- 편두통과 긴장형두통 환자에서의 자기공명영상 백질 이상
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Nayoung Kim, Suntae Hwang, Ja-Seong Koo, Ohyun Kwon, Jong-Moo Park
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Korean J Headache. 2007;8(2):69-72. Published online December 31, 2007
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- Background
Several reports have documented a high frequency of white matter abnormalities by MRI in migraineurs. However, there have been few studies on MRI abnormalities in tension-type headache. The purpose of our study was to determine whether the incidence and distribution of MRI abnormalities in tension-type headache differ from those in migraine Methods: We analyzed consecutive magnetic resonance imaging findings of 121 patients with migraine and tension type headache under 50 years old. Of the 121 patients, 74 were diagnosed as having migraine and 47 were diagnosed as having tension-type headache. Clinical information was obtained from headache patients database. MRI was revie- wed with respect to location, number and volume of focal white matter hyperintensities in FLAIR image. The location of white matter abnormalities were classified into periventricular and subcortical lesions. Results: White matter abnormalities were observed in 23% of migraine patients and; 28% of tension-type headache. Among the migraineurs, white matter abnormalities were seen in 22% with migraine without aura and 33% with mi- graine with aura. There was no significant difference in incidence of white matter abnormalities between the patients with migraine and tension-type headache(p=0.67) and between the patients with migraine without aura and with aura (p=0.62). The white matter abnormalities were most frequently located in subcortical area in both groups. Conclusions: The incidence and distribution of white matter abnormalities in MRI was not significantly different between the patients with migraine and tension-type headache. These findings suggest that two disorders may share a common pathomechanism.
- 일반연제-Clinical Characteristics of Migraine and Tension-type Headache: The Experience in Eulji Hospital
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Byung-Kun Kim, Hee-Jun Bae, Ja-Seong Koo, Oh-Hyun Kwon , Jong-Moo Park
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Korean J Headache. 2005;6(1):103-103. Published online June 30, 2005
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To analyze the epidemiological and clinical characteristics of migraine and tension-type headache(TTH) in secondary general hospital. Methods: Between January 2004 and April 2005, 625 patients(age, mean=42.7 years, ranging from 14 to 79 years; 454 women and 171men), who presented with headache as chief complaints, were recruited prospec- tively. Information on epidemiological and clinical characteristics was collected from the structured questionnaire and registry. The criteria defined by the International Headache Society were used in the diagnosis. A total of 95% of the patients had primary headache: migraine(26.9%, mean age±SD=36.0±11.4 years, 148 women and 20 men), probable migraine(5.1%), episodic TTH(21.3% mean age±SD=45.6±14.2 years, 89 women and 44 men), probable episodic TTH(6.6%), primary chronic daily headache which includes chronic migraine, chronic TTH, hemicrania continua, and new daily-persistent headache(19.4%), and other primary headache(15.7%). We analyze the clinical characteristics of migraine (except chronic migraine) and episodic TTH. Results: Sixteen patients(9.5%) of those with migraine had migraine with aura. The mean age at onset was 24.6±9.2 years in migraine and 37.9±14.5 years in TTH(p<0.05). Female sex was more prevalent in migraine (p<0.05). Migraine headaches were unilateral(57%), pulsating(52%), aggravated by physical activity(80%), and were accompanied by vomiting(58%), photophobia(70%), and phonophobia(76%). TTH were unilateral(55%), pulsating(18%), aggravated by physical activity(23%), and were occasionally accom- panied by photophobia(22%) and phonophobia(33%). The most frequently reported trigger factors for migraine were stress(82%), fatigue(72%), menstruation(36% of women), alcohol(30%), cold or hot weather(27%), missing a meal(24%), weekend(13%), overeating(12%), and food(7%). The most frequently reported trigger factors for TTH were stress(77%), fatigue (62%), missing a meal(20%), cold or hot weather(18%), alcohol(17%), menstruation(11% of women), overeating (8%), weekend(5%), and food(5%). Patients with migraine had a greater prevalence(p<0.05) of medication overuse history. Beck depression inventory score was not different between migraine(22.0±4.8) and TTH(23.4±5.8). Beck anxiety inventory score was significantly higher in TTH group(p<0.05). Sixty percent of migraineurs and 55% of patients with TTH reported receiving a physician diagnosis of headache. However, only 21% of migraineurs and 29% of patients with TTH received a diagnosis of their headache correctly. Sixty-five percent of misdiagnosed migraineurs reported a diagnosis of TTH. Thirty-one percent of misdiagnosed patients with TTH reported a diagnosis of migraine. Conclusions: Migraine and TTH are a common cause of recurrent headache in secondary general hos- pital. Stress and fatigue were most frequent triggering factors for both headache types. Prevalence of depression and unilaterality of headache is not different between two groups. Migraine most frequently misdiagnosed as TTH.
- 한국인 편두통 환자와 미토콘드리아 DNA 11,084 유전자 다형성의 연관성
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Byung-Kun Kim, Hee-Joon Bae, Ja-Seong Koo, Oh-Hyun Kwon, Man-Ho Kim
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Korean J Headache. 2002;3(2):111-115. Published online December 31, 2002
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The genetic and molecular basis of migraine is still unknown. Clinical similarities bet- ween migraine and mitochondrial encephalomyopathies and the bias toward maternal transmission in family studies suggest that mitochondrial DNA(mtDNA) may play a role in migraine pathogenesis. An A-11,084-G substitution at mtDNA, has been reported in 25% of Japanese migraineurs. In contrast, in Danish individuals, this A-to-G mutation at mtDNA 11,084 was detected neither in persons with mig- raine nor in persons who had never had migraine. The aim of the present study was to investigate the frequency of this mutation in Korean migraineurs. Methods: One hundred migraineurs were studied after obtaining informed consent. A diagnosis of migraine was made on the basis of the International Headache Society criteria. DNA was purified from whole blood using DNA purification kit. For the analysis of mitochondrial nucleotide A-11,084-G substi- tution, mtDNA(bases 10,835 to 11,236) was amplified by polymerase chain reaction(PCR) using primers described previously. An A-11,084-G substitution generates BsmI restriction site. BsmI site containing PCR product(13,031～13,610 bases) was also amplified for positive-control. The amplified products were digested with 1 unit of BsmI, and were sized on a 1% TAE agarose gel with 100-bp DNA ladder marker. Results: None of the PCR products were cleaved by BsmI, whereas the positive controls were all digested by BsmI. We failed to detect the mtDNA A-11084-G substitution in our Korean patients with migraine. Conclusions: Mitochondrial DNA A to G polymorphism at 11,084 is not a risk factor for Korean mig- raineurs. This mutation may be rare in non-Japanese populations, which suggests ethnic difference in SNP genotype. Korean Journal of Headache 3(2):111-115, 2002
- 특발성 자두통의 임상 양상
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Byung-Kun Kim, Hee-Joon Bae, Ja-Seong Koo, Oh-Hyun Kwon
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Korean J Headache. 2002;3(2):99-104. Published online December 31, 2002
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Although idiopathic stabbing headache(ISH) seems to be very common primary head- ache with unique clinical features, previous descriptions about ISH were rather confusing. The classi- fication of the International Headache Society emphasized pain location confined to the distribution of the first division of the trigeminal nerve. Other terms describing ISH, such as ice-pick like pain, jab and jolts syndrome, sharp short lived head pain syndrome and ophthalmodynia, had some different clinical features each other. ISH also have been described in conjunction with migraine or cluster headache. However, in clinical practice, ISH occurs more frequently in extra-trigeminal region and is usually not associated with other primary headache syndromes. Methods: From Feb 2001 to August 2001, 1126 consecutive series of patients suffering from headache were examined in our neurology out-patients clinics. Among the patients, 50 patients presented stabbing headache with chief complaints. This sample consisted 21 males and 29 females aged from 12 to 79 years. Inclusion criteria were: (a) manifesting recurrent stabs on the head as a chief complaint, (b) wit- hout other organic causes. Results: The pain was more frequently localized extratrigeminal area(parietal, retroauricular or occipital) (60%), less frequently in the trigeminal area(20%), or both(20%). The orbital region was never affected. Regarding other coexisting forms of headache, only 20% suffered from other types of head- ache(migraine 6%, tension type headache 14%). No body had the associated autonomic features. In most patients(64%), the paroxysms lasted only 1～2s. The maximal frequency of attacks was variable, ranging from several tens to hundreds for one day. ISH was lasted from 1 to 36 days(mean 9.2±6.7 days). Conclusions: Our results show that the clinical features of ISH are somewhat different from previous studies by its location and its lack of association with migraine or cluster. All had benign course. Korean Journal of Headache 3(2):99-104, 2002
- 만성 두통의 분류: Transcranial Doppler를 이용한 혈류역학적 접근
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Byung-Kun Kim, Hee-Joon Bae, Ja-Seong Koo
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Korean J Headache. 2001;2(1):41-47. Published online June 30, 2001
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s: The International Headache Society(IHS) headache classification, while widely used throughout the world, has a problem in the definition and classification of the daily and near-daily headache named chronic daily headache(CDH). According to the IHS criteria, a chronic tension-type headache(CTTH) is the only possible diagnosis in patients with CDH. Although several studies have demonstrated that many patients with CDH originally suffered from migraine and their headache has transformed from migraine into a CDH(this type of headache was called transformed migraine: TM), the nosological entity of TM is still disputed. Objective: To demonstrate that TM and CTTH have different pathogenesis, we investigated the cerebral hemodynamics of TM and CTTH by using transcranial Doppler (TCD). Methods: During 6 months, 33 patients with TM and 33 with CTTH, diagnosed according to the second revision of IHS criteria proposed by Silberstein, et al., were gathered. TCD was performed with standard methods to measure the mean flow velocities(MFV) and pulsatile indices(PI) of middle cerebral, anterior cerebral, posterior cerebral, vertebral, distal and proximal basilar, ophthalmic artery, and distal, proximal and siphon portion of internal carotid artery. MFV and PI of TM were compared with those of CTTH by student's t test. Results: MFV of all examined arteries in TM were higher than those in CTTH. The differences in MFV were statistically significant in middle cerebral(p=0.005), anterior cerebral(p=0.05), vertebral(p=0.007), distal internal carotid(p=0.003) and proximal internal carotid artery (p=0.04), respectively. Though there was no statistically significant difference, PI of most arteries were lower in TM than in CTTH. Conclusions: Our results show that the cerebral hemodynamic features of TM are clearly different from those of CTTH. Therefore, we propose that TM should be included as a separate disease entity in the next edition of the IHS classification. Korean Journal of Headache 2(1):41-47, 2001
- 만성 두통 환자의 분류
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Byung-Kun Kim, Hee-Joon Bae, Ja-Seong Koo
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Korean J Headache. 2000;1(1):67-73. Published online June 30, 2000
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s: Although daily and near-daily headache named chronic daily headache(CDH) is an important reason for consultation in headache clinics, the International Headache Society(IHS) headache classification has a problem in the definition and classi-fication of the CDH. This fact led Silberstein et al in 1996 to propose revised criteria for CDH. They subdivided CDH into transformed migraine(TM), chronic tension type headache(CTTH), hemicrania continua(HC), and new daily persistent headache (NDPH). The objective of the present study was to prospectively classify CDH into subtypes according to the revised criteria for CDH and evaluate the effectiveness of new classification. Methods: We used structured questionnaire and clinical interview to make diagnosis of headache. Subject who had headaches more than 15 headache days a month considered to have CDH. CDH was further classified into TM, CTTH, HC, and NDPH according to the second revision of IHS criteria proposed by Silberstein, et al. Results: During 9 months, we studied 193 consecutive outpatients with CDH. The average age of these patients was 46 years. One hundred sixty-four patients(85.0%) were women. Eighty-nine(46.1%) had CTTH. TM was diagnosed in 90(46.6%). The 3 cases(1.6%) in this series met the criteria of NDDH. However the remaining 11 cases(5.7%) were not classifiable. No one was diagnosed as having HC. Analgesic overuse was reported in 24.4% of cases. Conclusions: Although most of patients with CDH had CTTH or TM, we were still not able to classify all the CDH. Therefore, we propose that modifica- tion of this classification system is needed. Korean Journal of Headache 1(1):67-73, 2000
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