Headaches in Parkinson’s disease: a comprehensive review

Headaches are common but underrecognized non-motor symptoms in Parkinson's disease (PD). They may appear as primary headaches, secondary headaches or as a part of PD-related nociceptive and neuroplastic pain syndromes. The prevalence of headaches in PD varies widely, with observational studies suggesting that up to 49% of patients report headaches, including tension-type headaches (TTH) and migraines. Headaches related to PD may present prodromally, occur during motor fluctuations or as a side effect of dopaminergic therapy. This review summarizes the epidemiology, classification, pathophysiology and clinical management of headaches in PD, with an emphasis on evidence from population-based cohort studies, imaging research, and clinical observations.