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Article History

Received: 17 July 2026

Accepted: 9 September 2026

First Online: 14 September 2026

Declarations

Ethics approval and consent to participate: This manuscript is secondary research (there is no direct patient participation or data collection from individuals), so did not require ethical approval.

Patient and Public involvement: Andrew Cooklin and Gemma Pearce (PPI members) were co-applicants on the study grant application, made contributions to the manuscript, offering essential patient and public perspectives that improved our study methods and interpretation.

Consent for publication: Not applicable.

Competing interests: Callum Duncan is chair of Scottish Intercollegiate Guideline Network (SIGN) 155 and hasprovided advice on the use of Botox, CGRP monoclonal antibodies and CGRP antagonists tothe Scottish Medicines Consortium and on Eptinezumab to NICE. He was the Secretary forthe British Association for the Study of Headache 2015-2022 and is a Board member of AngloDutch Migraine Association. He has received support for attending a meeting from Teva. Manjit Matharu is the President of the medical advisory board of the CSF Leak Association. He has received consulting fees from AbbVie, TEVA, Lundbeck, Eli Lilly, Salvia, and Pfizer. He has received payment for the development of educational presentations from AbbVie, Pfizer and Eli Lilly and support for attending a meeting from Pfizer. He is on the advisory boardfor AbbVie, TEVA, Lunbeck, Eli Lilly, Salvia and Pfizer. He has the following patent issuedWO2018051103A1: System and method for diagnosing and treating headaches. He has stockoptions with Tesla, Adobe, Nvidia, META, and Microsoft. He has received grants from Abbott, Medtronic and Ehlers Danlos society. Erling Tronvik has received personal fees for lectures/advisory boards: Novartis, Eli Lilly, Abbvie, TEVA, Roche, Lundbeck, Pfizer, Biogen, Organon. Consultant for and owner of stocksand IP in Man & Science. Stocks and IP in Nordic Brain Tech. Stocks in Keimon Medical. Nonpersonal research grants from several sources, including Norwegian Research Council, KlinBeForsk, EU, Nordic Innovation. Commissioned research (non-personal): Lundbeck.Associate Editor in Cephalalgia. Board member of the European Headache Federation. Hema Mistry is a member of the NIHR HTA General Funding Commissioning Committee. All other authors declare they have no competing interests.