Headache and Pain Research

Volume 11(1); June 2010

유발점주사 효과: Gun-Sei Oh, Sang-Jun Lee; Korean J Headache. 2010;11(1):1-6. Published online June 30, 2010

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Abstract PDF: Trigger points are defined as discrete, focal, hyperirritable spots located in a taut band of skeletal muscle and their ligamentous junctions remote from the site of the pain. They are prevalent in regional musculoskeletal pain syndromes, either alone or in combination with other pain generators. The appropriate evaluation and management of trigger points is an important part of musculoskeletal rehabilitation of regional axial and limb pain syndrome. Acute trauma or repetitive microtrauma may lead to the development of stress on muscle fibers and formation of trigger points. Patients may have regional, persistent pain resulting in a limited range of motion in the affected muscles. Pain from myofascial trigger points can be identified by careful history taking and skillful physical examination, and they are quickly responsive to physical and medical management in the absence of serious perpetuating factors. Skeletal muscle makes up nearly half of body weight. Each of the approximately 500 skeletal muscles is subject to acute and chronic strain. Each muscle can develop myofascial trigger points and has its own characteristic pattern of referred pain. Palpation of a hypersensitive bundle or nodule of muscle fiber is harder than normal consistency and elicit pain directly over the affected area and/or cause referred pain and local twitch response. Trigger point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms.

소아, 청소년의 이차두통: Kon Hee Lee; Korean J Headache. 2010;11(1):7-12. Published online June 30, 2010

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Abstract PDF: Although most of headaches in children and adolescents are primary headaches, it is very important to diagnose the secondary causes of headaches. Secondary headaches are divided into the 8 disorder groups including psychiatric problems in ICHD II(The International Classification of Headache Disorders 2nd edition). Common etiologies for secondary headaches in children are Infections, disorders of the cranium, neck, eyes, ears, nose, sinuses, teeth, or other facial or cranial structures, disorders of homeostasis, substance or withdrawal from substances, psychiatric disorders and head and/neck trauma. The other causes are cranial or cervical vascular disorders and nonvascular intracranial disorders, which are rare but life-threatening. It is necessary for us to recognize how to approach several causes of secondary headaches in children, and strategies for neuroimaging studies for headache children.

두통질환에서의 약물 연구: Byung-Kun Kim; Korean J Headache. 2010;11(1):13-16. Published online June 30, 2010

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Abstract PDF: In 1991 the Clinical Trials Subcommittee of the International Headache Society(IHS) published its first edition of the guidelines on controlled trials of drugs in migraine. The guidelines were developed because of a need to improve the quality of controlled clinical trials in migraine and to draw investigator’s attention to the problems inherent in drug trials in migraine. In this article, I will briefly review the guidelines of migraine, tension-type headache and cluster headache.

편두통 치료의 과학적 근거: 급성 및 예방 치료: Jung Wook Park; Korean J Headache. 2010;11(1):17-22. Published online June 30, 2010

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Abstract PDF: The aim of this paper is to review the advancement in pharmacotherapy of migraine in parallel with understanding of the pathophysiology of the disease. Currently, migraine treatment are classified as acute attack and preventive therapies. The acute attack treatment is based on the fact that the migraine pain develops from nociceptive activation of trigeminal cranial afferents. In addition to recent review of triptans, specific agents with trigeminovascular pro- perties, recent development of acute treatment, CGRP receptor and glutamate antagonist, will be discussed. Till now, the exact mechanism of migraine preventive drugs is still unraveled. Recent study shows that most of preventive drugs are effective in reducing cortical spreading depression, corresponding to migraine aura. Newly introduced gap junction blocker, tonabersat, and glutamate antagonist would help for more sussessful management of migraine.

편두통의 치료 전략: Sung-Woo Chung; Korean J Headache. 2010;11(1):23-31. Published online June 30, 2010

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Abstract PDF: Migraine is a common, recurrent and disabling brain disorder with a strong inherited component. The goals of acute therapy of migraine are rapid relief of pain without recurrence, restoration of the patient’s ability to function, and minimal or no side effects. It is important to educate migraine patients and to discuss about their plan for therapy. Many migraine specific and nonspecific medications are used for acute therapy. Preventive therapy plays an important role in migraine management, and broad range of pharmaceutical and non-pharmaceutical options exist. Doctors must consider patient’s migraine characteristics, comorbidity, contraindication, and side effect profiles when choosing preventive drugs. Medication overuse is an important concern in migraine therapeutics and needs to be identified and managed. I tried to review the general principles and strategies in the acute and preventive treatment of migraine.

트립탄계 약물의 최신지견: Heui-Soo Moon; Korean J Headache. 2010;11(1):32-38. Published online June 30, 2010

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Abstract PDF: The objective of abortive treatment of migraine attack is to reduce the intensity and duration of pain with its attendant symptoms and to optimize the patient’s ability to function normally. The triptans, selective serotonin 5-HT1B/1D agonists, are very effective acute migraine drugs. Triptans work by decreasing neurogenic inflammation peripherally in the meninges, vasoconstriction of meningeal vessels and by modulating secondary order neurons in the brain stem. Treat- ment choices for acute migraine should be based on headache severity, migraine frequency, associated symptoms, and comorbidities. The aim of this article is to review the pharmacokinetics and clinical characteristics of these triptans and discuss how their individual characteristics lead to their preferred choice in various clinical aspects.

편두통의 급성기 치료: 트립탄 외의 약물들: Soo-Jin Cho; Korean J Headache. 2010;11(1):38-41. Published online June 30, 2010

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Abstract PDF: 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.

편두통 예방치료 약물: Jae-Myun Chung; Korean J Headache. 2010;11(1):42-49. Published online June 30, 2010

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Abstract PDF: Migraine is a common and disabling recurrent headache disorder. Its burden on individual's quality of life makes migraine to be a serious health problem. Preventive pharmacological treatment is one of major categories in migraine treatment along with acute and nonpharmacologic managements. Preventive treatment is required in those with fre- quent or disabling attacks of migraine to minimize the disability, to prevent medication overuse, and to improve the quality of life. Beta blockers, of which propranolol is the representative, are the most reliable preventive drugs of proven efficacy. Amitriptyline is also a reliable migraine preventive drug in antidepressants in spite of newer drugs such as SSRI or SNRI came to practice. Neuromodulators including valproic acid and topiramate are expected to be used more in the future based on their mechanism of action. All practitioners also should keep in mind several points considered in preventive managements, such as efficacy of drugs, comorbidities and duration of prophylaxis.

긴장형두통과 군발두통의 치료: Jin Kuk Do; Korean J Headache. 2010;11(1):50-54. Published online June 30, 2010

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Abstract PDF: Tension-type headache(TTH) is the most common and cluster headache(CH) is relatively uncommon of primary headache disorder. CH is the most unique and painful of the primary headache disorders. However TTH is featureless syndrome. Physicians often experience difficulty for managing TTH and CH. TTH is the most costly and common form of headache and what many people consider a normal headache, in contrast to migraine. Many TTH patients self treat acute attacks and seek advice when attacks become frequent or chronic. CH is characterized by recurrent monomorphic headache attacks associated with cranial autonomic symptoms. Despite its clear clinical presentation, many CH patients are misdiagnosed or mismanaged. Other primary headache syndromes can sometimes be managed nonmedicinally, but in regard to CH, medication, sometimes even polypharmacy, is indicated. Because most patients who have CH have episodic CH, medications are only used while a patient is in cycle and are stopped during remission periods.

소아청소년 두통의 치료: Young-il Rho; Korean J Headache. 2010;11(1):55-61. Published online June 30, 2010

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Abstract PDF: Headache is among the most common problems leading parents to seek medical attention for their children and adoles- cents and become increasing more frequent during adolescence. The majority of children and adolescents headache patients who are brought to a physician for evaluation will prove to have migraine. Although headaches in children and adolescents are generally benign, neuroimaging studies are frequently performed in clinical practice for the fear of missing a serious underlying disease. A thorough history, physical and comprehensive neurologic examination, and appropriate diagnostic testing will usually enable the clinician to distinguish a benign primary headache from a more serious disease with a secondary headache. To effectively treat sick episodic headache, the physician initially needs to identify potential triggers and outline an acute treatment strategy. The initial goal is to eliminate headache pain in two to four hours. The headache may last only one to two hours in children under the age of 12 years. In this case, a more moderate approach toward treatment can be taken. Not only were children shown to have significant disability due to migraine and recurrent headache, but also that successful acute and preventive treatment would resolve this disability. In dealing with headaches in children and adolescent, physician must consider both physical and psychological factors in determining the correct diagnosis. Here, I would like to mention about management of migraine, tension type headache in children and adolescents and comorbidity disorders in pediatric headache.

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