- Cluster Headache Characteristics and the Severity of Obstructive Sleep Apnea: Insights from Polysomnography Analysis
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Yooha Hong, Mi-Kyoung Kang, Min Kyung Chu, Soo-Jin Cho, Hee-Jin Im
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Headache Pain Res. 2024;25(1):63-71. Published online April 16, 2024
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DOI: https://doi.org/10.62087/hpr.2024.0001
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- Purpose: Cluster headache (CH) is characterized by circadian rhythmicity of the attacks, and it is known to respond exceptionally well to oxygen therapy. Furthermore, obstructive sleep apnea (OSA) frequently co-occurs with CH, and both conditions may be parallel outcomes of hypothalamic dysfunction rather than being causally related. The aim of this study was to analyze the association between CH characteristics and polysomnographic factors stratified by the severity of OSA in patients diagnosed with CH and OSA.
Methods
We retrospectively analyzed the data of OSA patients with CH who were enrolled in the Korean Cluster Headache Registry and underwent polysomnography due to clinical suspicion of OSA. Basic demographic data, headache-related parameters, and polysomnographic parameters were analyzed according to the severity of OSA (apnea-hypopnea index: <15 or ≥15 per hour).
Results
Twelve CH patients with OSA were evaluated. The onset age of CH was higher (38.5 years vs. 19.0 years, p=0.010), and the maximal duration of cluster bouts was longer (156.5 days vs. 47.0 days, p=0.037) in the moderate-to-severe OSA group than in the mild OSA group. Unlike other polysomnographic parameters, the apnea-hypopnea index and respiratory arousal index during rapid eye movement (REM) sleep were comparable across different OSA severity levels.
Conclusion
The onset age and duration of cluster bouts were associated with the severity of OSA in CH patients. Additionally, the relatively high susceptibility to hypoxia during REM sleep in patients with mild OSA implies that interventions may be potentially advantageous, even in CH patients with mild OSA.
- Diagnosis and Treatment of Hemicrania Continua, Paroxysmal Hemicrania, Short-lasting Unilateral Neuralgiform Headache Attacks
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Sang-Hwa Lee, Mi-Kyoung Kang, Soo-Jin Cho
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Korean J Headache. 2023;24(2):39-44. Published online December 31, 2023
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- Chronic paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua are rare headache disorders characterized by severe unilateral headache accompanied by ipsilateral autonomic symptoms. Accurate diagnosis and specific treatment approaches for these conditions are crucial for appropriate management. This article covers the clinical features, diagnostic criteria, and treatment strategies of each disorder, aiming to differentiate them from other major headaches and provide targeted treatment strategies to improve patient outcomes.
- Sleep Disorders in Headache Patients
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Hye Jeong Lee, Hee-Jin Im, Soo-Jin Cho, Min Kyung Chu
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Korean J Headache. 2023;24(1):1-10. Published online June 30, 2023
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- Headache disorders and sleep problems are common conditions with a high prevalence in the general population, and impose a considerable socio-economic burden. They show a close association with headache disorders through various relationship. The prevalence of sleep problems is elevated in individuals with headache, especially for migraine. In most headache disorders, sleep problems are accompanied by the deterioration of clinical characteristics
of headache disorders. The sharing brain structures and neurotransmitters involved in the pathogenesis of headache disorders and sleep disorders may be an explanation for the close relationship between two disorders. In this article, we briefly review the relationship of headache disorders with sleep disorders including insomnia, sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders,
parasomnias, and sleep related movement disorders.
- Paradoxical Postural Headache in Spontaneous Intracranial Hypotension with
Infratentorial Superficial Siderosis
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Dae Woong Bae, Min Seung Kim, Soo-Jin Cho
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Korean J Headache. 2023;24(1):20-23. Published online June 30, 2023
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- Spontaneous intracranial hypotension is characterized by orthostatic headache caused by cerebrospinal fluid (CSF) leakage. However, clinical presentation of SIH is variable, and normal or high intracranial pressure in CSF study is not uncommon. Infratentorial superficial siderosis (ISS) shares similar pathomechanism with SIH, as developed after chronic CSF leakage, whilst several years of latency after SIH onset. Here, we report a 47-year-old male patient who had experienced prominent orthostatic headache twenty years before, and presented reverse-orthostatic headache in this time, accompanying with radiological features of SIH and ISS in brain magnetic resonance imaging (MRI). CSF leakage was confirmed by spinal MRI and MR myelography, and his headache was aggravated after epidural blood patch.
- A Intractable Headache Caused by Increased Intracranial Pressure after Surgical Resection of the Spinal Arachnoid Cyst
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Mi-Kyoung Kang, Han Beet Kim, Il Choi, Soo-Jin Cho
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Published online December 31, 2022
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- 척추 지주막낭의 수술적 제거 후 발생한 두개내압 상승에 기인한 난치성 두통
- Giant Cell Arteritis Diagnosed by HALO Score of Ultrasonography and Fat-saturated Contrast Enhanced Vessel Wall Magnetic Resonance Imaging
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Han-Beet Kim, Mi-Kyoung Kang, Min-Jun Song, Ki-Won Nam, Sang Won Jo, Ki-Han Kwon, Soo-Jin Cho
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Published online December 31, 2022
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- 초음파 검사의 달무리 징후와 지방포화혈관벽조영증강자기 공명영상으로 진단된 거대세포동맥염
- Diagnostic Delay in Spontaneous Intracranial Hypotension
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Jiyoung Kim, Younjin Park, Jong-Hee Sohn, Sang-Hwa Lee, Eun Kyung Khil, Hee Jin Im, Min Jun Song, Myoung-Jin Cha, Soo-Jin Cho
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Published online June 30, 2022
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- 자발두개내저압의 진단 지연
- 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
- Two Case Report of Melatonin Add-on Therapy for Cluster Headache
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Byung-Su Kim, Myoung-Jin Cha, Soo-Jin Cho
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Published online December 31, 2021
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- 군발두통에서 멜라토닌 추가 치료에 효과를 보인 2례
- Prevalence and Characteristics of Neck Pain in Patients with Migraine
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Hee Jin Im, Jong Hee Sohn, Soo-Jin Cho
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Published online June 30, 2021
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- 편두통 환자에서 경부통의 빈도 및 특징
- Mindfulness-Based Cognitive Therapy for Patients with Migraine
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Sun Hwa Lee, Mi Hyun Kim, Jong-Hee Sohn, Soo-Jin Cho
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Published online December 31, 2019
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- 편두통 환자를 위한 마음챙김에 기반한 인지치료
- Stanford Type A Aortic Dissection Presenting with Bitemporal Headache
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Yoo-Ha Hong, Hye Won Lee, Sang Won Choi, Myeong Jin Son, Min Uk Jang, Jooyong Kim, Ki-Han Kwon, Soo-Jin Cho, Jun Lee
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Published online December 31, 2018
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- 경도의 양관자쪽 두통으로 나타난 스탠포드 A형 대동맥 박리
- 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
- Infected Dentigerous Cyst Masquerading as Recurrent Trigeminal Neuralgia
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Myeong Jin Son, Sang Won Choi, Min Ki Kim, Ki-Han Kwon, Joo-Yong Kim, Soo-Jin Cho, Suk-Yun Kang, Mee Ran Shin, Ji Yeon Kang
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Published online June 30, 2016
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- 재발성 삼차신경통처럼 발현한 감염된 함치성낭
- Clinical Factors Influencing Headache Impact Test-6 in Migraine and Tension-type Headache Patients
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Jong Hee Sohn, Min Kyung Chu, Soo-Jin Cho
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Published online December 31, 2015
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- 편두통과 긴장형두통 환자에서 HIT-6에 영향을 미치는 임상 요인
- The Trigger Factors in Migraine - Food and Dietary Habit
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Soo-Jin Cho, Jong-Hee Sohn
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Published online December 31, 2014
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- 편두통 유발 요인 - 음식과 식습관
- Physical Activity in Migraine and Tension-type Headache
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Si-Won Eum, Min Kyung Chu, Jong Hee Sohn, Min-Woo Koo, Soo-Jin Cho
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Published online June 30, 2014
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- 편두통, 긴장형두통과 신체활동
- Pharmacological Treatment of Cluster Headache
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Soo-Jin Cho, Kyungmi Oh
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Published online December 31, 2013
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- 군발두통의 약물 치료
- Headache Update 2013
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Jong-Hee Sohn, Soo-Jin Cho
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Published online December 31, 2013
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- 두통의 최신지견 2013
- A Preliminary Study of Compliance and Satisfaction to Headache Diary in the Patients with Migraine
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Kee-Hoon Choi, Suk Yun Kang, Joo Yong Kim, Ki-Han Kwon, Min Kyung Chu, Soo-Jin Cho
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Published online June 30, 2013
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- A Preliminary Study of Compliance and Satisfaction to Headache Diary in the Patients with Migraine
- 개연적 편두통과 편두통: 연속 질환 범주로서의 접근
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Gyoung Im Suh, Byung-Kun Kim, Min Kyung Chu, Soo-Jin Cho
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Published online December 31, 2012
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- A considerable proportion of individuals suffering from headache were classified as probable migraine, which is fulfilling all but one criterion for migraine. In the continuum severity theory, the mild end is thought to be tension type headache which transform into migraine with increasing severity of condition and the gray zone of headache occupies the middle ground of the continuum. Because of dichotomous diagnostic criteria between migraine and tension type headache, the position of probable migraine also could be located at this gray zone.
- 한국인구집단에서 편두통환자의 냄새공포증과 편두통 대체진단기준의 타당도 평가
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Yeo Jin Kim, Soo-Jin Cho, Byung-Kun Kim, Kwang-Soo Lee, Byung-Chul Lee, Min Kyung Chu
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Korean J Headache. 2011;12(2):91-96. Published online December 31, 2011
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- Objective: Osmophobia, intolerance to smell, is often reported by migraine patients during headache attack and is included as an item of alternative diagnostic criteria for migraine in the appendix of ICHD-2. Most of previous reports on osmo- phobia were hospital-based studies and osmphobia of migraineurs across population sample was not reported yet. The aims of this study are to assess osmophobia in migraineurs across Korean populationand to assess validity of alternative diagnostic criteria of migraine. Methods: We used data of Korean Headache Survey(KHS), a population-based study by a stratified random sampling in Korean population over age 19, and totally 1,507 were evaluated. Demographic profile, headache characteristics and impact of headache were assessed with a 12-item semi-structured interview. Headache type was identified according to ICHD-2. We assessed osmophobia by a question ‘Do you feel changes in your sense of smell during headache?(stronger or differently)’. Results: Prevalence for migraine was 6.1%. 50.5% of migraineurs reported osmophobia during migraine attack. Mig- raineurs with osmophobia had more headache aggravation by routine physical activity, phonophobia and higher HIT-6 score than migraineurs without osmophobia. There were no significant difference in unilaterality of pain, pain intensity in VAS score, pulsating quality and photophobia between migraineurs with osmophobia and migraineurs without osmo- phobia. The sensitivity of alternative criteria was 0.95[95% confidence interval(CI), 0.87-0.98] and specificity was 0.99(95% CI, 0.98-0.99). Conclusions: Approximately half of migraineurs across Korean population sample reported osmophobia. Alternative criteria showed good specificity and sensitivity.
- 원발벼락두통의 임상양상
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Jiyeon Kim, Byung-Kun Kim, Gun-Sei Oh, Jae Myun Chung, Kyungmi Oh, Jeong Wook Park, Soo-Jin Cho
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Korean J Headache. 2011;12(2):85-90. Published online December 31, 2011
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- 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.
- 망막편두통과 유사한 고혈당성 단안시각증상
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Ji-Hyun Lee, Woo-Joo Choi, Yoo-Kyung Kim, Min-Woo Ku, Yang-Ki Minn, Ki-Han Kwon, Soo-Jin Cho
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Korean J Headache. 2011;12(1):71-73. Published online June 30, 2011
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- Retinal migraine is a rare subtype of migraine characterized by recurrent monocular visual symptoms(MVS). Severe hyperglycemia can cause chorea, seizure, or coma, but its association with retinal migraine has rarely been reported. A 54-year-old migraineur with diabetes mellitus complained of bright light in his left eye. MVS lasted from 2 to 3 minutes, recurred 5 to 50 times a day, and sometimes were followed by severe right-side headaches. Three years ago, he had had recurrent MVS associated with a colorful rainbow in the left eye, after discontinuing oral hypogly- cemic agents by his own volition. Hyperglycemia (613 mg/dl) and elevated glycosilated haemoglobin(10.5%) were detected. Initial and second EEGs, brain MRIs and MR angiography did not reveal any significant abnormalities. MVS decreased with improved glycemic and headache control and finally ceased in 3 weeks. MVS can develop due to hyperglycemia, and may be related to neuronal hyperexcitability or spreading depression.
- 한국인 인구집단에서 교육수준이 긴장형두통의 유병률에 미치는 영향
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Dong-Won Lee, Yang-Ki Minn, Min Kyung Chu, Kyung-Mi Oh, Byung-Kun Kim, Kwang Soo Lee, Soo-Jin Cho
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Korean J Headache. 2011;12(1):57-60. Published online June 30, 2011
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- Objective: Education reflects socioeconomic status and may influence pain modulation or thresholds in primary headache disorders. Tension-type headache(TTH) is the most common type of primary headache and the influence of education on the prevalence of TTH has not been well evaluated. The aims of this study were to evaluate the asso- ciation between education level and the prevalence of TTH and the influence of other contributors. Methods: For this study, a stratified random population sample of Koreans, over the age of 19, was selected and evalua- ted using a 12-item, semi-structured interview designed to identify headache type using ICHD-2 criteria. Education levels were classified into college, high school, and middle school or below. Household income and occupation were evaluated as contributors. Results: Among 1507 participants, 463(30.7%) were diagnosed with TTH; 228 were frequent episodic TTH, 224 were infrequent episodic TTH, and 11 were chronic TTH. College level was associated with a lower prevalence of tension-type headache(25.8% vs 33.8% in high school, 32.9% in middle school or below, p=0.006). Prevalence of frequent episodic TTH was lower in college graduate(p=0.002). After adjusting age, gender, and income, education level is the significant contributor for prevalence of TTH. Conclusions: Among variables of socioeconomic status, education is the important modulator of TTH, especially in women.
- 편두통, 난원공개존증, 뇌졸중
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Soo-Jin Cho
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Korean J Headache. 2011;12(1):38-41. Published online June 30, 2011
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- Traditional concepts of migraine as a benign recurrent headache have been challenged. Recent epidemiologic studies suggest that migraine is related to white matter hyperintensities or silent infarcts. The relation between silent infarcts is more evident in migraine with aura. The risks of symptomatic ischemic or hemorrhage stroke and cardiovascular disease are also increased in migraine in some epidemiologic studies. Although, there are some critics about the possible error in classification of headache or exaggeration of small burden, the association between migraine and vascular disease looks like more than causal. Patent foramen ovale is the possible mediator of the association. Patent foramen ovale is frequently detected in migraine patient, especially in migraine with aura. Empirical data have suggested that closure of patent foramen ovale was effective in improving symptoms of migraine. Although a recent randomized controlled trial failed to prove this hypothesis, microembolisation through right-left shunt can evoke migraine attack and silent infarcts in some experi- mental studies. Therefore, the concept of migraine as a chronic or progressive disorder may highlight the importance of proper management and preventive therapy of migraine.
- 한국인 인구집단에서 고빈도 삽화성 긴장형두통의 영향
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Soo-Jin Cho, Min Kyung Chu, Byung-Kun Kim, Jae-Myun Chung, Kwang Soo Lee
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Korean J Headache. 2010;11(2):91-94. Published online December 31, 2010
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- Background
Frequent episodic tension-type headache (ETTH) is a subtype of tension-type headache (TTH) based upon ICHD-2 criteria. ETTH is generally considered as mild primary headache disorder but the impact of frequent ETTH has not been evaluated separately from infrequent ETTH. Therefore, this study evaluated the impact of frequent ETTH. Method: For this study, a stratified random population sample of Koreans, over the age of 19, was selected and evaluated using a 12-item, semi-structured interview designed to identify headache type using ICHD-2 criteria. The burden of the headache was evaluated by the headache impact test-6 (HIT-6). Results: Among 1507 participants, 463 (30.7%) were diagnosed with TTH; 228 were diagnosed with frequent ETTH, 224 were infrequent ETTH, and 11 were chronic TTH. Thirty-two patients (6.9%) with TTH had substantial to severe impact in HIT-6 (≥56); 22 had frequent ETTH, 7 had infrequent TTH, and 3 had chronic TTH (p<0.01). Frequent TTH, severity of pain by visual analogue scales, aggravation with physical activity, moderate or severe intensity, and phonophobia influenced on total scores of HIT-6. Conclusion: Frequent ETTH is a common headache disorder and had significant impact, so medical and social attentions are promptly needed.
- 편두통의 급성기 치료: 트립탄 외의 약물들
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Soo-Jin Cho
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Korean J Headache. 2010;11(1):38-41. Published online June 30, 2010
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- Triptans have been suggested as standard acute medication of migraine, but triptan-users are still a few among the patient with migraine. The many migrainers obtained their headache relief with nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, over the counter drugs(OTCs), ergotamine agents, and et cetera. The main causes of these trends are lack of experience, broad contraindication, high cost, and insufficient efficacy of triptans in some patients. Additionally, these other drugs have some strength in acute treatment of migraine. For example, NSAIDs can use by the patients combined with other headache, OTCs have good accessibility, ergotamine has long half life, and dopamine-antagonist has high efficacy in nausea. Overuses of these medications induce loss of their efficacy, addition, and eventually drug-overuse headache, so the limitation of its usage per day, week, and month is essential. Finally the guidance of physician could not be overemphasized in acute treatment of migraine from the patient with mild episodic migraine to those with chronic daily headache or severe migraine.
- 응급실에 방문한 일차 두통환자의 현황
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Bohm-Nam Kim, Ji-Ee Kim, Min-Kun Park, Kyung-Mo Gu, Ki-Chul Yoo, Ki-Hoon Choi, Yang-Ki Minn, Ki-Han Kwon, Soo-Jin Cho
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Korean J Headache. 2009;10(2):156-159. Published online December 31, 2009
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- Background
Primary headaches such as migraine is tend to be neglected by a physician in the emergency department (ED) due to limited resources and low priority. In this study, the frequency of primary headache patients in the ED is figured and evaluates current management status for primary headache in the ED. Methods: We retrospectively selected 137 non-traumatic headache patients were presented to the ED of Hospital in 2008, based on diagnosis by a physician in the ED at discharge. Among the patients with non-traumatic headache, patients with secondary headaches were excluded. Evaluation of demographic characteristics, previous history, ED management and status of non-traumatic primary headaches patient those who visit out-patient clinic after discharge Emergency Department were included. Results: Out of 137 non-traumatic headache patients, 80 patients(58.4%) were diagnosed of primary headaches: 73.8% were women and the mean age was 40±15.7 years. Forty-two patients(52.5%) had previous history of headache. Fifty- eight patients(72.5%) were prescribed simple analgesics or anti-emetics in the ED and 17(21.2%) visited out-patient clinic after their discharge. Presumed diagnoses at the ED were migraine in 20 patients, tension type headache in 29, cluster headache in 1, trigeminal neuralgia in 2 and unclassified in 28 patients. Conclusion: Primary headaches are common in the patients presenting to the ER with non-traumatic headaches. Hence, in order to get specific diagnosis or to consider preventive therapy, visits to out-patient clinic might be recommended.
- 약물에 의한 두통
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Soo-Jin Cho, Sang-Moo Lee
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Korean J Headache. 2009;10(2):121-123. Published online December 31, 2009
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- Drug-induced headache is one of the important causes of poor compliance. Drug-induced headache can be diagnosed by withdrawal of suspected agents and plausible relationship. The drugs most likely reported to be associated with headache are nitric oxide donors, phosphodiesterase inhibitors, lithium, and tetracycline and suggested mechanisms are vasodilatation, increased intracranial pressure, and aseptic meningitis. Some patients are more susceptible to drug-induced headache. Drug-induced headache can be controlled by reducing dose, discontinuation of the drug, and symptomatic medications, if needed. Consideration about previous headache history is recommended in randomized drug trial and starting new drug.
- 벼락두통을 포함한 응급두통
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Soo-Jin Cho
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Korean J Headache. 2009;10(1):66-71. Published online June 30, 2009
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- Headache is a common complaint encountered in the emergency room and can be caused by life threatening serious diseases. After history taking & examination, brain imaging and/or spinal fluid examination are mandatory for patients with first ever severe headache or abnormal neurological findings. In addition, the physician’s roles in the emergency department are to control the pain and to refer these patient to follow up visits to start effective therapy for future recurrence. Thunderclap headache is a headache that begins suddenly and is maximum in intensity at onset. A lot of intracranial illnesses cause thunderclap headache. For example, there are subarachnoid hemorrhage, cerebral venous sinus thrombosis, stroke, spontaneous intracranial hypotension, and reversible cerebral vasoconstriction syndrome. However, more than half of those with thunderclap headache have normal imaging and cerebrospinal fluid examination and primary thunderclap headache can be suspected in case with prolonged symptom. Primary cough headache and exertional headache is suspected in the cases with recurrent headaches in a special situation.
- 왜 어떤 편두통 환자는 예방 약물에 반응하지 않을까?
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Soo-Jin Cho
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Korean J Headache. 2005;6(1):70-73. Published online June 30, 2005
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- Migraine is a chronic recurrent headache disorder and preventive medications can lessen the burden or disability due to severe migraine attacks. About a half of patients responded(a greater than 50% reduc- tion in either mean migraine frequency or mean numbers of days with migraine) to traditional preventive medications and some gave up the medications due to adverse effect before the maximum effects. Causes of failure to preventive medications were poor compliance or premature discontinuation, inappropriate choice of medications, or neglect the exacerbating factors in habit or environment. The frequency of mig- raine can change purely with time, so non-pharmacological management is worthwhile after comprehen- sive evaluations for primary or secondary headache. The patients with previous failure of several courses of preventive medications can respond to new preventive therapy or combined therapy with previous par- tial effective medications. Korean Journal of Headache 6(1):70-73, 2005
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KHS
