Headache and Pain Research

Volume 2(1); June 2001

목차: Published online June 30, 2001

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편두통의 예방치료: Jeong Geun Lim; Korean J Headache. 2001;2(1):1-9. Published online June 30, 2001

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Abstract PDF: The first priority in migraine treatment is to optimize acute treatment. But there remains a significant group of migraine patients with unsatisfactorily treated attacks. Prophylactic treatment is indicated if the migraine attacks are severe enough to impair the patients' quality of life or if the patient has more than 2 to 3 migraine attacks per month that fail to respond adequately to symptomatic therapy. Preventive medication is usually given daily for months to years. The medications can be divided into two major categories, the first-line and second-line choices. The choice of drug depends on the individual drug's efficacy, side effects and the presence of any comorbid or coexistent disease. Korean Journal of Headache 2(1):1-9, 2001

Triptan계열 약물 이외의 급성기 편두통치료: Nack-Cheon Choi; Korean J Headache. 2001;2(1):10-19. Published online June 30, 2001

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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 efficacy of most abortive anti-migrainous drug is probably related to their inhibitory effects on neurogenic inflammation mediated through serotoninergic control mechanisms. A variety of treatment strategies provide effective treatment for most attacks of moderate to severe migraine when utilizing one or a combination of the following classes of drugs: anti-emetics, simple analgesics, nonsteroidal anti- inflammatory drugs, ergot derivatives, and narcotic analgesics. The choice of medication for an acute attack depends on factors such as the severity of the attack, the presence or absence of vomiting, time from onset of pain to peak pain level, rate of bioavailability of the drugs, comorbid medical conditions, and the side effect profile of the drug. Korean Journal of Headache 2(1):10-19, 2001

편두통의 비약물적 치료: Byeong-Keon Kim; Korean J Headache. 2001;2(1):20-26. Published online June 30, 2001

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Abstract PDF: Non-pharmacological approach is important for effective treatment of migraine, at least in some appro- priate patients. These include biofeedback, relaxation techniques, avoidance of precipitating factors, acupunct- ure, nerve block, and so forth. Biofeedback is most effective to young, intelligent, and motivated patients. These treatment modalities often neglected. Principles, indications and limitations of each modality are herein discussed. More active utilization of these approaches are recommended for more effective migraine therapy. Korean Journal of Headache 2(1):20-26, 2001

급성기 편두통 치료: Triptan계 약물: Chin-Sang Chung; Korean J Headache. 2001;2(1):27-40. Published online June 30, 2001

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Abstract PDF: Traditional therapies like simple analgesics, the nonsteroidal anti-inflammatory drugs and prokinetic and antiemetic compounds are nonspecific drugs for acute migraine attacks. And then ergotamine tartrate and dihydroergotamine(DHE) have been developed but because they have high affinities for a wide range of receptors, including dopamine, α- and β-adrenoceptors and serotonin receptors, clinical use of these drugs have been limited due to many side effects. Thus, the need for development of antimigraine drugs with higher specificity for serotonin receptors and with less side effects was recognized in the 1980s. The first specific 5-HT1B/1D agonist, injection form of sumatriptan, became clinically available in early 1990s. Its introduction prompted the search for new medications based on the neuropharmacology of sumatriptan. Very recently many new triptan drugs(zolmitriptan, naratriptan, rizatriptan, etc.) have been developed and seem to offer greater oral efficacy, a better adverse-events profile, a more rapid onset of action, and a better res- ponse consistency within patients from attack to attack, which could reduce migraine-associated symptoms. But their actual clinical data are limited so far, particularly in Koreans. In this review I will discuss the neuropharmacology and available clinical data of the triptans that are currently available or seem to become available in Korea. Korean Journal of Headache 2(1):27-40, 2001

만성 두통의 분류: Transcranial Doppler를 이용한 혈류역학적 접근: Byung-Kun Kim, Hee-Joon Bae, Ja-Seong Koo; Korean J Headache. 2001;2(1):41-47. Published online June 30, 2001

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Abstract PDF: Background
s: The International Headache Society(IHS) headache classification, while widely used throughout the world, has a problem in the definition and classification of the daily and near-daily headache named chronic daily headache(CDH). According to the IHS criteria, a chronic tension-type headache(CTTH) is the only possible diagnosis in patients with CDH. Although several studies have demonstrated that many patients with CDH originally suffered from migraine and their headache has transformed from migraine into a CDH(this type of headache was called transformed migraine: TM), the nosological entity of TM is still disputed. Objective: To demonstrate that TM and CTTH have different pathogenesis, we investigated the cerebral hemodynamics of TM and CTTH by using transcranial Doppler (TCD). Methods: During 6 months, 33 patients with TM and 33 with CTTH, diagnosed according to the second revision of IHS criteria proposed by Silberstein, et al., were gathered. TCD was performed with standard methods to measure the mean flow velocities(MFV) and pulsatile indices(PI) of middle cerebral, anterior cerebral, posterior cerebral, vertebral, distal and proximal basilar, ophthalmic artery, and distal, proximal and siphon portion of internal carotid artery. MFV and PI of TM were compared with those of CTTH by student's t test. Results: MFV of all examined arteries in TM were higher than those in CTTH. The differences in MFV were statistically significant in middle cerebral(p=0.005), anterior cerebral(p=0.05), vertebral(p=0.007), distal internal carotid(p=0.003) and proximal internal carotid artery (p=0.04), respectively. Though there was no statistically significant difference, PI of most arteries were lower in TM than in CTTH. Conclusions: Our results show that the cerebral hemodynamic features of TM are clearly different from those of CTTH. Therefore, we propose that TM should be included as a separate disease entity in the next edition of the IHS classification. Korean Journal of Headache 2(1):41-47, 2001

Chronic Paroxysmal Hemicrania의 임상적 특성: Ji Soo Kim, Chang Ho Yun; Korean J Headache. 2001;2(1):48-50. Published online June 30, 2001

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Abstract PDF: Background
Chronic paroxysmal hemicrania(CPH) is a rare disorder characterized by attacks of severe unilateral headache associated with autonomic phenomena. The absolute response to indomethacin is an important feature of this disease. The clinical characteristics of CPH has rarely been reported. Objective: To characterize clinical features of CPH. Methods: Three patients diagnosed as having CPH from September 2000 to May 2001 have been recruited from the Headache Registry of Cheju Medical Center. The diagnosis was made using the criteria of International Headache Society. Results: Two patients were women and the other was a man. All patients presented with severe excruciating pain in the periorbital or retroauricular area. The attack lasted 20 to 40 minutes. The frequency of attack ranged from 10 to more than 20 per day. Conjunctival injection was the most common autonomic phenomenon. All patients showed a dramatic response to indomethacin 50mg bid. Discussion: In view of severe pain with dramatic response to indomethacin in CPH, diagnotic suspicion and therapeutic trial of indomethacin are warranted in all patients with severe unilateral headache suspected to be CPH. Korean Journal of Headache 2(1):48-50, 2001

급성기 편두통 환자에서 Naratriptan 2.5mg의 이중맹검, 위약대조, 다기관 교차 투여 연구: Yong-Woo Noh, Te Gyu Lee, Kyu-Hyun Park, Seung-Min Kim, Kyung-Cheon Chung; Korean J Headache. 2001;2(1):53-60. Published online June 30, 2001

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Abstract PDF: Background
Naratriptan is one of the new 'triptans' for the acute migraine treatment, but its effect for Asian patients is not known to our awareness. Methods: From December 1999 to November 2000, we studied the efficacy and safety of 2.5mg oral naratriptan with a randomized, placebo-controlled, cross-over, multi-center design in Korea. The study was implemented at the out-patient clinic in three university hospitals. For diagnosis of migraine, we used the Headache Classification proposed by the International Headache Society(1988). We randomly assigned 102 migraineurs, of whom 62 completed the study. The priamay endpoint was significant headache improvement after 4 hours of intervention, either 2.5mg naratriptan or placebo. Results: The rate of significant headache improvement after 4 hours is statistically higer with 2.5mg naratritan administration(56.7%) than with placebo(34.8%) (p=0.01). When 2.5mg oral narastriptan was administered, the clinical disability score was siginificantly improved after 1, 2, and 4 hours. There was no difference in adverse effects between naratriptan and placebo. With the relevant laboratory monitoring, naratriptan 2.5mg was safe at least in single oral dose. The headache recurrence rate after 24 hours, frequency of other medication use during migraine attacks, associate symptoms after 4 hours were better with naratriptan than placebo, but these were not statistically significant(p>0.05). Conclusion: Comparing to previous studies on randomized trials of naratriptan, the rate of signifianct headache improvement(56.7%) was slightly lower in our study. This may partly reflect racial genetic/neuropharmacological difference, such as serotonin receptors, in Asians. We suggest that 2.5mg oral naratriptan is effective and safe for the acute migraine treatment in Asians, as well as Cau- casians. Korean Journal of Headache 2(1):53-60, 2001

다른 임상 증상 없이 두통으로 내원한 발진열 1례: Joong-Seok Kim, Jee-Yeon Lee, Yeong-In Kim, Si-Ryung Han; Korean J Headache. 2001;2(1):61-73. Published online June 30, 2001

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Abstract PDF: Neurologic symptoms associated with murine typhus is relatively rare, almost accompanies with ma- culopapular rash, often fever, chilling and myalgia. We report a case of murine typhus, diagnosed by complement fixation test, exhibited initially only intractable headache without other cardinal features. This case suggest that neurologic manifestations such as isolated intractable headache and encephalopathy in murine typhus should be included in the differential diagnosis in epidemic areas. Korean Journal of Headache 2(1):61-73, 2001

후천성면역결핍증 환자에서 보인 무세포성 크립토콕쿠스 뇌막염 2례: Tae-Ho Guak, Joong-Seok Kim, Sung-Woo Chung, Kwang-Soo Lee; Korean J Headache. 2001;2(1):64-77. Published online June 30, 2001

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Abstract PDF: Cryptococcus meningitis is extraordinarily common in AIDS patients, with reported incidences varying between 1.9% and 11.0%. Cryptococcal meningitis in human immunodeficiency virus(HIV)-infected patients often results in relatively minor cerebrospinal fluid(CSF) changes, though in some cases, CSF profiles may be normal. We report here on the clinical manifestations of cryptococcal meningitis in AIDS patients without pleocytosis. As the number of patients with HIV infection increases in Korea, cryptococcal menin- gitis should be included in the differential diagnosis, if clinically warranted. Korean Journal of Headache 2(1):64-77, 2001

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