Headache in patients with joint hypermobility

Background Headache disorders are highly prevalent in patients with joint hypermobility, particularly in hypermobility spectrum disorders and hypermobile Ehlers–Danlos syndrome, yet they remain frequently underrecognized in routine clinical practice. Failure to identify underlying hypermobility may lead to diagnostic oversimplification, delayed recognition of secondary headache mechanisms, and suboptimal therapeutic strategies. Methods We conducted a narrative review with a structured literature search to synthesize current evidence on the epidemiology, clinical characteristics, pathophysiological mechanisms, and management of headache in patients with joint hypermobility. Results In hypermobile populations, migraine is the most common primary headache phenotype; however, secondary causes, including spontaneous intracranial hypotension, craniocervical instability, temporomandibular dysfunction, Chiari malformation, and vascular complications, occur with increased frequency and require systematic consideration. Dysautonomia and orthostatic intolerance frequently interact with headache expression, contributing to clinical heterogeneity and management complexity. Conclusions Recognition of joint hypermobility broadens the differential diagnosis of headache. We highlight key clinical red flags, outline a structured, mechanism-based approach to multimodal assessment, including musculoskeletal and autonomic evaluation, and discuss practical considerations for individualized management.