Vascular Contributions to Headache and Orofacial Pain: From Mechanism to Endovascular Intervention

Dear Colleagues,

Vascular structures of the head and face are both a source of pain and, increasingly, a targeDet for treating it. Cervical artery dissection presenting as toothache or trigeminal neuralgia, craniofacial arteriovenous malformations discovered only after hemorrhage at extraction, and styloidogenic jugular venous compression (styloid compression of jugular outflow) all reach dental and orofacial pain clinicians before they reach vascular specialists. Yet the literature describing them is scattered across journals this readership rarely encounters. The therapeutic landscape has also changed materially. Venous sinus stenting for idiopathic intracranial hypertension has moved from salvage to established practice; transvenous embolization of CSF-venous fistulas has become a durable treatment for orthostatic headache; and middle meningeal artery embolization for refractory migraine has produced its first prospective outcome data. These interventions act on the same trigeminovascular anatomy-dural afferents, meningeal arteries, cerebral venous outflow, that underpins current mechanistic models of migraine and the CGRP-directed therapies built upon them.

The evidence base nonetheless remains immature: patient selection is heterogeneous, phenotyping inconsistent, controlled comparisons few, and outcome measures variable between series. This Special Issue convenes that emerging field within a journal grounded in diagnostic rigor. We invite original research, systematic and narrative reviews addressing vascular pathology as a cause of, mimic of, and treatment target for pain in the head and face. We particularly welcome work that sharpens patient selection and outcome measurement for endovascular intervention and clarifies red flags distinguishing vascular pathology from primary orofacial pain disorders. The goal is a shared evidence base and clearer referral pathway across dental, orofacial pain, neurological, and neurointerventional practice.