Headache and Pain Research

Volume 1(1); June 2000

목 차: Published online June 30, 2000

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창간사: Published online June 30, 2000

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편두통의 병태생리: 혈관성 이론: Sun Uck Kwon; Korean J Headache. 2000;1(1):1-5. Published online June 30, 2000

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Abstract PDF: The vascular theory, the most classical theory for the pathophysiology of the migraine, has been raised during recent a few centuries. The key-point of vascular theory is that the aura symptoms are secondary to cerebral vasoconstriction-induced ischemia and the headache secondary to reactive hyperemia. The recent studies showed, however, that the pattern of regional cerebral blood flow(rCBF) is incompatible with spasm of major cerebral arteries. Although rCBF is entirely normal during attacks of migraine without aura, we have some evidences of dilatation of the ipsilateral middle cerebral artery during migraine attacks and normalization after treatment with sumatriptan. The vascular changes still remains as an important role in the pathophysiology of migraine. Korean Journal of Headache 1(1):1-5, 2000

편두통과 Cortical Spreading Depression: Te Gyu Lee; Korean J Headache. 2000;1(1):6-14. Published online June 30, 2000

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Abstract PDF: Cortical spreading depression(CSD) seems to be an important phenomenon explaining migraine aura. It occurs in four stages in animal model and starts from the occipital lobes, spreading forward on the cortical surfaces. Neuroimaging studies in migraineurs showed ictal blood flow changes compatible with CSD in the animal models. The brain stem nuclei(raphe and locus ceruleus) and cortical hyperexcitability may well have important role in generating CSD. Presence of CSD in migraine without aura remains controversial. The aura mechanisms in familial hemiplegic migraine and ophthalmoplegic migraine are also discussed. Korean Journal of Headache 1(1):6-14, 2000

편두통과 세로토닌: Te Gyu Lee; Korean J Headache. 2000;1(1):15-17. Published online June 30, 2000

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Abstract PDF: Serotonin seems to have an important role in migraine pathogenesis and treatment. It is abundant in the brain, intestinal mucosa and platelats, which are important in migraine symptomatology. Recently developed specific serotonin(5-HT1) agonists, namely “triptans” showed the way how to effectively treat acute migraine in view of serotonin hypothesis. Further development of specific receptor angonists and antagonists may well define receptor function and elucidate the validity of the serotonin hypothesis. Korean Journal of Headache 1(1):15-17, 2000

삼차신경 - 혈관계과 세로토닌 수용체: Won Suk Lee; Korean J Headache. 2000;1(1):18-24. Published online June 30, 2000

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Abstract PDF: The trigeminal nerve transmits migraine headache from blood vessels of the dura mater. Triggers of this pain are not well understood, but probably are multiple and largely chemical, and develop within the brain parenchyma, the blood vessel wall, and the blood itself. These unknown triggers stimulate the trigeminovascular nerve fibers, causing pain, and releasing vasoactive neuropeptides(e.g. substance P, neurokinin A, and calcitonin generelated peptide) from perivascular nerve fibers. Released neuropeptides activate endothelial cells, mast cells, and platelets, and mediate the neurogenic inflammation including the endothelium-dependent vasodilation and the enhanced permeability. Electric stimulation of trigeminal ganglion or intravenous administration of capsaicin induces neurogenic plasma protein extravasation within the dura mater. This extravasation is markedly attenuated or absent in animals whose perivascular afferent fibers have been destroyed by capsaicin treatment during the neonatal period. Antimigraine drugs such as sumatriptan and dihydroergotamine significantly reduce the neurogenic plasma protein extravasation via prejunctional mechanisms involving 5-HT1D receptors or analogous 5-HT1B receptors in rats. On the basis of these results, it is concluded that the neurogenic inflammation in dura mater caused from activation of trigeminovascular system is important in the pathophysiology of migraine and related headaches, and to the action of antimigraine drugs. Korean Journal of Headache 1(1):18-24, 2000

편두통과 Nitric Oxide: Ki-Hyeon Cho; Korean J Headache. 2000;1(1):25-31. Published online June 30, 2000

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Abstract PDF: Although the vascular, neurogenic, and inflammatory theories are introduced as the pathomechanism of migraine, any single one is not enough for explaining the whole clinical manifestations of migraine. Accumulating evidences of nitric oxide(NO) involvement in migraine headache have been reported on the basis of the NO-cGMP pathway. Three hypotheses can be thought for explaining NO involvement in migraine. First, activation of the NO-cGMP pathway causes migraine attacks in migraineurs. Second, drugs that are effective in the treatment of migraine exert their activity by inhibiting one or more steps in the NO-cGMP pathway or by antagonizing the effects of products of this pathway. Third, substance which can cause an attack of migraine do so by stimulating one or more steps in the NO-cGMP pathway or by exerting effects which are agonistic to those of one or more effects in this pathway. The possible mechanisms whereby NO could cause migraine are by dilatation of cerebral and extracerebral blood vessels, by changes of cerebrovascular regulation following cortical spreading depression, by direct effect of perivascular sensory nerves, and so on. In this context, NO may play a key role in migraine, and the importance of NO as a potential initiator of the migraine attack indicates new direction for the phar- macological treatment of migraine. Korean Journal of Headache 1(1):25-31, 2000

편두통의 유전학적 기초: Yong-Seok Lee; Korean J Headache. 2000;1(1):32-38. Published online June 30, 2000

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Abstract PDF: Clinical and genetic heterogeneity as well as the influence of environmental factors have hampered the identification of the genetic factors, which are involved in episodic diseases such as migraine and episodic ataxia. Although not sufficiently reliable, family studies and twin studies suggest that migraine likely is influenced by hereditary susceptibility. Migraine with aura(MWA) seems to be largely determi- ned by genetic factors, whereas migraine without aura(MOA) caused by a combination of both genetic and environmental factors, hence migraine is supposed to be a multifactorial disorder. Recently, different types of mutations in the brain specific P/Q type calcium channel 1A subunit gene(CACNA1A) on chromosome 19p13 were shown to be involved in familial hemiplegic migraine(FHM), episodic ataxia type 2(EA-2), and spinocerebellar ataxia type 6(SCA-6). A gain of function variant of the calcium channel subunit would probably influence presynaptic neurotransmitter release, possibly of excitatory aminoacid or inhibitory serotonergic systems, leading to postsynaptic neuronal excitability. The impor- tance of these discoveries is now being extended to a growing list of membrane excitability disorders of the nervous system. And identification of candidate genes for migraine is expected in the future. Korean Journal of Headache 1(1):32-38, 2000

성 호르몬과 편두통: Cha-Ok Bang; Korean J Headache. 2000;1(1):39-48. Published online June 30, 2000

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Abstract PDF: As the pathophysiological factor of migraine, the role of female sex hormone has long been recogni- zed. On the basis of current epidemiological data, migraine occurs three times more frequently in women than in men, and the peak incidence of female migraine occurs at menarche. A half of female migrai- neurs may be worsened around menstruation. Pregnancy, use of oral contraceptives, and menopause can change its natural course. Hormonal replacement therapy with estrogen can exacerbate migraine. Changes in the clinical presentation of migraine with menstruation, pregnancy, use of oral contraceptives, and menopause may be related to estrogen level. The relationship between migraine and female sex hor- mone is discussed. Korean Journal of Headache 1(1):39-48, 2000

편두통 비급성기에서의 대뇌피질 과흥분성: Jae-Moon Kim; Korean J Headache. 2000;1(1):49-56. Published online June 30, 2000

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Abstract PDF: Pathogenesis of migraine is still far from clear understanding. Vascular, neurogenic and mixed mecha- nisms are suggested as its etiogenesis. Currently, clinical characteristics of paroxysmal attack, common genetic trait, and neurophysiological evidence of hyperexcitability of cortical neuron in migraineurs sugges- ted migraine as an episodic disorder sharing common pathogenesis, certain types of epilepsy, and other channelopathies. Paroxysmal nature of migraine precipitated by trigger factors resembles periodic paralysis or episodic ataxia. Also, though genetic basis of migraine needs to be determined, the classical concept of genetic trait playing a crucial role in migraine attack is well established. Neurophysiological data from migraineurs are controversial in many aspects, but previous investigations using transcranial magnetic stimulation(TMS), visual evoked potentials(VEPs), and other evoked potentials suggests the cortical neurons of migraine patients are more easily excitable and facilitated than controls. Recently, functional MRI(fMRI) showed hyperemia during the classic spreading depression of potassium-induced migraine in rats. Prog- ression in neurophysiological methods and imaging technique will be helpful in understanding the mechanisms of migraine and clinical diagnosis as well. Research for genetic and molecular basis of migraine is largely obtained from uncommon varieties of familial hemiplegic migraine and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy(CADASIL). Although molecular and genetic understanding of migraine headache in these disorders are firmly established, whether these findings can be generalized in classic/common migraine patients is still under investigation. These new concepts of pathogenesis of migraine answers to many old questions of the nature of spreading depression, triggering of migraine attacks, and the precise cellular mechanisms undergoing in the brain of migraine patients. Korean Journal of Headache 1(1):49-56, 2000

한국 성인에서의 편두통 유병률 연구: Te Gyu Lee, Kyung Cheon Chung, Jae Wook Choi; Korean J Headache. 2000;1(1):57-66. Published online June 30, 2000

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Abstract PDF: Background
s: Since the International Headache Society(IHS) announced the classification and diag- nostic criteria for headache in 1988, migraine prevalence has been studied in many developed countries. However, no prevalence study of migraine with significant reliability is available in Korea hitherto. We believed the previous Korean study in 1998 was biased due to a very high rate of drop-out, thus revea- ling the world-highest prevalence rate of migraine since the IHS criteria was introduced. Methods: Among Koreans of 20 years old or more, we randomly selected about 1,500 target population by stratified random sampling with clustering, considering residential area, age, and gender. The headache questionnaire was designed to sort out headache and classify migraine based on the IHS classification and criteria for headache(1988). Results: Interviews using headache questionnaire and phone was sequen- tially conducted. The trained interviewers met the target individuals, then let him/her answer the questionnaire. If a target individual was not present during the inter- view period, a substitute candidate with the most similar demographic condition was interviewed in the same cluster area. A neurologist, expert in headache, gathered and analysed these data, then called target individuals if necessary to confirm whether(s)he has migraine or not. The number of target individuals was 1,523. There was no drop-out during questionnaire interviews. The investigator could not get phone interview with 17% of the target individuals who needed it. The overall migraine prevalence for last 12 months was 6.5%. The rate of migraine with aura was 1.3%, migraine without aura was 5.2%.(Male patients 3.2%, and females 9.7%). Prevalence of migrainous disorder was 5.9%. The fourth decade in life showed the highest prevalence(10.3%). Eigthy percent experienced difficulty in their school/job activities due to migraine. Two percent of the migraineurs occasionally visited emergency room for very severe migraine attacks. Conclusions: This study showed very similar results with those of Japanese and U.S. Asian studies. Among possible variables which determine migraine prevalence in a given population(country), genetic background seems to be the most influential. In conclusion, this is the first nationwide Korean study of migraine prevalence with good reliability and validity. Korean Journal of Headache 1(1):57-66, 2000

만성 두통 환자의 분류: Byung-Kun Kim, Hee-Joon Bae, Ja-Seong Koo; Korean J Headache. 2000;1(1):67-73. Published online June 30, 2000

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Abstract PDF: Background
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

뇌척수액 감소 증후군: Sun Ju CHung, Jong Sung Kim, Myoung Chong Lee; Korean J Headache. 2000;1(1):74-85. Published online June 30, 2000

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Abstract PDF: Background
To investigate clinical, MRI and radioisotope findings and therapeutic outcome of the syndrome of CSF hypovolemia. Methods: We retrospectively reviewed 30 consecutive patients with syndrome of CSF hypovolemia admitted to Asan Medical Center. Results: There were 10 men and 20 women with the mean age of 37 years. All patients had an orthostatic headache, which was alleviated to a variable extent upon recumbency. Additional clinical symptoms included nausea, dizziness, neck stiffness, blurring of vision, tinnitus, plugged ear, hearing difficulties and radicular pain of the arm. 82% of the patients had CSF opening pressure <60 mmH2O, 59% had CSF pleocytosis, and 95% had increa- sed CSF protein. Brain MRI showed diffuse pachymeningeal gadolinium enhancement on T1-weighted image in 83%, which was seen as hyperintense signals on T2-weighted imaging. Other features included subdural hematoma/hygroma in 17%, and descent of the brain in 48% of the patients. Radioisotope cisternographic results identified CSF leakage sites in 52%, most often at the lumbar region. Also obser- ved were limited ascent of the tracer to the cerebral convexity(91%), early appearance of radioisotope in the bladder(65%) and early soft tissue uptake of radioisotope(43%). Epidural blood patches were performed in 23 patients, which produced complete resolution of headaches in 70%. Two patients under- went drainage of subdural hematoma. None died or were disabled during hospitalization. Conclusions: The patients with CSF hypovolemia frequently have distinct MRI and radioisotope cisternographic abnormalities and respond favorably by an epidural blood patch. The prognosis is good if appropriately diagnosed and treated. Korean Journal of Headache 1(1):74-85, 2000

수면성 두통 증후군의 임상 양상과 병태생리적 기전: Jeong Ho Ha, Sun Uck Kwon, Te Gyu Lee; Korean J Headache. 2000;1(1):86-91. Published online June 30, 2000

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Abstract: Hypnic headache syndrome is a rare headache disorder characterized by recurrent nocturnal attack at a consistent time that awaken the patients from sleep frequently. The pathophysiology is not well known, but a “perturbation of chronologic rhythm” and 'REM related phenomenon' have been suggested. We herein describe two patients with nocturnal headache compatible with a hypnic headache syndrome and the polysomnographic findings and discuss about the clinical features and the pathophysiology. Korean Journal of Headache 1(1):86-91, 2000

편두통 환자에서 현훈의 기원: 중추성 전정계 손상의 증거: Hyung Lee, Jeong-Geun Lim, Sang-Doe Yi, Young-Choon Park; Korean J Headache. 2000;1(1):92-96. Published online June 30, 2000

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Abstract PDF: Migraine is a common neurological disorder whose most readily recognized manifestation is headache. However, many patients with migraine also suffer from vestibular abnormalities such as vertigo or movement associated disequilibrium. So far, origin of vertigo in patients with migraine is still obscured. We described the presentation of migrainous infarction with sudden severe objective vertigo, right facial pain, unilateral pulsating headache and sensory loss on the left extremity. MRI showed hyperintensity in the right upper medulla on T2 weighted image. Electronystagmographic findings were consistent with central vestibulopathy including normal caloric response. Extensive work-up for young age stroke were all negative except for typical migraine history. Based on the history and laboratory findings, we concluded that objective vertigo in this case was likely originated from asymmetric damage of central vestibular system. Migraine should be considered in the differential diagnosis of central vertigo, especially in young woman. Korean Jouranl of Headache 1(1):92-96, 2000

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