Headache and Pain Research

Volume 7(1); June 2006

진행성 뇌질환으로서의 편두통: Heui-Soo Moon; Korean J Headache. 2006;7(1):1-3. Published online June 30, 2006

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Abstract PDF: Migraine is a primary neurovascular headache w hich affects approximately 12% of the adult population. It is also known migraine is a risk factor for ischemic stroke in young w omen w ith m igraine w ith aura. Recently, it was reported that some individuals that experience m igraine w ith and w ithout aura m ay be at an increased risk for subclinical lesions in certain areas of the brain. A subgroup of person with episodic m igraine m ay progress to chronic daily headache. These data have im plications for current concepts of m igraine as a progressive brain disease. So, the goals of treatm ent may also shift to preventing the accumulation of brain lesion and disease progression. Korean Journal of Headache 7(1):1-3, 2006

두통의 만성화 기전과 위험인자: Kyungmi Oh; Korean J Headache. 2006;7(1):4-11. Published online June 30, 2006

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Abstract PDF: Chronic headache imposes considerable burdens on the sufferer and on society as w ell. Recent evidence suggests that migraine is a chronic and sometimes clinically progressive disorder characterized by recurrent episodes of headache. Indentifying risk factors for headache chronification and understanding of its mechanism help to establish intervention strategies on disease progression. In this article, I review the epidem iology of chronic daily headache, the em erging concepts of m igraine as a progressive disorder based on clinical evidences, the known risk factors for headache pro-gression, the reported m echanisms of m igraine chronification, and the treatm ent strategies that could reduce the burden of m igraine and possibly prevent disease progression. Korean Journal of Headache 7(1):4-11, 2006

편두통과 어지럼: Byung-Kun Kim; Korean J Headache. 2006;7(1):12-22. Published online June 30, 2006

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Abstract PDF: Patients w ith m igraine frequently have hypersensitivity to light, sound, and smell. In addition to these hallmark features of m igraine, patients often describe vestibular complaints ranging from frank vertigo to less specific symptoms of dizziness, unsteadiness, and head m otion intolerance. O ver the last two decades a number of studies have stressed the association of m igraine with vestibular and ocular m otor disorders. M igraine m ay be a m ost common cause of various forms of episodic vertigo, but definite diagnostic criteria for m igraine related vertigo are still lacking. A review of the literature on this chapter demonstrates the difficulties in pinpointing migraine-related vertigo as a clearly defined entity. The interrelations of migraine and dizziness can be classified into seven categories: ① vertigo as an aura of m igraine-basilar type m igraine, ② episodic vertigo attack w ithout typical temporal relationship to migraine headache - m igraine equivalent, ③ Vertigo/dizziness during m igraine attack, ④ susceptibility of motion sickness in m igraine patients, ⑤ CACNA1A gene m utation 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 w ith m igraine-Meniere disease, BPPV, ⑦ non-vestibular dizziness in m igraine patients-psychiatric comorbidity, antim igraine m edication. Each part of categories will be discussed. Korean Journal of Headache 7(1):12-22, 2006

수면과 두통: Ki-Young Jung; Korean J Headache. 2006;7(1):23-26. Published online June 30, 2006

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Abstract PDF: Headache and sleeping problems are both some of the m ost commonly reported problems in clinical practice, and cause considerable social and family problems, as well as socio-economic impact and costs. The mechanisms of relationship between sleep and headache are complex, multifactorial and poorly understood. Identifying and classifying the specific headache disorder in patients with both headache and sleep disturbances can facilitate an appropriate diagnostic evaluation. Korean Journal of Headache 7(1):23-26, 2006

난원공 개존과 편두통: Sun Uk Kwon; Korean J Headache. 2006;7(1):27-30. Published online June 30, 2006

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Abstract PDF: Previous clinical studies have suggested an increased prevalence of cerebral infarction and subclinical brain lesions in migraineurs, although the m echanisms are not clear. Recent clinical studies showed that patent foramen ovale (PFO), which is one of important causes of ischemic stroke in young people, is m ore common in m igraine w ith aura, and migraine w ith aura is m ore prevalent in patients w ith PFO. Retrospective analyses of PFO closure for stroke prevention and decompressive illness in divers have suggested that m igraineurs w ith and w ithout aura may disappear or im prove after PFO closure. A recent prospective random ized sham-controlled study show ed some benefits of PFO closure in migraine prevention, which suggested the causative roles of PFO in development of migraine attacks. H owever, considering the periprocedural complication risk of PFO closure, further confirmative prospective clinical trials to evaluate the efficacy and safety of percutaneous device closure of PFO for migraine prevention is essential before application in the clinical practice. Korean Journal of Headache 7(1):27-30, 2006

만성 긴장형두통 환자들에서 두통으로 인한 활동 무능에 기여하는 인자들에 관한 연구: Jeong Wook Park, Kwang Soo Lee; Korean J Headache. 2006;7(1):31-36. Published online June 30, 2006

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Abstract PDF: Objective: To evaluate the impact of headache variables, such as frequency, intensity, duration of attack episode and demographics on functional disability in chronic tension-type headache patients. Background: Chronic tension-type headache does not reduce life expectancy, but it can have considerable impact on functional disability and socioeconomic status. R eduction of headache related disability is one of the m ain treatm ent goals in the m anagement of headaches. Therefore, it is essential to understand w hich headache characteristics contribute to headache related disability.
Methods
D ata from patients w ith chronic tension-type headache (n = 109) were used to evaluate the relationship between headache variables (frequency, pain intensity, duration of attack), headache related demographics (age, duration of headache illness, analgesics consumption) and headache related functional disability. The patients w ere divided into different groups based on each variable. Headache related functional disability was assessed as scores on the activity interference scale of three aspects of daily living and m issing days due to headache.
Results
In this study, higher average pain intensity w as significantly associated w ith m ore severe headache related disability. A lthough there was a tendency for patients w ith the higher frequency, longer duration attack of headache to show severe disability, these w ere not statistically significant. M ultiple regression analysis revealed that average pain intensity is only significant predictor of headache related disability.
Conclusions
For chronic tension-type headache, headache intensity appears to be a major determinant of headache related disability, while headache frequency w as not clearly related to disability. A ccording to our findings, effective symptomatic medication that can stop headache before it reaches high intensity would have great potential to reduce headache related disability and headache attacks w ith severe intensity should not be underestimated even if they are infrequent. Korean Journal of Headache 7(1):31-30, 2006

재진방문을 하지 않은 두통 환자의 원인 및 경과에 대한 후향적 분석: Hyun-Jung Park, Ji-young Shim, Sun-hee Whang, Suk-Hee Kim, Jong-Ha Park, Soon-Tae Lee, Kon Chu, Man-ho Kim; Korean J Headache. 2006;7(1):37-40. Published online June 30, 2006

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Abstract PDF: Background
The lost to follow-up is frequent among the patients w ith headache, but the extent or the reasons is unknown. To determine the frequency and the reason for the loss to follow-up, and to further evaluate the clinical course of headache w ithout m edication. Objects and M ethod s: Consecutive patients w ith headache visited the headache clinic in SNU H ospital w ere retros-pectively analyzed. Lost to the follow-up (LF) is determined w ho didn't m ake a re-visit following the prescription. Demographic characteristics, headache subtypes, and the reasons for the w ithdraw al w ere recorded by m edical record or telephone survey.
Results
1,090 patients w ith LF w ere evaluated (61.4% ). Sex ratio w as not different between LF group and follow-up group (men 24.0% , women 76.0% for LF). A ge distribution shows two folds higher in 20s and 30s when compared to follow-up group (5.6% 20s, 12.1% 30s for LF; 3.1% 20s, 6.4% 30s for follow-up). M igraine w as 17.6 times higher than the patients w ith tension type headache. The reasons for the LF were, ① improvem ent 35.8%, ② adverse event 12.0%, ③ no improvem ent 17.7% , ④ visit another hospital 5.0% , ⑤ etc 1.3% . Further analysis with the patients w ithout medications showed that ① headache aggravated 6.4% , ② stationary 45.4%, ③ improvement 23.3%, ④ unknown 24.9%.
Conclusions
Improvement is the m ost common reason for the LF. The outcom e w ithout m edication w as variable, suggesting it m ust be considered at a clinical research analysis. Korean Journal of Headache 7(1):37-40, 2006

한국인에서의 편두통과 도파민 D4수용체 유전자 다형태의 연관성: Tae Jin Song, Ji Man Hong, Hyun-Suk Kim, Kyung-Yul Lee, Won-Joo Kim, Young-Chul Choi; Korean J Headache. 2006;7(1):41-45. Published online June 30, 2006

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Abstract PDF: Background
The dopam ine m etabolism is believed to play an important part in the pathophysiology of migraines. It was reported that the distribution of alleles for the dopamine D4 receptor gene (DRD4) in migraine w ithout aura patients is significantly different from those in control group. A polymorphism of the D RD4 m ight be related to genetic suscep- tibility of m igraine. The aim of this study w as to investigate the association of DRD4 exon III polymorphism between patient group w ith m igraine and control group.
Methods
This study compared 150 patients with m igraine (38 m ales, 112 females and m ean age 42.4±10.23) 100 healthy control subjects (25 males, 75 females and mean age 42.6±10.35) in order to determine the association between a polymorphism of the DRD4 exon III and m igraine. Using PCR techniques, the DRD4 polymorphism was denoted by 48-base-pair tandem repeat in exon III of the gene.
Results
There w as no significant difference between the healthy controls, m igraine without aura patients and m igraine with aura patients in age and sex distribution. Significant differences w ere noted in the genotype betw een m igraine without aura group and m igraine w ith aura group. Also significant differences w ere observed in allele frequencies compared m igraine w ithout patients w ith control group and m igraine w ith aura patients.
Conclusions
The DRD4 polymorphism appears to be involved in the genetic predisposition to m igraine w ithout aura. Migraine w ithout aura m ay have different pathophysiology from m igraine w ith aura in genetic field. Korean Journal of Headache 7(1):41-45, 2006

편두통 환자에서 뇌혈류 속도 파형의 비선형 분석 - 예비 연구 -: Hee-Jung Song, Eun-Gyong Ahn; Korean J Headache. 2006;7(1):46-49. Published online June 30, 2006

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Abstract PDF: Background
A lthough the transcranial D oppler (TCD) has been used to detect cerebrovascular hemodynamic changes in m igraine patients, the interpretation is limited. Reportedly, the TCD w aveform shows low dimensional chaotic patterns in normal conditions. The purpose of this study is to evaluate the changes of nonlinear parameters of the TCD w aveforms in m igraine patients.
Methods
W e m easured the TCD w aveforms in the middle cerebral artery (MCA) and analyzed the m aximum blood flow velocities. The phase trajectories w ere reconstructed and draw n in a three-dimensional phase portrait. The values of conventional and nonlinear analysis (correlation dimension, D2; the largest Lyapunov exponent, LLE) w ere compared betw een tw o groups.
Results
C erebral blood flow velocities of the left M CA w ere higher in m igraine patients (p<0.05). N onlinear analysis of the TCD time series showed dynamical chaos based on the fractal dimension of the TCD signal and the positive Lyapunov exponents in both groups. The value of D 2 of right M CA w aveform w as decreased in m igraine patients (p<0.05). The D 2 of left M CA w as not different (p>0.05). The LLE did not show any significant trend.
Conclusion
The variability of the TCD signal is not due to a random process but due to a low dynamical chaos. The change of D 2 in m igraine patients seems to be related to changes in compliance and vascular tone, w hich are known to influence the TCD w aveform profoundly. Korean Journal of Headache 7(1):46-49, 2006

재발한 톨로사-헌트 증후군 3예의 임상적 특징: 안구운동장애와 MRI로 예후를 예측할 수 있는가?: Hak Seung Lee, Jin Seok Kim, Jin Seong Jung, Hyun Young Park, Hyuk Chang, Yo Sik Kim, Kwang Ho Cho; Korean J Headache. 2006;7(1):50-52. Published online June 30, 2006

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Abstract PDF: Tolosa-Hunt syndrome (THS) is characterized by a painful, unilateral ophthalm oplegia caused by a nonspecific granulo-matous process in the cavernous sinus, the superior orbital fissure, or the orbital apex. The clinical differences and risk factors between episodic and recurrent syndrome have not been demonstrated, either. W e report patients with recurrent THS, w ho had a complete palsy of the cranial nerve III, IV and VI initially. Two of them show ed lesions in the ipsilateral cavernous sinus on brain M RI. Korean Journal of Headache 7(1):50-52, 2006

베게너육아종증에서 보인 자두통: Jeong-Yoon Choi, Kyungmi Oh, Ho-Jung Kim, Sang-Hyun Jang, Byung-Jo Kim; Korean J Headache. 2006;7(1):53-56. Published online June 30, 2006

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Abstract PDF: Secondary stabbing headache has been infrequently reported as a m anifestation of giant cell arteritis, intracranial aneurysm, cerebral atherosclerosis, or m eningioma. W egener's granulomatosis is a multi-system autoimmune disorder characterized by necrotizing granulomatous vasculitis predominantly in respiratory tract and kidney. H eadache is a very rare presenting symptom in these patients because m ost neurological symptoms are caused by involvem ent of peripheral nervous system. W e report a 61-year-old m an w ith stabbing headache as a presenting m anifestation of W egener's granulomatosis. Korean Journal of Headache 7(1):53-56, 2006

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