Background Pressure Pain Thresholds (PPT) has been the main sensory modality studied in headache disorders. It is usually repetitive, leading to potential variability between measurements. Since threshold estimation relies on the observer, patient, body site, and the device used, it is important to assess measurement reliability in the specific clinical and methodological scenario to be studied in order to minimize error. Objective The aim of this study is to confirm intra-rater reliability of PPT in the head of adults using a digital algometer device. Methods PPT was measured with a digital algometer in 3 consecutive assessments conducted 10 min apart. Eight sites were measured in each time at the occipital, temporal and masseter regions bilaterally, frontal and vertex at midline. The reliability using intra-class variability (ICC) and covariance were calculated between times 1, 2, 3, and all times versus the mean. Scores above 0,75 were considered as having excellent reliability. Results Ten healthy volunteers aged (21-55) were studied. The sum of all sites measured in the head was 2182 (+-672) KPa for the first measure, 2085 (+- 626) KPa for the second, 2185 (+-685) for the third, and 2150 (+-685) KPa for the mean. All ICC coefficients calculated were 0,975 or higher in all areas. Conclusions We concluded that one PPT measure in the head with a digital algometer is as reliable as 3 repetitive measures The intra-rater reliability for PPT is considered excellent. Future studies assessing pain vulnerability or predicting headache occurrence can be performed without a significant risk of bias. Keywords: Pressure PainThreshold, Algometry, Reliability, Intra-class.

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.

Prayer is a widely used coping strategy that engages affective and cognitive processes implicated in pain regulation. Despite growing interest in the effec

BackgroundPressure pain threshold assessment is used to quantify pain sensitivity in headache disorders, reflecting peripheral and central sensitization of the nociceptive system. Traditional protocols involve multiple measurements to ensure reliability, but these protocols are time-consuming and may cause participant fatigue and discomfort. ObjectiveTo evaluate the agreement and reliability between a single Pressure Pain Threshold (PPT) measurement and the mean of three measurements in the craniofacial of individuals without a history of headache disorders, using a digital algometer. MethodsCross-sectional methodological study with ten volunteers (60% female, mean age 43±8 years) without headache history. Pressure pain threshold was assessed at eight craniofacial sites (bilateral: occipital, temporal, masseter; central: frontal, vertex) using a digital algometer. Three consecutive measurements were performed at each site with 10-minute intervals. Reliability between measurements was assessed using Intraclass Correlation Coefficient (ICC), while agreement and systematic bias were evaluated using Bland–Altman analysis. ResultsIntra-rater reliability ranged from moderate to good (ICC=0.54–0.96) across individual sites, with good-to-excellent reliability in bilateral occipital, temporal, and masseter sites (ICC=0.62–0.96). Reliability between the single measurement and the mean of three trials was uniformly excellent (ICC=0.93–0.98) Bland-Altman analysis showed minimal bias (mean differences near zero) and relatively narrow limits of agreement in peripheral sites, with wider limits observed in central regions.ConclusionA single pressure pain threshold measurement demonstrated agreement comparable to the mean of three measurements, supporting the potential use of simplified assessment protocols.