Headache and Pain Research

Volume 6(1); June 2005

일반연제-Patent Foramen Ovale in Migraine Patients in Korea:A Transcranial Doppler Study: Ahyun Cho, Sang Beom Jeon , Sun U. Kwon; Published online June 30, 2005

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Abstract PDF: Background
and Objectives: Migraine headaches are common in the general population with signi- ficant morbidity. Migraine, especially with aura is known to increase relative risk of ischemic stroke although the stroke mechanism is unclear. Recent data shows a high prevalence of patent foramen ovale(PFO) in migraine patients and PFO is known to be associated with cryptogenic stroke in young patients. In some studies, migraine headaches were relieved by PFO closure, and randomized controlled trial for that is ongoing. Transcranial Doppler(TCD) study is noninvasive tool and easily available test for detection of right to left shunt. By TCD study, we aimed to investigate the prevalence of PFO in migraine patients and to find the specific subgroup associated with the presence of PFO in Korean. Methods: From February 23, 2005 to April 25, 2005, we prospectively included the patients who had migraine diagnosed by international headache society(IHS) criteria. The clinical features including frequency, and aura were obtained. Headache frequency was divided to low(1 or less per month), moderate(2 to 7), high(8 or more). PFO was assessed with TCD with IV injection of agitated saline. The degree of right to left shunt was divided grade I when the embolic track was 5 or less, grade II when 6 to 15, grade III when above 16. Results: Among 38 patients included, 22(57.9%) patients showed positive results for PFO test by TCD. The most common degree of PFO was grade I(12), followed by Gr II(6), Gr III(4). The prevalence of PFO was not significantly different according to the presence of aura and severity of headache; PFO was positive in the 13/20(65%) of migraine with aura and in the 9/18(50%) of migraine without aura. Frequent headache(>8 per months) was more common in the patients with PFO(38.9%) than in patients without PFO(23.1%). Conclusions: In Korea, more than half of migraine patients were identified to have PFO in TCD study, while the prevalence of PFO in general population has been known as 15～25%. The PFO was more prevalent in patients with higher frequency, although it is not statistically signficant. These findings may suggest that the presence of PFO contributes development and manifestation of migraine.

토피라메이트에 반응을 보인 기저형편두통 1예: Young-Jo Bae, Kyung-Hun Kang, Ho-Won Lee, Doo-Kyo Jung, Chung-Kyu Suh, Sung-Pa Park; Published online June 30, 2005

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Abstract PDF: Basilar-type migraine is a subtype of migraine with aura. Recently, topiramate(TPM) has been demonst- rated to be effective as a monotherapeutic device for migraine prevention. However, there is no report to describe its efficacy on basilar type migraine. A 17-year-old woman admitted to our hospital with basilar type migraine. Her symptoms including aura relieved with TPM of a daily dose of 100mg after four months. There were several adverse events including paresthesia, weight loss or speech problem, even though they were mild and transient. We report a patient with basilar type migraine who responded to TPM. Korean Journal of Headache 6(1):95-98, 2005

대한두통학회 춘계학술대회 2005 일정표: Published online June 30, 2005

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두통을 연구하기 위한 임상 연구의 설계: Sun U. Kwon, Kyun S. Bae; Korean J Headache. 2005;6(1):1-5. Published online June 30, 2005

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Abstract PDF: The clinical research is the only way to give evidences of evidence based medicine which has a major role in the establishing management strategy. Clinical research consists of observational study and clinical trials. Observational studies include cohort study, case-control study, cross sectional study, case series study and others, and they have given numerous valuable informations, such as prevalence, natural history, clinical characteristics, and outcomes of migraine and other headache disorders. In desinging of clinical trials, we should consider not only scientific aspects but also ethical aspects because clinical trials always require dedication of participants. To be scientifically valid and valuable, clinical trials must have social and sicentific needs, methodological validity, and statistical reilability. Considering the requirements, needs and resources, investigators can make a design of clinical trials inclu- ding sample size, blinding methods, how to measure primary and secondary outcomes, statistical methods and others. Well-designed clinical trials only supply credible and useful evidence for evidence based medicine. Korean Journal of Headache 6(1):1-5, 2005

편두통 치료의 병태생리적 접근: Byung Kun Kim; Korean J Headache. 2005;6(1):6-13. Published online June 30, 2005

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Abstract PDF: The pathophysiology of migraine is not fully understood. Neuronal hyperexcitability can explain the interictal status of migraine. Cortical spreading depression appears to underlie the aura phase in patients with migraine aura. The pain of the headache phase is mediated by the trigeminal vascular system and central projection. Preventive medications may target brain excitability, consequently blocking triggers of aura or headache. Acute medications inhibit trigeminal activation from either a peripheral or central location. Triptans ameliorate migraine headache primarily by constricting the dilated cranial blood vessels and by inhibiting the neurogenic inflammation. Recently published clinical study has reported that a selective CGRP receptor antagonist is effective in treating acute migraine attacks without significant side effects. Several new targets will be reviewed in this article. Korean Journal of Headache 6(1):6-13, 2005

트립탄계열 약물을 포함한 급성기 편두통 치료: Heui-Soo Moon; Korean J Headache. 2005;6(1):14-20. Published online June 30, 2005

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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 serotonergic control mechanisms. The migraine specific therapies are representative of new migraine abortive medications, which act as serotonin agonist- triptans and ergots. Treatment choices for acute migraine should be based on headache severity, migraine frequency, associated symptoms, and comorbidities. In this review, I described recent trends in acute migraine therapy with stress on evidence- based guideline for migraine headache in company with some remarks on the various triptans. Korean Journal of Headache 6(1):14-20, 2005

편두통 급성기 치료의 비특이 약물들: Jae-Myun Chung; Korean J Headache. 2005;6(1):21-25. Published online June 30, 2005

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Abstract PDF: Migraine as a chronic, intermittent disabling condition affects physical, mental, and social quality of life. Among various medications being used in acute treatment of migraine, analgesics, nonsteroidal antiinflam- matory drugs(NSAIDs), antiemetics, and opioids constitute nonspecific treatment. Analgesics and NSAIDs are the mainstay of the self-administered treatment options in many migraineurs, and thus have a huge influence on their migraine status, even make them suffer from medication-overuse headache. Antiemetics, especially metoclopramide exert ancillary effect for rapid absorption of other anti-migraine drugs as well as anti-migraine effect by itself. Opioids can be used as a rescue medicine only in special circumstances because of its addictive feature. These nonspecific acute anti-migraine medications should be used accor- ding to practice guideline so that could enhance patients' quality of life. Korean Journal of Headache 6(1):21-25, 2005

편두통 급성기 치료의 실패: 원인과 대책: Jeong Wook Park; Korean J Headache. 2005;6(1):26-33. Published online June 30, 2005

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Abstract PDF: Acute management of migraine attacks is often difficult and many patients show to be refractory to treatment. As therapeutic option multiply, it is increasingly important to understand patients's attitudes and preferences regarding various treatment characteristics. A survey of populaton based sample of mig- raineurs indicated that majority of patients consider complete relief of headache, no recurrence, and rapid onset of action as important attributes of acute migraine therapy. In this paper, we also summarize and categorize the common reasons for treatment failure in acute management. That is, the diagnosis is in- complete or incorrect; important exacerbating factors have been missed; pharmacotherapy has been inade- quate; other factors, including unrealistic expectations and comorbidity. Finally we describe the strategy for swithching the way to care when primary pharmacotherapy was inadequate and suggest drugs that could be used for case of refractory to triptans. Korean Journal of Headache 6(1):26-33, 2005

두통 치료에 있어 항우울제와 항정신병 약제의 역할: Kun-Woo Park; Korean J Headache. 2005;6(1):34-39. Published online June 30, 2005

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Abstract PDF: Antidepressants are included in the major medication group for preventive and adjunct headache treat- ment. Although they have several side effects and are to be caution in older patients, some of them have well-documented efficacy. Amitriptyline has demonstrated a consistent efficacy in prophylactic therapy of migraine and chronic tension type headache. There is fair support for the effectiveness of serotonine reup- take inhibitors in migraine prevention. Neuroleptis and antiemetics have long been used for acute headache treatment. However, they have not been widely used because of general unfamiliarity with them and concern for adverse effects. Neuroleptics are appropriate as second line agents in outpatient clinic such as triptans have failed, and as first line agents in emergency room. Korean Journal of Headache 6(1):34-39, 2005

항고혈압제를 이용한 편두통의 예방 치료: Ki Hyun Cho; Korean J Headache. 2005;6(1):40-46. Published online June 30, 2005

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Abstract PDF: In spite of great effort to make sure the pathogenesis of migraine, it is still remains an enigma, which is reflected by the several number of drugs are used or have been used to treat or prevent migraine attacks. The most important progress in the treatment of migraine in the last decade is the introduction of triptans to abort the acute attack of migraine. However, only about 50% to 60% of patients consis- tently respond to this type of medication. Therefore prophylactic treatments are needed in the patients with inadequate effect of acute treatment and if patients experience 2 or more migraine attacks per month. The prophylactic agents available today have been introduced serendipitously at the beginning and antihypertensive agents are among them. This review focuses on the antihypertensive agents including receptor blocker, calcium channel blocker, angiotensin converting enzyme inhibitor and angiotensin II receptor blocker for the prevention of migraine. Korean Journal of Headache 6(1):40-46, 2005

항경련제의 편두통 예방 요법: Ki-Young Jung; Korean J Headache. 2005;6(1):47-53. Published online June 30, 2005

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Abstract PDF: Migraine and epilepsy are comorbid episodic central nervous system disorders that can have stereoty- ped symptoms with negative and positive phenomena. Controlled trials have demonstrated that anticon- vulsants appear to be both effective in reducing migraine frequency and reasonably well tolerated. There is noticeable variation among individual agents, but there are insufficient data to know whether this is due to chance or variation in true efficacy. Relatively few robust trials are available for agents other than sodium valproate/divalproex sodium. Three recently published and large trials of topiramate demonstrated reasonable efficacy. Anticonvulsants are a useful option for the preventive treatment of migraine. Korean Journal of Headache 6(1):47-53, 2005

두통질환에서 보툴리눔 독소의 활용: Man-Wook Seo; Korean J Headache. 2005;6(1):54-69. Published online June 30, 2005

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Abstract PDF: Botulinum toxin, the most potent biological toxin known to man, was first isolated in 1897. For 2 deca- des, botulinum toxin A has been used for treating various disorders associated with muscular hypertrophy. Current research efforts focus on new areas of application for botulinum toxin A in specific pain therapy, particularly in headache. Clinical data and experience to date have demonstrated that BTX-A is an effec- tive and well-tolerated therapy for various headache disorders. Its long-term action lasting several months obviates the need to remember to take medication several times a day. Although inhibition of neuromus- cular activity may alleviate a portion of the pain associated with headache disorders, it does not fully explain the pain-relief mechanisms mediated by BTX-A. A reduction in afferent sensory activity coming from pericranial and cervical muscles, and inhibition of peripheral and central trigeminal sensitization, may be the potential mechanisms by which BTX-A exerts its therapeutic effect in various headache disor- ders. Further investigations will define the accurate pathophysiologic mechanisms of BTX-A in the head- ache management. Korean Journal of Headache 6(1):54-69, 2005

왜 어떤 편두통 환자는 예방 약물에 반응하지 않을까?: Soo-Jin Cho; Korean J Headache. 2005;6(1):70-73. Published online June 30, 2005

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Abstract PDF: 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

간호사들의 월경관련 편두통 - 한림대학교 간호사 편두통 연구 -: Min-Kyung Chu, Kyung-Ho Yu, Hyeo-Il Ma, Yoon Kim, Joo-Yong Kim, Su-Jin Cho, Cheol-Ho Kim, Byung-Chul Lee; Korean J Headache. 2005;6(1):74-81. Published online June 30, 2005

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Abstract PDF: Background
& Objectives: It is known that migraines in women are associated with menstruation. We analyzed the data of Hallym university migraine in nurses study to identify the prevalence and clinical features of menstruation related migraine in Korean nurses. Method: All 1501 nurses working at Hallym Medical Center were asked 72-item questionnaire on mig- raine including general information, occupational environments and characteristics, characteristics of headache, triggering factors, management of headache and migraine related disabilities. We categorized participants as having menstrually associated migrtaine(MAM) who answered that migraine attacks were associated to menstruation. Results: 89.2% of participants completed the questionnaire. All were female with mean age of 27.5±5.7, 276(17.5%) were classified as having migraine. 59(25.0%) of migraineurs had MAM. 36(61.0%) had migraine attacks in premenstrual period, 13(22.0%) in menstruation period, 1(1.7%) in postmenstrual period. 9(15.3%) of migraineurs reported varying relationship between migraine attacks and menstruation. Headache aggravation by routine physical activity was more common in MAM than non-MAM. There were no signi- ficant difference in attack frequency, headache severity and MIDAS scores between MAM and non-MAM. Conclusion: 25.0% of nurses with migraine had MAM. Migraine attacks occurring in premenstrual period was the most common form of MAM. MAM showed some different clinical features from those of non-MAM. Korean Journal of Headache 6(1):74-81, 2005

경두개 초음파를 이용한 편두통 환자에서의 뇌혈관 반응성 연구: Ki Sung Kim, Yong Soo Shim, Dong Won Yang, Beum Saeng Kim, Young Min Shon; Korean J Headache. 2005;6(1):82-88. Published online June 30, 2005

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Abstract PDF: Background
Transcranial Doppler(TCD), a safe non-invasive method, can evaluate cerebrovascular reac- tivity. Although the vascular theory has many controversies, the patients with migraine show the changes of cerebral blood flow, which seems to contribute the pathophysiology and development of the migraine. In this study, we investigated cerebraovascular reactivity to hypoventilation in migraineurs, and compared their findings with those of normal controls. Methods: According to International Headache Society criteria and a headache paperweight, a total of 46 subjects, including 23 migraineurs and 23 controls were studied. The doppler signals from the middle cerebral artery(MCA) and posterior cerebral artery(PCA) at a depth of 6.0cm and 7.2cm were selected for the evaluation. After the resting baseline mean flow velocities(mFVs) were obtained, all subjects were instructed to hyperventilate for at least 2 minutes, to obtain the mFV in hyperventilation. Then, the subjects were allowed to breathe normally, and returning to the baseline mFV was confirmed. After mean flow velocities(mFVs) as a baseline were obtained, all subjects were instructed to hold breath al least for 30 seconds, and 3rd mFVs were recorded. Results: The significant differences in cerebrovascular reactivity of MCA between normal controls and migraineurs were observed during hypoventilation(40.64±13.20cm/sec vs. 56.58±11.50cm/sec, p<0.01 on Mann-Whitney test). The differences of cerebrovascular reactivity of PCA between normal controls and migraine groups were not significant. Conclusion: The cerebrovascular reactivity(CVR) of MCA in migraineurs was more increased than that in normal controls. Our studies suggest that vasoreactivity to hypoventilation measured by TCD can be an aid for the understanding of the pathophysiology of the migraine and the differentiation from normal subjects. Korean Journal of Headache 6(1):82-88, 2005

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