (primary) headaches, where pain is both the essence and the main symptom of the disease. Idiopathic headaches are difficult to diagnose as they differ mainly in intensity. When collecting medical history, the focus should be placed on the duration and location of pain. Therefore, a thorough interview to assess subjective pain intensity is one of the basic elements of the diagnostic workup. Tension-type headache, migraine and cluster headaches are also characterised by specific symptoms, identification of which is essential for the diagnosis. Cluster headache produces the most typical symptoms. Since these types of headaches require different therapeutic strategies, it is necessary to differentiate them. Their treatment requires interdisciplinary cooperation of, among others, dentists, neurologists, and physiotherapists. In this paper, we made an attempt to discuss the pathogenesis, symptoms and differential diagnosis of tension headache, migraine and cluster headache, based on literature review.

Background: Tension type headache has been reported as one of the most common complains among adolescents. This study investigates the prevalence of tension type headache and its impact on quality of life in adolescents of Hayatabad, Peshawar. Objectives: To determine the prevalence of tension-type headache and its impact on the quality of life among adolescents of Hayatabad. Methods: This study was a cross-sectional study, that included 375 participants with mean age 16.67±1.39 in which male participants were 145 and female participants were 230. Study was done in schools and colleges of Hayatabad, Peshawar. Convenient sampling technique was used. HARDSHIP questionnaire based on ICHD-3 criteria was used for data collection. Analysis was done using SPSS version 22. Results: Among the participants 29.1% were diagnosed with TTH; 21.6% with PTTH, 5.9% with migraine, 27.2% with probable migraine 0.3% with medicine overuse headache and 2.4% with undetermined headache. According to severity of headache 46% students reported with severe impact, 4.8% students reported with substantial impact, 6.4% reported with some impact and 6.4% students reported with little to no impact on their life. While 8.2%, 5.06%, 4.53% and 2.6% students with probable tension type headache had severe impact, substantial impact, little impact and no impact on their lives respectively. Conclusion: Overall, this study concluded, 29.1% tension type headache prevalence and 20% probable tension type headache prevalence. Almost one third students with tension type headache had severe impact on their lives and also one third students with probable tension type headache had severe impact on their lives.

Introduction: Body pain disorders like knee pain, low back pain and primary headache disorders impose burdens that include substantial personal suffering, impaired quality of life, and financial cost. Repeated attacks, and often fear of future attacks, affects the family life, social life, and employment. Objectives: To evaluate the Safety, Efficacy and tolerability of four types of Amrutanjan Pain Balm preparations for rapid pain relief in patients with primary type of headache and body pain disorders. Materials &amp; Methods: This study is a randomized, multicentric, open label, interventional study conducted at a secondary care centre in Vellore. A total of 150 patients were screened and 144 patients were enrolled who were diagnosed with either body pain disorders like knee pain, low back pain or primary type of headache disorders like migraine, tension type headache and other primary head ache disorders. All the study participants were randomized to four arms of 36 each such that each arm comprised of 12 patients with knee pain, 12 patients with low back pain and 12 patients with primary headache disorder to receive four different formulations of Amrutanjan pain balms. Efficacy was evaluated by assessing pain reduction after treatment at various time points and duration of action. Visual analogue scale questionnaires were used post study to obtain feedback on overall status of improvement. Results: Patients enrolled with headache had 75 % tension-type, 17% migraine and 8% Cluster headache; those with knee joint Pain had osteoarthritis (80%) and reactive arthritis (20%) whereas patients with low back pain had lumbar strain and lumbar spondylosis. The onset of action was 55 seconds for patients with headache disorders, while it ranged between 95 to 115 seconds for joint pain and low back pain respectively. Highly significant improvement in the VAS score, was observed after 5, 10 and 30 minutes of test product application. Conclusion: All the four types of topical Amrutanjan balms were found to be effective and safe for the treatment of primary headache and body pain disorders.

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.

Headache is one of the most common and persistent symptoms following traumatic brain injury (TBI). The current study examines the prevalence and characteristics of headache following mild TBI (mTBI). We prospectively enrolled 212 subjects within one week of mTBI who were hospitalized for observation or other system injuries in a single level 1 US trauma center and followed by telephone at three, six, and 12 months after injury for evaluation of headache. Headaches were classified according to ICHD-2 criteria as migraine, probable migraine, tension-type, cervicogenic, or unclassifiable headache. Subjects were 76% male and 75% white, and 58% were injured in vehicle-related crashes. A follow-up rate of 90% (190/212) occurred at 12 months post-injury. Eighteen percent (38/212) of subjects reported having a problem with headaches pre-injury while 54% (114/210) of subjects reported new or worse headaches compared to pre-injury immediately after injury, 62% (126/203) at three months, 69% (139/201) at six months, and 58% (109/189) at one year. Cumulative incidence was 91% (172/189) over one year. Up to 49% of headaches met criteria for migraine and probable migraine, followed by tension-type headaches (up to 40%). Age (≤ 60) was found to be a risk factor, but no significant difference was found in persistence of new or worse headache compared to pre-injury between males and females. More than one-third of the subjects reported persistent headache across all three follow-up time periods. Headache after mTBI is very common and persistent across the first year after injury. Assertive, early treatment may be warranted to avoid chronicity and disability. Further research is needed to determine whether post-traumatic headache (PTH) responds to headache treatment used in the primary headache disorders and whether chronic PTH is preventable.

BackgroundHeadache disorders are the most common complaints worldwide. Migraine, tension type and cluster headaches account for majority of primary headaches and improvise a substantial burden on the individual, family or society at large. There is a scanty data on the prevalence of primary headaches in sub-Saharan Africa in general and Ethiopia in particular. Moreover there is no population based urban study in Ethiopia. The purpose of this study is to determine the prevalence and burden of primary headaches in local community in Addis Ababa, Ethiopia.MethodsCross-sectional sample survey was carried out in Addis Ketema sub city, Kebele 16/17/18 (local smallest administrative unit). Using systematic random sampling, data were collected by previously used headache questionnaire, over a period of 20 days.ResultsThe study subjects were 231 of which 51.5% were males and 48.5% were females. The overall one year prevalence of primary headache disorders was 21.6% and that for migraine was 10%, migraine without aura 6.5% migraine with aura was 2.6% and probable migraine was 0.9%. The prevalence of tension type of headache was found to be 10.4%, frequent episodic tension type headache was 8.2% followed by infrequent tension type headache of 2.2%. The prevalence of cluster headache was 1.3%. The burden of primary headache disorders in terms of missing working, school or social activities was 68.0%. This was 78.3% for migraineurs and 66.7% for tension type headache. Majority 92.0% of primary headache cases were not using health services and 66.0% did not use any drug or medications during the acute attacks and none were using preventive therapy.ConclusionPrevalence and burden of primary headache disorders was substantial in this community. Health service utilization of the community for headache treatment was poor.

To determine whether the diagnostic ability of the newly designed hierarchical fuzzy diagnosis method is consistent with that of headache experts for probable migraine (PM) and probable tension-type headache (PTTH). Clinical decision support systems (CDSS) are computer systems designed to help doctors to make clinician decisions by information technology, and have proven to be effective in improving headache diagnosis by making medical knowledge readily available to users in some studies. However, one serious drawback is that the CDSS lacks the ability to deal with some fuzzy boundaries of the headache features utilized in diagnostic criteria, which might be caused by patients' recall bias and subjective bias. A hybrid mechanism of rule-based reasoning and hierarchical fuzzy diagnosis method based on International Classification of Headache Disorders, 3rd edition (ICHD-3) was designed and then validated by a retrospective study with 325 consecutive patients and a prospective study with 380 patients who were clinically diagnosed with migraine and TTH at the headache clinic of Chinese PLA General Hospital. The results of the diagnostic test in the retrospective study indicated that the fuzzy-based CDSS can be used in the diagnosis of migraine without aura (MO) (sensitivity 97.71%, specificity 100%), TTH (sensitivity 98.57%, specificity 100%), PM (sensitivity 91.25%, specificity 98.75%) and PTTH (sensitivity 90.91%, specificity 99.63%). While in the prospective study, the diagnostic performances were MO (sensitivity 91.62%, specificity 96.52%), TTH (sensitivity 92.17%, specificity 95.47%), PM (sensitivity 85.48%, specificity 98.11%) and PTTH (sensitivity 87.50%, specificity 98.60%). Cohen's kappa values for the consistency test were 0.984 ± 0.018 (MO), 0.991 ± 0.018 (TTH), 0.916 ± 0.051 (PM), 0.932 ± 0.059 (PTTH) in the retrospective study and 0.884 ± 0.047 (MO), 0.870 ± 0.055 (TTH), 0.853 ± 0.073 (PM), 0.827 ± 0.118 (PTTH) in the prospective study, which indicated good consistency with the fuzzy-based CDSS and the gold standard (p < 0.001). We developed a fuzzy-based CDSS performs much more similarly to expert diagnosis and performs better than the routine CDSS method in the diagnosis of migraine and TTH, and it could promote the application of artificial intelligence in the area of headache diagnosis.