- 원발벼락두통의 임상양상
-
Jiyeon Kim, Byung-Kun Kim, Gun-Sei Oh, Jae Myun Chung, Kyungmi Oh, Jeong Wook Park, Soo-Jin Cho
-
Korean J Headache. 2011;12(2):85-90. Published online December 31, 2011
-
-
-
 Abstract
 PDF
- Objective: Thunderclap headache is a sign of a medical emergency such as a life-threatening subarachnoid hemorrhage (SAH). However, it also may occur in primary headache conditions such as cough, physical exertion, sexual activity and even without any provoking factors. International Headache Society classified thunderclap headache disorders into four different subtypes: (1) primary thunderclap headache(PTH); (2) primary cough headache(PCH); (3) primary exertional headache (PEH); and (4) primary headache associated with sexual activity(PSH). Subtypes of thunderclap headaches are reported to share many common characteristics, although studies on the clinical features and triggering factors of thunderclap headaches are limited. Methods: Seventy and two patients with thunderclap headache were prospectively enrolled from March 2008 to June 2010. The patients presented sudden severe headaches, reaching maximal intensity within 1 minute, without focal neu- rologic deficit. SAH and other organic disorders were excluded in this study. We described clinical features, triggering factors and vasospasm, and compared between the four subtypes of thunderclap headache. Results: Of the 72 recruited patients, PTH(n=25, 34.7%) was the most frequent thunderclap headache subtype, followed by PCH(n=23, 31.9%), PSH(n=15, 20.1%) and PEH(n=9, 12.5%). 49(68.1%) patients suffered recurrent thunderclap head- ache attacks at presentation. 49(68.1%) patients had more than one provoking factor. Defecation(n=13, 16.0%) was the most frequent provoking factor followed by sexual intercourse(n=11, 13.7%). Mean age was 45.1±12.6 years(range: 15-70). PEH group (36.6 years old) was younger than other groups. Overall male to female ratio in this study was 1:1.7. Mean duration of headache was 40.7±56.3 minutes(range: 0.17-720). The headache duration was shorter in PEH(25.2±14.2 minutes) than other groups. Vasospasm was documented in 10 patients(13.9%). Conclusions: More than two-thirds of patients with thunderclap headache have more than one provoking factor at presentation. Contrary to the previous studies, vasospasm was associated in small proportion of patients.
- 통증의 해부학 및 생리학
-
Gun-Sei Oh
-
Korean J Headache. 2011;12(1):1-15. Published online June 30, 2011
-
-
-
Abstract
PDF
- Acute, nociceptive pain results from the complex convergence of many signals traveling up and down the neuraxis and serves to warn us of impending harm. Recently, considerable advances have been made in knowledge of nocicep- tive transmission. It is now widely believed that stimulation of primary afferent neurons in the peripheral nervous system results in activation of neurons in the dorsal horn of the spinal cord and then in transmission rostrally to the brain. This article reviews the transmission of a nociceptive or pain impulse from the site of stimulus in the peripheral to the central nervous system. The basic anatomic pathways of nociceptive transmission and descending nociceptive modula- tions are described. Some of the basics of physiology also are discussed. The studies reviewed here is likely apply more to acute pain than to chronic pain, because most of the experimental paradigms used are more closely analogous to the injury of acute pain than chronic pain.
- 유발점주사 효과
-
Gun-Sei Oh, Sang-Jun Lee
-
Korean J Headache. 2010;11(1):1-6. Published online June 30, 2010
-
-
-
Abstract
PDF
- Trigger points are defined as discrete, focal, hyperirritable spots located in a taut band of skeletal muscle and their ligamentous junctions remote from the site of the pain. They are prevalent in regional musculoskeletal pain syndromes, either alone or in combination with other pain generators. The appropriate evaluation and management of trigger points is an important part of musculoskeletal rehabilitation of regional axial and limb pain syndrome. Acute trauma or repetitive microtrauma may lead to the development of stress on muscle fibers and formation of trigger points. Patients may have regional, persistent pain resulting in a limited range of motion in the affected muscles. Pain from myofascial trigger points can be identified by careful history taking and skillful physical examination, and they are quickly responsive to physical and medical management in the absence of serious perpetuating factors. Skeletal muscle makes up nearly half of body weight. Each of the approximately 500 skeletal muscles is subject to acute and chronic strain. Each muscle can develop myofascial trigger points and has its own characteristic pattern of referred pain. Palpation of a hypersensitive bundle or nodule of muscle fiber is harder than normal consistency and elicit pain directly over the affected area and/or cause referred pain and local twitch response. Trigger point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms.
- 두통의 해부학 및 생리학
-
Gun-Sei Oh, Hee-Jun Park
-
Korean J Headache. 2009;10(1):84-95. Published online June 30, 2009
-
-
-
Abstract
PDF
- Understanding the anatomy and physiology of pain transmission system is important for the pain management. Some types of headaches, including migraine, are caused by activity in nociceptive afferents that innervate the cranial meninges, particularly the dura mater encephali and large intracerebral blood vessels. Pain can be evoked by electrical, mechanical, thermal, or chemical stimulation of dural blood vessels and sinuses or large intracerebral arteries. Importantly, the painful sensations were referred to the trigeminal dermatomes where typically headaches are localized. This article reviews the transmission of a nociceptive or pain impulse from the site of stimulus in the trigeminal nervous system to the central nervous system. The basic anatomic pathways of nociceptive transmission and of descending nociceptive modulations are described. The studies reviewed here likely apply more to acute pain than to chronic pain. It is now widely believed that stimulation of a primary afferent neuron in the peripheral nervous system results in activation of neurons in the dorsal horn of the spinal cord or the trigeminal brain stem nuclear complex, and then in transmission rostrally to the brain.
- 통증의 기본원리 및 치료 원칙
-
Gun-Sei Oh
-
Korean J Headache. 2008;9(1):1-12. Published online June 30, 2008
-
-
-
Abstract
PDF
- The sensations w e call pain-pricking, buring, aching, stinging, and soreness-are the m ost distinctive of all the sensory modalities. Pain is a submodality of somatic sensation like touch, pressure, and position sense and serves an important protective function: It w arns of injury that should be avoid or treated. U nlike other somatic subm odalities pain has an urgent and primitive quality, a quality responsible for the affective and emotional aspect of pain perception. Moreover, the intensity w ith w hich pain is felt is affected by surrounding conditions, and the same stim ulus can produce different responses in different individuals under similar conditions. A cute, nociceptive pain results from the complex convergence of m any signals traveling up and down the neuraxis and serves to warn us of impending harm. the painful sensations ultim ately leave the periphery and travel centrally, carried by the axons of the primary sensory neurons, the dorsal root ganglia, which are relatively quiescent unless specifically stim ulated by sensory input. H owever, if inflammation or injury damages the neural structures, pain sensation (neuropathic pain) may continue long after the noxious stimuli subside. The pain response can then harm rather than help the individual. Injured dorsal root ganglia m ay become hyperexitable and display considerable spontaneous electrical activity. Such increased activity results from the expression of a dramatically different constellation of m any cell-specific m olecules in injured cells compared w ith norm al ones. U nlikely, the operation of complex neuronal circuits m ay be m arkedly altered. Chronic pain sensation result from such injury. Considerable advances have been m ade in the last decade, w hich have given some insight into the m echanisms responsible for the development of chronic pain. U nderstanding the changes that follow injury at a cellular and m olecular level m ay help lead to new therapeutic interventions.
- 일차두통과 근막통증증후군과의 연관성에 관한 연구
-
Hwa-Young Lee, Gun-Sei Oh
-
Korean J Headache. 2005;6(2):137-146. Published online December 31, 2005
-
-
-
Abstract
PDF
- Background
Myofascial pain syndrome (MPS) is a regional pain syndrome characterized in part by a trigger point in a taut band of skeletal muscle and its associated referred pain. Myofascial pain due to trigger points has been reported as the most prevalent cause of painful symptoms in temporomandibular disorders. Similarly, sufficient evidence exists supporting a substantial role of myofascial trigger point pain in chronic tension-type and migraine headaches. However, the clinical features of MPS have rarely been studied in the primary headache in Korea.
Methods
This study was a retrospective, single-center chart review. Forty-two patients with primary headache and MPS, who were followed up for longer than 3 months and did not suffer from other diseases except for headache, were recruited from October 2003 to April 2004. They were divided into chronic tension-type headache (24, 57%), chronic migraine (16, 38%), and cluster headache (2, 5%). We treated a series of 42 patients with myofascial trigger point by injecting 0.5% lidocaine with multiple needle penetrations in a fanwise pattern.
Results
Trigger point injection was shown to produce complete headache elimination in 58.3% of chronic tension-type headache patients, 62.5% of chronic migraine patients, and 100% of cluster headache patients. The most common muscle that produced headache was sternocleidomastoid muscle and trapezius muscle.
Conclusion
We should understand myofascial trigger points for better treatment of the primary headache patients. The intensity of myofascial pain due to trigger points should not be underestimated as patients have rated it as equal or slightly greater than pain from other causes. Korean Journal of Headache 6(2):137-146, 2005
- 근막동통 증후군과 연관된 편두통
-
Gun-Sei Oh, Hwa-Young Lee
-
Korean J Headache. 2004;5(1):43-64. Published online June 30, 2004
-
-
-
Abstract
PDF
- Pain and tenderness are characteristically referred from myofascial trigger points(MTrPs) located in muscle remote from the site of the pain. Pain from myofascial trigger points can be identified by careful history taking and skillful physical examination, and it is quickly responsive to physical and medical management in the absence of serious perpetuating factors. Skeletal muscle makes up nearly half of body weight. Each of the approximately 500 skeletal muscles is subject to acute and chronic strain. Each muscle can develop myofascial trigger points and has its own characteristic pattern of referred pain. Perpetuating factors can increase irritability of muscles, leading to the propagation of trigger points and increasing the distribution and severity of pain. Because myofascial trigger points appear to play an important role in migraine and tension-type head- aches, all headache patients should be evaluated for their presence. If found, the treatment regimen should include myofascial trigger point pain reduction techniques or a myofascial trigger point pain management program. One current source of confusion is use of the term myofascial pain syndrome(MPS) for two different concepts. Sometimes, MPS is used in a general sense that applies to a regional muscle pain syndrome of any soft tissue origin. Historically, the term MPS has been used in the restricted sense of that syndrome which is caused by TrPs within a muscle belly(not scar, ligamentous, or periosteal TrPs). Korean Journal of Headache 5(1):43-64, 2004
|
KHS
