{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T04:30:41Z","timestamp":1786595441001,"version":"build-2736575974"},"reference-count":6,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Ophthalmol."],"abstract":"<jats:p>Birdshot chorioretinopathy (BSCR) is a type of chronic posterior uveitis with limited characterization of extraocular manifestations, including headache. We describe two HLA-A29-positive patients with BSCR who developed refractory unilateral periorbital headaches temporally associated with visual symptom onset. Headaches lateralized to the more affected eye and the patients exhibited migrainous and prominent cranial autonomic features resembling trigeminal autonomic cephalalgias (TACs) and variable responses to standard headache therapies. Together, this supports the International Classification of Headache Disorders (ICHD-3) classification as a secondary headache attributed to ocular inflammatory disease. The biological plausibility of this association is supported by trigeminal innervation of the uveal tract, providing a substrate for inflammation-driven trigeminovascular activation. Systematic studies are needed to define BSCR-associated headache prevalence, phenotype, and mechanisms and to inform diagnosis and management.<\/jats:p>","DOI":"10.3389\/fopht.2026.1838200","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T04:23:57Z","timestamp":1786595037000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Headache as an extraocular manifestation of birdshot chorioretinopathy: a case series"],"prefix":"10.3389","volume":"6","author":[{"given":"Jonathan D.","family":"Groothoff","sequence":"first","affiliation":[{"name":"Wake Forest University School of Medicine","place":["Winston-Salem, NC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maninder K.","family":"Sohi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Wake Forest University School of Medicine","place":["Winston-Salem, NC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Shuman","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Wake Forest University School of Medicine","place":["Winston-Salem, NC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandy W.","family":"Hardy","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine","place":["Winston-Salem, NC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C.","family":"Goodrich","sequence":"additional","affiliation":[{"name":"Department of Neurology, Wake Forest University School of Medicine","place":["Winston-Salem, NC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristyn S.","family":"Pocock","sequence":"additional","affiliation":[{"name":"Department of Neurology, Wake Forest University School of Medicine","place":["Winston-Salem, NC, United States"]},{"name":"Comprehensive Headache Program, Atrium Health Wake Forest Baptist","place":["Winston-Salem, NC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1186\/s13023-016-0429-8","article-title":"Birdshot chorioretinopathy: current knowledge and new concepts in pathophysiology, diagnosis, monitoring and treatment","volume":"11","author":"Minos","year":"2016","journal-title":"Orphanet J Rare Dis"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1097\/wno.0000000000000935","article-title":"Not all that flickers is snow","volume":"41","author":"Patel","year":"2021","journal-title":"J Neuroophthalmol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e97","DOI":"10.1016\/j.lpm.2009.12.005","article-title":"Extraocular manifestations of birdshot chorioretinopathy in 118 French patients","volume":"39","author":"Pagnoux","year":"2010","journal-title":"Presse Med"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajoc.2023.101802","article-title":"Birdshot chorioretinopathy in an HLA-A29 positive Asian patient","volume":"29","author":"Regenold","year":"2023","journal-title":"Am J Ophthalmol Case Rep"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1097\/wno.0000000000000660","article-title":"More than meets the eye: The eye and migraine-what you need to know","volume":"38","author":"Digre","year":"2018","journal-title":"J Neuroophthalmol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci10010030","article-title":"Calcitonin gene-related peptide (CGRP) and cluster headache","volume":"10","author":"Carmine Belin","year":"2020","journal-title":"Brain Sci"}],"container-title":["Frontiers in Ophthalmology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fopht.2026.1838200\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T04:23:58Z","timestamp":1786595038000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fopht.2026.1838200\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":6,"alternative-id":["10.3389\/fopht.2026.1838200"],"URL":"https:\/\/doi.org\/10.3389\/fopht.2026.1838200","relation":{},"ISSN":["2674-0826"],"issn-type":[{"value":"2674-0826","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]},"article-number":"1838200"}}