Headache and Pain Research

Volume 5(1); June 2004

대한두통학회 춘계학술대회 2004 일정표: Published online June 30, 2004

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Headache Care in Japan Based on New International Headache Classification: Fumihiko Sakai; Korean J Headache. 2004;5(1):1-1. Published online June 30, 2004

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Abstract PDF: International Headache Classification is now revised based on the evidence accumulated in the last 15 years since the first edition of the classification. Owing to the standardized diagnostic criteria and the introduction of triptans, headache care improved significantly. However, there are many aspects of head- ache care which we are trying to improve in Japan The overall prevalence of migraine in Japan is 8.4%(8 million sufferers). Doctor attendance rate is very low and 69.4% with migraine had never consulted a physician for headache. Only 2.7% is visiting physicians regularly. Yet, 74.2% complained that migraine headache impaired their daily activity signi- ficantly. The loss of disability adjusted life years due to migraine was calculated to be 2.1 years. A large number of migraine sufferers still work during headache attacks of considerable severity, which makes the evaluation by MIDAS scores difficult. The average time required for patients to reach a proper medi- cal care is estimated to be 11 years after the onset and 4 years after the initial visit to a physician for headache. Patients with migraine often do not know if they should consult physician or which phy- sicians to visit This communication is presenting our preliminary data on the effort to establish a clinical path for the patient to reach an appropriate medical care, and to propose an efficient and evidence-based medical procedure. Headache diary was designed to serve as a tool for the patient to give as much information on headache as possible. It should also serve as a prospective history taking to reevaluate headache. The increase in doctor-patient communication should create a mutual participation model. Several experi- mental trials to establish headache center associated with GP-network appear very successful for provi- ding migraine medicine. Korean Journal of Headache 5(1):1-1, 2004

편두통과 간질, 항경련제: Kim Jae-Moon; Korean J Headache. 2004;5(1):2-9. Published online June 30, 2004

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Abstract PDF: Migraine and epilepsy are both chronic diseases characterized by recurrent, paroxysmal neurologic attacks with additional symptoms of headache and gastrointestinal, autonomic, and psychological features. Migraine and epilepsy are clinically linked by their symptoms, comorbidity, and treatment. In some inhe- rited syndromes such as MELAS or BEOP(benign epilepsy with occipital paroxysm), both disorders are closely related. In addition, a number of migraine syndrome can be confused with epilepsy. Before the diagnosis and treatment of each disorder, consideration of the potential presence of the other is crucial. In clinical practice, some of antiepileptic drugs are effective in the treatment of both disorders and is sugges- ting the common pathophysiology of both disorders. Korean Journal of Headache 5(1):2-9, 2004

편두통; 정신과적 문제와 바이오피드백 치료: Joo-Eon Park, Bum-Hee Yu; Korean J Headache. 2004;5(1):10-22. Published online June 30, 2004

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Abstract PDF: Migraine headache is a common disorder, which is associated with numerous psychiatric conditions, especially mood and anxiety disorders. Behavioral therapy including biofeedback has been proved to be effective in the treatment of migraine. The efficacy of behavioral therapy may be comparable to that of conventional prophylactic pharmacotherapy and is maintained for a long-time time. In chronic and refrac- tory migraine patients, multidisciplinary approaches including pharmacotherapy, behavioral intervention including biofeedback, and cognitive-behavioral therapy are more effective than any single therapeutic approach. Korean Journal of Headache 5(1):10-22, 2004

소아 편두통 증후군: Kyungmi Oh; Korean J Headache. 2004;5(1):23-32. Published online June 30, 2004

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Abstract PDF: Recurrent primary headache is the most frequent neurological symptom at school age and the most frequent manifestation of pain in childhood. Migraine is one of the most common causes of headache resulting in missed school days and interfering with other daily activities. Prevalence of migraine is 3～10% in children. Clinical features and diagnostic criteria of childhood migraine differ from those in adult. The children and adolescents have attacks of shorter duration and bilateral location. This review intended to give an outline of general characteristics of childhood migraine. 'Childhood episodic synd- rome that are commonly precursors of migraine' according to International Classification of Headache Disorders, 2nd Edition(ICHD-II) includes cyclic vomiting, abdominal migraine, and benign paroxysmal vertigo of childhood. The clinical features and diagnostic criteria were described respectively. Other unclassi- fied episodic syndromes were introduced also. Korean Journal of Headache 5(1):23-32, 2004

편두통과 연관된 어지럼: Byung-Kun Kim; Korean J Headache. 2004;5(1):33-42. Published online June 30, 2004

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Abstract PDF: Over the last two decades a number of studies have stressed the association of migraine with vestibular and ocular motor disorders. Migraine may be a most common cause of various forms of episodic vertigo. The interrelations of migraine and dizziness can be classified into seven categories: ① vertigo as an aura of migraine-basilar type migraine, ② episodic vertigo attack without typical temporal relationship to migraine headache-migraine equivalent, ③ Vertigo/dizziness during migraine attack, ④ susceptibility of motion sickness in migraine patients, ⑤ CACNA1A gene mutation and migraine-familial hemiplegic migraine, episodic ataxia type 2, ⑥ well defined vertigo syndromes that are not caused by migraine but show a statistical association with migraine-Meniere's disease, BPPV, ⑦ non-vestibular dizziness in mi- graine patients-psychiatric comorbidity, antimigraine medication. Each part of categories will be discussed. Korean Journal of Headache 5(1):33-42, 2004

근막동통 증후군과 연관된 편두통: Gun-Sei Oh, Hwa-Young Lee; Korean J Headache. 2004;5(1):43-64. Published online June 30, 2004

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Abstract PDF: Pain and tenderness are characteristically referred from myofascial trigger points(MTrPs) located in muscle remote from the site of the pain. Pain from myofascial trigger points can be identified by careful history taking and skillful physical examination, and it is 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. Perpetuating factors can increase irritability of muscles, leading to the propagation of trigger points and increasing the distribution and severity of pain. Because myofascial trigger points appear to play an important role in migraine and tension-type head- aches, all headache patients should be evaluated for their presence. If found, the treatment regimen should include myofascial trigger point pain reduction techniques or a myofascial trigger point pain management program. One current source of confusion is use of the term myofascial pain syndrome(MPS) for two different concepts. Sometimes, MPS is used in a general sense that applies to a regional muscle pain syndrome of any soft tissue origin. Historically, the term MPS has been used in the restricted sense of that syndrome which is caused by TrPs within a muscle belly(not scar, ligamentous, or periosteal TrPs). Korean Journal of Headache 5(1):43-64, 2004

편두통과 성호르몬: Jeong Wook Park, Kwang Soo Lee; Korean J Headache. 2004;5(1):65-74. Published online June 30, 2004

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Abstract PDF: The usual woman life cycle is associated with carefully orchestrated hormonal milestones: Menarche, pregnancy, oral contraceptive use, menopause, and the use of replacement sex hormone. All these events alter the sex hormones and may cause a change in the migraine. There is a variety of evidence on the relationship between migraine and sex hormones. Before menarche, there seems to be no differences in the prevalence of migraine between girls and boys. But after puberty, women with migraine begin to outnumber men by at least 3～5 times and definite changes of patterns of attacks are noted at menstrual period, related pregnancy, at menopause. The hormone treatment can change the migraine attack. This paper also suggests the approaches to the management of hormone related migraine associated with oral contraceptives and hormone replacement therapy. Korean Journal of Headache 5(1):65-74, 2004

편두통과 뇌혈관질환: Chin-Sang Chung; Korean J Headache. 2004;5(1):75-82. Published online June 30, 2004

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Abstract PDF: Migraine can be defined as a neurovascular pain disorder and is occasionally associated with various cerebrovascular events as a cause of stroke or as a result of stroke-so-called 'migraine-stroke connec- tion'. This may be categorized as ① migrainous infarction as defined in the IHS classification, ② migraine as a risk factor for cerebral infarction, ③ cerebral infarction associated with comorbid conditions of migraine, ④ cerebral infarction of other cause presenting with symptoms resembling migraine with aura, ⑤ drug-induced migraine-related stroke, and ⑥ hereditary conditions that cause migraine and stroke. Korean Journal of Headache 5(1):75-82, 2004

주야 교대 근무가 편두통에 미치는 영향 - 한림대학교 의료원 간호사 연구 -: Min-Kyung Chu, Kyung-Ho Yu, Hyeo-Il Ma, Yoon-Jung Kim, Joo-Yong Kim, Hong- Ki Song, Byung-Chul Lee; Korean J Headache. 2004;5(1):83-89. Published online June 30, 2004

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Abstract PDF: Background
It is well known that migraine is related to sleep. Shift working was also reported as a triggering factor of migraine. The impact of shift working on migraine prevalence, frequency, and migraine related quality of life were not studied yet. The purposes of our study is to elucidate the relationship between shift working with migraine prevalence, attack frequency and migraine related quality of life. Method: All 401 nurses working at Hallym University Sacred Heart hospital were asked a 72-item questionnaire concerning migraine prevalence, attack frequency, migraine disability assessment(MIDAS), and Epworth sleepiness scale(ESS). The returned questionnaire was analyzed on the basis of the existence of shift working(SW). Result: Three hundreds seventy two nurses completed and returned the questionnaire for a response rate of 93.0%. According to International Headache Society criteria, 18.8% of the responding nurses were classified as having migraine. 285 of them were SW nurses. 58 of the SW nurses have migraine. 65.6% of the SW nurses with migraine answered that migraine was related to SW and night working was the most common working time related to migraine. Migraine prevalence, attack frequency, and MIDAS scores were not significantly different between SW and non-shift working(NoSW) nurses. ESS score was significantly higher in SW nurses than NoSW nurses. In NoSW nurses, sleepiness was related to migraine prevalence. However, sleepiness was not related to migraine prevalence in SW nurses. Conclusion: Even though many nurses believed that SW was a triggering factor for migraine attack, there were no significant differences in migraine prevalence, attack frequency, and migraine related quality of life between SW and NoSW nurses. Sleepiness was related to migraine prevalence in NoSW nurses. Revealing the relationship between migraine and SW would help for both unveiling the nature of disease and the effective management of migraine. Korean Journal of Headache 5(1):83-89, 2004

암성 뇌막염 환자의 뇌척수액에서 사이토카인의 변화: Min Jeong Kim, Sun Gun Lee, Ji Hyun Lee, Bong Goo Yoo, Kwang Soo Kim, Kyung Moo Yoo; Korean J Headache. 2004;5(1):90-97. Published online June 30, 2004

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Abstract PDF: Background
and Objective: Carcinomatous meningitis(CM) is an uncommon metastatic disease of the CNS, occuring in 1 to 5% of patients with solid cancer. It is important to make the accurate diagnosis of CM because the institution of appropriate therapy may produce symptomatic improvement, prevent neurologic deterioration and prolong survival. The purpose of this study is to suggest the effective diag- nostic method through analyzing interleukin(IL)-1β, IL-6, IL-8, IL-10, tumor necrosis factor(TNF)-α and monocyte chemoattractant protein(MCP)-1 by the cerebrospinal fluid(CSF) of CM, and to evaluate the correlation between cytokines with other chemical and tumor marker. Methods: 12 samples were evaluated by twelve patients with CM, who had diagnosed by CSF cytology or elevated tumor marker. The cytokines were measured by sandwich ELISA(enzyme linked immunosor- bent assay) method and compared the diagnostic value of each cytokines with that of other biochemical markers of CM. Results: The mean CSF concentrations of IL-8 and MCP-1 from CM were significantly higher than in the normal control group(p<0.005). IL-6 concentrations in CSF samples from patients with CM were higher than those in normal control, but not significantly different in CM group. IL-1β was positive in 2 cases and TNF-α was positive in only 1 case. IL-10 was negative in all cases. Carcinoembryonic antigen (CEA) is elevated in 9 CSF samples of CM. There was no significant relationship between cytokine levels and other diagnostic marker. Conclusion: CSF IL-6, IL-8, MCP-1 and CEA are a valuable tool in the investigation of CM, hence a rapid assay for cytokines and tumor marker in CSF may contribute to the early diagnosis of CM. Korean Journal of Headache 5(1):90-97, 2004

안와 농양을 동반한 톨로사헌트증후군: Sung-Je Kim, Ji-Eun Kim; Korean J Headache. 2004;5(1):98-101. Published online June 30, 2004

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Abstract PDF: The Tolosa-Hunt syndrome(THS) is a syndrome of painful ophthalmoplegia which is caused by a lesion in the cavernous sinus. A 41-year-old man presented a diplopia and left retroorbital pain. Neurologic examination showed a left 6th cranial nerve palsy. The 6th cranial nerve palsy was improved after steroid pulse therapy. About two months later, left 3rd, 4th, and 6th cranial nerve palsies were developed. Brain MRI showed a soft tissue change in the region of the left cavernous sinus and superior orbital fissure. The abnormality was seen as an isosignal intensity on T1 weighted image and high signal intensity on T2 weighted image. There was mild enhancement of the abnormal area after intravenous gadolinium injection. Cranial nerve palsies and retroorbital pain were improved by steroid pulse therapy again. After about 3 months later from the first symptom onset, a retroorbital pain without cranial nerve palsy was developed. The pain was relieved after steroid therapy. During the low dose steroid maintenance therapy after the second recurrence, left periorbital abscess was developed. With antibiotics therapy, the retroor- bital pain and swelling were improved, but the visual acuity was diminished to blindness on the affected side. The lesion of the cavernous sinus was slightly enlarged to ipsilateral orbital apex on the follow up MRI. We report a case of relapsing THS accompanied by orbital abscess. Korean Journal of Headache 5(1):98-101, 2004

Upregulation of Tumor Necrosis Factor-alpha and Matrix Metalloproteinase-9 in Nitric Oxide-induced Animal Model of Migraine: Gyeong-Moon Kim, Kyung-Sil Jin, Ki-Jung Choi, Chin-Sang Chung; Korean J Headache. 2004;5(1):103-103. Published online June 30, 2004

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Abstract PDF: Objectives
We sought to evaluate the expression of two key inflammatory mediators, tumor necrosis factor-alpha(TNF-α) and matrix metalloproteinase-9(MMP-9) in a nitric oxide(NO) mediated animal model of migraine and investigated the effect of glucocorticoid on MMP-9 activation. Background: Migraine is thought to result from neuronal nociceptive activity in the trigeminovascular system, which results in meningeal inflammatory reaction. Despite considerable research into the patho- genesis of migraine, signaling pathways mediating neurogenic inflammation are poorly understood. TNF-α and MMP-9, which are regulated by transcription factor nuclear factor-kB(NF-kB), have been known to play important roles in many physiologic processes of immune and inflammatory responses. Method: TNF-α and MMP-9 expression were investigated in the meningeal blood vessels following continuous intravenous infusion of NO donor, glyceryl trinitrate(GTN, 10mg/kg/min), for 30 minutes in rats. Time course of TNF-α expression was evaluated by Western blot at 1, 3, 6, and 18 hours and the activity of MMP-9 was analysed by enzyme zymography. Expression of TNF-α and MMP-9 in the meningeal blood vessels was investigated using double immunofluorescence staining with endothelial cell marker vWF. To evaluate the effect of glucocorticoid on the inhibition of MMP-9 activation, methylpred- nisolone(MP, 30mg/kg) was administerd after GTN infusion. Furthermore, to understand whether the transcriptional modulation of MMP-9 activation, glucocorticoid receptor(GR) antagonist(RU486, 15mg/ kg) was pretreated before GTN infusion. Results: By Western blot analysis, TNF-α expression was increased at 3-6 hr after GTN infusion. MMP-9 activity was upregulated at 3 hr and reached the peak at 6 hr. Furthermore, TNF-α and MMP-9 immunoreactivity was extensively detected in the meningeal blood vessels in GTN-infused group as com- pared to controls. MP treatment inhibited MMP-9 activation and pretreatment with RU486 successfully reversed this MP effect. Conclusion: These results indicate TNF-α and MMP-9 are involved in NO-mediated inflammation in meningeal blood vessels. In addition, MMP-9 activation was affected by modulation of GR. Inhibition and blockade of proimflammatory transcription factors or their downstream effectors might have therapeutic implications for preventing migraneous headache. Korean Journal of Headache 5(1):103-103, 2004

Genetically Determined Serotonergic Tone Contribute to Development of Analgesics Overuse in Chronic Tension-Type Headache: Jeong Wook Park, Joong Seok Kim, Yeong In Kim, Kwang Soo Lee; Korean J Headache. 2004;5(1):104-104. Published online June 30, 2004

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Abstract PDF: Background
Approximately one half of all patients with chronic daily headache report an associated regular use of analgesics, making the issue of an important public health matter. But the analysis of factors related to the development to analgesics overuse in chronic tension-type headache remain poorly unders- tood. We tried to establish the role played by chronic analgesics exposure in the natural course and clinical phenotype of headache in patients of chronic tension-type headache. And we also evaluated genetically determined innate factor that could exert a profound influence in development of analgesics overuse using serotonin transporter protein polymorphism and serotonergically related harm avoidance(HA) personality dimension. Methods: We surveyed headache characteristics via a standardized questionnaire in 38 patients with chronic tension-type headache with analgesics overuse(CTTH-AO) and in 40 patients with chronic tension- type headache with analgesics non-overuse(CTTH-NO), and in 100 healthy controls. We amplified sero- tonin transporter protein gene linked polymorphic region(5-HTTLPR) by means of polymerase chain reaction and performed genotype polymorphism analyses and investigated the serotonin related personality trait by evaluating the HA dimension in tridimensional personality questionare(TPQ). Results: We found significantly higher pain intensity and disability score in patients with CTTH-AO. Most of patients with CTTH-AO used caffeine contained compound analgesics as for instant pain relief drugs. There was excess frequency of the short allele and a different genotype distribution in patients with CTTH-AO. S/S genotype frequency was higher in patients with CTTH-AO(83%) than in those with CTTH-NO(74%) and controls(59%; P = 0.02). TPQ questionnaires showed significantly higher HA scores in both CTTH-AO(22.35.4) and CTTH-NO(19.96.7) compared with controls(16.36.1). In those of chronic tension-type headache, individuals with S/S allele have significantly higher frequency of analgesics usage (13.3/month) than with S/L, L/L allele(7.0/month). Conclusions: This suggests a serotonergic activity might be involved in development of analgesics over- use in chronic tension-type headache, and 5-HTTLPR might be one of the genetically contributing factors. Korean Journal of Headache 5(1):104-104, 2004

Single Nucleotide Polymorphisms of the TNF Region in Migraine: Sue-Yon Jang, Chin-Sang Chung, Jong-Won Kim; Korean J Headache. 2004;5(1):105-105. Published online June 30, 2004

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Abstract PDF: Background
and Objectives: Migraine is a benign and recurring syndrome of headache, nausea, vomi- ting, or other symptoms of neurologic dysfunction in varying admixtures; also migraine is as common neurological disorder as prevalence of patients is 9.7% of the female and 3.2% of the male in Korean population. However, the pathogenesis of migraine is still largely unknown. Migraine has a strong(up to 50%) genetic component, which is higher in migraine with aura: MA than migraine without aura: MO, with a probable multifactorial polygenic inheritance. Tumor necrosis factors(TNF: TNFA and TNFB) are major pro-inflammatory cytokines that are thought to be significant in the pathogenesis of migraine. Thus, we scrutinized an association of TNFA and TNFB gene with the risk of migraine. TNF-308 and LTA+252 polymorphisms have been previously reported to be associated with migraine patients without aura in Caucasian population. Such findings are not extensively studied in Asian population including Koreans. Method: We investigated the genetic association study of polymorphisms in the diverse SNPs of tumor necrosis factor(TNF) as well as the promoter region of the TNFA gene and the first intron region of the TNFB gene. 410 female patients with migraine and 383 healthy controls were genotyped with massarray, snapshot and direct sequencing. Results: Significant difference of allele frequency was observed between SNP that located in the pro- moter region of LTA gene and MA patients, but allele frequency of MO patients was significantly diffe- rent from those of the control. Conclusions: These findings suggest that the LTA gene influence susceptibility of migraine with aura, but TNFA gene doesn't influence two most clinical subtype of migraine. Korean Journal of Headache 5(1):105-105, 2004

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