- New Targeted Drugs for Acute Treatment of Migraine
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Heui-Soo Moon, Pil-Wook Chung, Byung-Kun Kim
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Korean J Headache. 2023;24(2):56-65. Published online December 31, 2023
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- Acute migraine treatments primarily aim to relieve headache pain and address accompanying symptoms such as photophobia, phonophobia, and nausea. Triptans have traditionally been the first-line treatment for moderate to severe migraine attacks. Nevertheless, they have several limitations, such as causing temporary vasoconstriction of blood vessels, contraindications in patients with cardiovascular issues, and distinctive side effects like chest tightness. Medication overuse is another concern with triptans, prompting research into new antimigraine drugs targeting calcitonin gene-related peptide (CGRP) or 5-HT1F receptors. Lasmiditan, an agonist at the 5-HT1F receptor, has emerged as a safe and effective option for abortive treatment in acute migraine attacks. It lacks the vasoconstrictive effects associated with triptans, making it a safer choice for individuals with contraindications to triptans. However, it may lead to central nervous system-related adverse effects, particularly dizziness and paresthesia. Gepants, which are CGRP antagonists, offer an innovative approach by targeting CGRP receptors which is believed to be central in migraine pathophysiology. These medications have demonstrated efficacy in alleviating migraine symptoms, providing alternatives to traditional treatments like triptans and ergots. Ubrogepant and rimegepant are the first approved oral gepants for acute migraine treatment, while Zavegepant is the first approved intranasal gepant. The most common treatment-related adverse events are gastrointestinal symptoms, including nausea. No vascular or hepatic concerns have emerged to date. In this review, we delve into the development of ditans and gepants for acute migraine treatment in adults and discuss their potential advantages and disadvantages in clinical use.
- Secular Trend of Sex Ratio in Participants under Randomized Controlled Trials for Cluster Headache
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Pil-Wook Chung, Heui-Soo Moon
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Korean J Headache. 2023;24(2):70-76. Published online December 31, 2023
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- Background
Although cluster headache (CH) is well known as a disorder of predominantly young males, the male to female ratio decreased from 5-7:1 before 1980s to -2:1 in the 2000s and afterward in Western observational studies. It is unclear whether this represents a true rise of CH in women or better recognition of CH in women. We sought to assess whether the sex ratio of CH were changing or not in randomized controlled trials (RCTs) over time in accordance with observational studies.
Methods
We included RCTs regarding pharmacologic medication, as well as procedural and surgical treatment, devices. Time trend of sex ratio was compared among 3 different publication era (1985-2000 vs 2001-2010 vs 2011-). Sex ratio between different cluster headache type (Episodic vs Chronic) was also compared.
Results
22 acute treatment trials and 25 preventive treatment trials were initially selected for inclusion. 5 acute treatment trials and 10 preventive treatment trials were excluded due to small sample size (n<20) and/or no demographic information. All studies were underwent in western countries. Of 32 trials finally included, 10 studies were published between 1985 to 2000 (1st era), 8 studies from 2001 to 2010 (2nd era), 14 studies after 2010 (3rd era). Of the 2,476 patients, 80% were male. Secular tendency of decreasing male predominance was shown over time. 542 of 623 patients (87%) were male in 1st era, while 83% were male in 2nd era, and 75.3% were male in 3rd era (p<0.001). Male to female ratio was 6.7:1 in 1st era, 4.9:1 in 2nd era, and 3:1 in 3rd era. In chronic CH, 28% of subjects were female, while in episodic CH, 14.6% were female (p<0.001)
Conclusions
As suggested by observational and registry data, the population enrolled in the RCT also exhibited a decreasing trend in male predominance over time in CH.
- Comorbid Medical Conditions in Patients with Medication Overuse Headache: Multicenter Prospective Medication Overuse Headache Registry Analysis
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Yooha Hong, Soo-Jin Cho, Min Kyung Chu, Sun-Young Oh, Heui-Soo Moon, Tae-Jin Song, Mi Ji Lee, Jin-Ju Kang, Hong-Kyun Park
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Published online December 31, 2021
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- 약물과용두통 환자에서 동반 이환되는 내과적 문제: 국내 다기관 전향적 약물과용두통 등록체계
- Clinical Practice Guideline of Pharmacologic Treatment for Migraine Prevention in Adults 2021: The Committee of Clinical Practice Guideline of the Korean Headache Society
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Kim Byung-Su, Jae Myun Chung, Pil-Wook Chung, Kwang-Yeol Park, Jin-Young Ahn, Heui-Soo Moon, Hong-Kyun Park, Dae Woong Bae, Jong-Geun Seo, Jong-Hee Sohn, Tae-Jin Song
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Published online December 31, 2021
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- 성인 편두통 예방치료 약제 진료지침 2021: 대한두통학회 진료지침위원회
- A Case of Superior Orbital Fissure Syndrome Attributed to Sinusitis Presenting Unilateral Throbbing Headache
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Byung-Su Kim, Byung-Kun Kim, Soo-Kyoung Kim, Jae-Moon Kim, Heui-Soo Moon, Kwang-Yeol Park, Jong-Hee Sohn, Tae-Jin Song, Min Kyung Chu, Myoung-Jin Cha, Soo-Jin Cho, J
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Published online December 31, 2017
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- 두통 초진 환자에서 이차두통의 임상적 예측인자: 다기관 연구
- The Frequency and Characteristics of Other Primary Headache Disorders in First-Visit Headache Patients in Korea: A Multicenter Study
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Myoung-Jin Cha, Byung-Kun Kim, Byung-Su Kim, Jong-Hee Sohn, Soo-Kyoung Kim, Heui-Soo Moon, Tae-Jin Song, Jae-Moon Kim, Jeong Wook Park, Min Kyung Chu, Kwang-Yeol Park
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Published online December 31, 2017
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- 신경과 외래를 방문한 두통 초진 환자에서 기타 원발두통의 빈도와 특징 - 다기관 연구
- 보툴리눔 독소의 두통 치료
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Heui-Soo Moon
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Korean J Headache. 2011;12(1):21-26. Published online June 30, 2011
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- Clinical data and experience to date have demonstrated that botulinum toxin is an effective and well-tolerated therapy for several headaches, especially chronic migraine(CM). CM is a severely disabling condition and has been showed to significantly reduce patients’ quality of life. Current treatment of CM may be complicated by the frequent use of acute headache pain medications such as analgesics, triptans, or ergots. Botulinum toxin reduced headache and migraine days and frequency of moderate to severe headache days with botulinum toxin, which in turn reduced the burden of illness in patients with disabling CM. Further investigations will define the accurate pathophysiologic mechanisms of botulinum toxin in the headache management. Further studies are needed in order to compare the efficacy of botulinum toxin with other prophylactic drugs.
- 트립탄계 약물의 최신지견
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Heui-Soo Moon
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Korean J Headache. 2010;11(1):32-38. Published online June 30, 2010
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- The objective of abortive treatment of migraine attack is to reduce the intensity and duration of pain with its attendant symptoms and to optimize the patient’s ability to function normally. The triptans, selective serotonin 5-HT1B/1D agonists, are very effective acute migraine drugs. Triptans work by decreasing neurogenic inflammation peripherally in the meninges, vasoconstriction of meningeal vessels and by modulating secondary order neurons in the brain stem. Treat- ment choices for acute migraine should be based on headache severity, migraine frequency, associated symptoms, and comorbidities. The aim of this article is to review the pharmacokinetics and clinical characteristics of these triptans and discuss how their individual characteristics lead to their preferred choice in various clinical aspects.
- 자가편두통 선별 도구의 개발 및 타당도 평가 -한국 편두통 선별 설문-
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Min-Kyung Chu, Byung Kun Kim, Sung Taek Kim, Jae-Moon Kim, Heui-Soo Moon, Jeong Wook Park, Kwang-Soo Lee, Kyung-Mi Oh, Jae-Myun Chung, Chin-Sang Chunge
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Korean J Headache. 2007;8(2):84-91. Published online December 31, 2007
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- Background
Migraine is a common and disabling illness. But substantial migraine sufferers were underdiagnosed or undiagnosed. To improve migraine diagnosis, Korean Migraine Screening Questionnaire(KMSQ) was developed and validated in outpatient setting. Methods: A total of 507 patients who visited out patient clinic for headache were recruited in 10 hospitals in Korea and asked 10-item questionnaire concerning headache. 487 completed and returned the questionnaire. All patients were evaluated for headache and diagnosed by headache experts. Migraine diagnosis was assigned on International Head- ache Society(IHS) criteria after completing semi-structured diagnostic interview. Results: Of ten diagnostic questions derived from IHS criteria and headache expert experience, three-item subsets were deduced. Combination of questions regarding nausea, pulsating quality and photophobia showed optimum perfor- mances. Any two from the three items showed a sensitivity of 0.74, a specificity of 0.80, a positive predictive value of 80.8 and a negative predictive value of 73.5. Conclusion: The three-item Korean Migraine Screening Questionnaire was a valid and reliable migraine screening instru- ment in outpatient setting. It could help in improvement of migraine diagnosis and enhance migraine management.
- 여성에서의 편두통
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Heui-Soo Moon
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Korean J Headache. 2007;8(1):32-37. Published online June 30, 2007
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- Women have headaches more commonly than men. The prevalence of migraine is 18% of women and 6% of men. This gender ratio increases from menarche, peaks at middle age, and then declines. Estrogen levels are a key factor in the increased prevalence of migraine in women. Evidence includes the following: migraine prevalence increases at menarche; estrogen withdrawal during menstruation is a common migraine trigger; estrogen administration in oral contraceptives and hormone replacement therapy can trigger migraines; migraines typically decrease during the second and third trimesters of pregnancy when estrogen levels are high; migraines are common immediately post-partum with the precipitous drop in estrogen levels; and migraines generally improve with physiologic menopause. The biological basis, however, is not completely understood. This report will review some important headache issues for women including menstrual migraine, menopause and migraine, oral contraceptive use in migraineurs, and headaches during pregnancy and the postpartum.
- 진행성 뇌질환으로서의 편두통
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Heui-Soo Moon
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Korean J Headache. 2006;7(1):1-3. Published online June 30, 2006
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- Migraine is a primary neurovascular headache w hich affects approximately 12% of the adult population. It is also known migraine is a risk factor for ischemic stroke in young w omen w ith m igraine w ith aura. Recently, it was reported that some individuals that experience m igraine w ith and w ithout aura m ay be at an increased risk for subclinical lesions in certain areas of the brain. A subgroup of person with episodic m igraine m ay progress to chronic daily headache. These data have im plications for current concepts of m igraine as a progressive brain disease. So, the goals of treatm ent may also shift to preventing the accumulation of brain lesion and disease progression. Korean Journal of Headache 7(1):1-3, 2006
- 트립탄계열 약물을 포함한 급성기 편두통 치료
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Heui-Soo Moon
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Korean J Headache. 2005;6(1):14-20. Published online June 30, 2005
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- The objective of abortive treatment of migraine attack is to reduce the intensity and duration of pain with its attendant symptoms and to optimize the patient's ability to function normally. The efficacy of most abortive anti-migrainous drug is probably related to their inhibitory effects on neurogenic inflammation mediated through serotonergic control mechanisms. The migraine specific therapies are representative of new migraine abortive medications, which act as serotonin agonist- triptans and ergots. Treatment choices for acute migraine should be based on headache severity, migraine frequency, associated symptoms, and comorbidities. In this review, I described recent trends in acute migraine therapy with stress on evidence- based guideline for migraine headache in company with some remarks on the various triptans. Korean Journal of Headache 6(1):14-20, 2005
- Evidence-Based Recommendations on Pharmacologic Treatment for Migraine Prevention: A Clinical Practice Guideline from the Korean Headache Society
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Byung-Su Kim, Pil-Wook Chung, Jae Myun Chung, Kwang-Yeol Park, Heui-Soo Moon, Hong-Kyun Park, Dae-Woong Bae, Jong-Geun Seo, Jong-Hee Sohn, Tae-Jin Song, Seung-Han Lee, Kyungmi Oh, Mi Ji Lee, Myoung-Jin Cha, Yun-Ju Choi, Miyoung Choi
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Received June 23, 2024 Accepted September 11, 2024 Published online September 27, 2024
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DOI: https://doi.org/10.62087/hpr.2024.0019
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Abstract
- Purpose: The aim of this clinical practice guideline (CPG) from the Korean Headache Society is to provide evidence-based recommendations on the pharmacologic treatment for migraine prevention in adult migraine patients.
Methods
The present CPG was developed based on the guideline adaptation methodology through a comprehensive systematic search for literature published between January 2012 and July 2020. The overall quality of the CPGs was assessed using the Korean version of the Appraisal of Guidelines for Research and Evaluation II tool. High-quality CPGs were adapted to make key recommendations in terms of strength (strong or weak) and direction (for or against).
Results
The authors selected nine available high-quality guidelines throughout the process of assessment of quality. Regarding oral migraine preventive medications, propranolol, metoprolol, flunarizine, sodium divalproex, and valproic acid are recommended to adult patients with episodic migraines based on high-quality evidence (“strong for”). Topiramate can be recommended for either episodic or chronic migraine (“strong for”). For migraine prevention using calcitonin gene-related peptide monoclonal antibodies, galcanezumab, fremanezumab, erenumab, and eptinezumab are recommended for adult patients with either episodic or chronic migraine on the basis of high-quality evidence (“strong for”). OnabotulinumtoxinA is recommended for adult patients with chronic migraine based on high-quality evidence (“strong for”). Last, frovatriptan, naratriptan, and zolmitriptan are recommended for short-term prevention in women with menstrual migraine (“strong for”).
Conclusion
In the present CPG, the authors provide specific, straightforward, and easy-to-implement evidence-based recommendations for pharmacologic migraine prevention. Nevertheless, these recommendations should be applied in real-world clinical practice based on optimal individualization.
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