Headache and Pain Research

Oh-Hyun Kwon

1 Article

일반연제-Clinical Characteristics of Migraine and Tension-type Headache: The Experience in Eulji Hospital: Byung-Kun Kim, Hee-Jun Bae, Ja-Seong Koo, Oh-Hyun Kwon , Jong-Moo Park; Korean J Headache. 2005;6(1):103-103. Published online June 30, 2005

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Abstract PDF: Objectives
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.

Oh-Hyun Kwon

2 Articles

한국인 편두통 환자와 미토콘드리아 DNA 11,084 유전자 다형성의 연관성: Byung-Kun Kim, Hee-Joon Bae, Ja-Seong Koo, Oh-Hyun Kwon, Man-Ho Kim; Korean J Headache. 2002;3(2):111-115. Published online December 31, 2002

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Abstract PDF: Background
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: Byung-Kun Kim, Hee-Joon Bae, Ja-Seong Koo, Oh-Hyun Kwon; Korean J Headache. 2002;3(2):99-104. Published online December 31, 2002

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Abstract PDF: Background
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

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