Transcultural headache medicine: A framework for integrating cultural contexts into headache science and care – a call to action from the International Headache Society

Headache disorders are among the most disabling neurological conditions, affecting over 1.5 billion people globally. Despite advances in pharmacological therapies, major inequities persist due to underdiagnosis, undertreatment and limited access to effective care, particularly in low- and middle-income countries. Social determinants of health, including cultural meanings, language and health beliefs, are increasingly recognized as key drivers of disparities in burden, diagnosis and treatment outcomes. Traditional medicine, used by more than 80% of the global population, remains first-line care in many regions and continues to influence therapeutic choices in high-income settings. Major systems such as Ayurveda, Traditional Chinese Medicine, Unani and Tibetan medicine, as well as diverse indigenous traditions, emphasize holistic approaches that integrate mental and physical symptoms into diagnosis and management. Additionally, religious and spiritual practices are commonly used to relieve suffering and pain. These culturally grounded explanatory models not only strongly shape health-seeking behavior, treatment adherence and patient narratives, but also may delay biomedical care when misconceptions or unsafe practices predominate. This paper introduces Transcultural Headache Medicine as an emerging framework that integrates cultural contexts, linguistic diversity and traditional practices into headache research, clinical care and policy. We review global traditions and therapeutic modalities including herbal, physical, mental and spiritual approaches, and propose a research agenda combining ethnography, culturally adapted diagnostic tools, experimental studies and clinical trials to evaluate benefits, risks, and contextual effects. We conclude with a call to action from the International Headache Society, aiming to map and evaluate culturally embedded practices, strengthen rigorous evidence and build a global learning network that supports culturally safe integration of effective, affordable and safe headache care.

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Publication Details

Journal
Cephalalgia
Published
2026-03-31
DOI
https://doi.org/10.1177/03331024261432929
Primary Topic
Migraine and Headache Studies
Type
article
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article

Transcultural headache medicine: A framework for integrating cultural contexts into headache science and care – a call to action from the International Headache Society

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Cephalalgia
Migraine and Headache Studies
article

Transcultural headache medicine: A framework for integrating cultural contexts into headache science and care – a call to action from the International Headache Society

Tsubasa Takizawa, Massimo Leone, Rami Burstein, Juliana Ramos de Andrade, Hsiangkuo Yuan, Anna P. Andreou, Homero Vallada, Taoufik Alsaadi, Abdulrazaq Albilali, Wanakorn Rattanawong, Henry Riyanto Sofyan, Leonardo Caixeta, Georgia Kleinschmitt Westenhofen, Freda Dodd-Glover, Morris Levin, Mario F P Peres, Fayyaz Ahmed, Ivy Liger Riso, Sait Ashina, Antoinette MaassenVanDenBrink, Patricia Pozo-Rosich, Giancarlo Lucchetti, Marcelo Moraes Valença, K. C. Brennan, Shuu-Jiun Wang, Peter J. Goadsby
article en

Abstract

Headache disorders are among the most disabling neurological conditions, affecting over 1.5 billion people globally. Despite advances in pharmacological therapies, major inequities persist due to underdiagnosis, undertreatment and limited access to effective care, particularly in low- and middle-income countries. Social determinants of health, including cultural meanings, language and health beliefs, are increasingly recognized as key drivers of disparities in burden, diagnosis and treatment outcomes. Traditional medicine, used by more than 80% of the global population, remains first-line care in many regions and continues to influence therapeutic choices in high-income settings. Major systems such as Ayurveda, Traditional Chinese Medicine, Unani and Tibetan medicine, as well as diverse indigenous traditions, emphasize holistic approaches that integrate mental and physical symptoms into diagnosis and management. Additionally, religious and spiritual practices are commonly used to relieve suffering and pain. These culturally grounded explanatory models not only strongly shape health-seeking behavior, treatment adherence and patient narratives, but also may delay biomedical care when misconceptions or unsafe practices predominate. This paper introduces Transcultural Headache Medicine as an emerging framework that integrates cultural contexts, linguistic diversity and traditional practices into headache research, clinical care and policy. We review global traditions and therapeutic modalities including herbal, physical, mental and spiritual approaches, and propose a research agenda combining ethnography, culturally adapted diagnostic tools, experimental studies and clinical trials to evaluate benefits, risks, and contextual effects. We conclude with a call to action from the International Headache Society, aiming to map and evaluate culturally embedded practices, strengthen rigorous evidence and build a global learning network that supports culturally safe integration of effective, affordable and safe headache care.

CephalalgiaVol. 46(4)
Universidade Federal de Juiz de Fora (BR), Beth Israel Deaconess Medical Center (US), National Yang Ming Chiao Tung University (TW), Thomas Jefferson University (US), Universidade de São Paulo (BR), University of California, San Francisco (US), King's College London (GB), Keio University (JP), University of Utah (US), Universidade Federal de Pernambuco (BR), Hull University Teaching Hospitals NHS Trust (GB), Hospital Israelita Albert Einstein (BR), King Saud Medical City (SA), Erasmus MC (NL), King Saud University (SA), Chinese PLA General Hospital (CN), Korle Bu Teaching Hospital (GH), University of Indonesia (ID), Beijing Tian Tan Hospital (CN), Vall d'Hebron Institut de Recerca (ES), Hospital de Câncer de Pernambuco (BR), Vall d'Hebron Hospital Universitari (ES), Hospital da Restauração (BR), Fondazione IRCCS Istituto Neurologico Carlo Besta (IT), Universidade Federal de Goiás (BR), King Abdullah University of Science and Technology (SA), King Mongkut's Institute of Technology Ladkrabang (TH)
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Openalex Percentile: Top 33%
Migraine and Headache Studies
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