- 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.
- Invasive Aspergillosis Manifesting as Painful Ophthalmoplegia
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Sorae Lee, Sumin Kim, Sanggyu Han, So-Ei Ann, Pil-Wook Chung, Bum Chun Suh, Jun-Sang Sunwoo
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Korean J Headache. 2023;24(2):84-86. Published online December 31, 2023
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- 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
- Diagnostic Delay of Cluster Headache in Korea
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Byung-Su Kim, Soo-Kyoung Kim, Pil-Wook Chung, Byung-Kun Kim, Mi Ji Lee, Min Kyung Chu, Jin-Young Ahn, Dae Woong Bae, Tae-Jin Song
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Published online June 30, 2020
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- 국내 군발두통의 진단지연
- MRI of Spinal Trigeminal Nucleus in Postherpetic Neuralgia with Trigeminal Territory
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Hong-Jik Kim, Pil-Wook Chung
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Published online December 31, 2017
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- 삼차신경 영역 대상포진후신경통에서의 척수삼차신경핵의 MRI 소견
- 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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