Headache and Pain Research

Volume 10(2); December 2009

약물에 의한 두통: Soo-Jin Cho, Sang-Moo Lee; Korean J Headache. 2009;10(2):121-123. Published online December 31, 2009

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Abstract PDF: Drug-induced headache is one of the important causes of poor compliance. Drug-induced headache can be diagnosed by withdrawal of suspected agents and plausible relationship. The drugs most likely reported to be associated with headache are nitric oxide donors, phosphodiesterase inhibitors, lithium, and tetracycline and suggested mechanisms are vasodilatation, increased intracranial pressure, and aseptic meningitis. Some patients are more susceptible to drug-induced headache. Drug-induced headache can be controlled by reducing dose, discontinuation of the drug, and symptomatic medications, if needed. Consideration about previous headache history is recommended in randomized drug trial and starting new drug.

난치성 두통의 치료: Jae-Myun Chung; Korean J Headache. 2009;10(2):124-129. Published online December 31, 2009

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Abstract PDF: Refractory headache is the most troublesome problem in headache clinic. In spite of its frequent encounter in clinical practice, the definition of "refractoriness" started to be discussed recently. Operational definition of refractory migraine and refractory chronic migraine has been suggested for clinical and basic research purpose although debates exists. Pathogenetic mechanisms of refractory headache are also being unveiled nowadays, including genetic causes and structural changes. In clinical practice, many of the patients having refractory headache might be successfully managed with basic principles. These include correct disgnosis, attention to medication-overuse or comorbid illness, proper optimized acute and preventive pharmacologic treatments, and nonpharmacological lifestyle modifications.

소아 편두통과 소아기 주기성 증후군: Young-il Rho; Korean J Headache. 2009;10(2):130-136. Published online December 31, 2009

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Abstract PDF: In the revised IHS criteria published in 2004, the childhood periodic syndromes are considered as conditions that are commonly precursors of migraine. These include cyclical vomiting syndrome, abdominal migraine, and benign paro- xysmal vertigo of childhood. Cyclical vomiting syndrome is a disorder characterized by repeated episodes of nausea and vomiting that last for hours to days, separated by symptom-free periods of variable length. The protracted vomiting may lead to severe volume depletion and the need for intravenous therapy. Symptoms often begin in young children and typically stop spontaneously at puberty, although some adolescents are affected. Abdominal migraine affects up to 4 percent of school age children. It is characterized by recurrent episodes of abdominal pain, typically midline or poorly localized, dull and moderate to severe in intensity. Abdominal pain is associated with at least two additional features that may include anorexia, nausea, vomiting, and pallor. Benign paroxysmal vertigo of childhood is the most frequent cause of dizziness in children. Episodes are usually brief, lasting only a few minutes, but may cluster, with recurrence of attacks several times within a few hours. Affected patients may suddenly appear frightened or unable to walk and will hold on for support. Children may experience decreased alertness or loss of strength and usually accompanied by features common in migraine, including nausea, pallor, phonophobia, and photophobia. The disorder resolves spontaneously after several episodic attacks. However, typical migraine may develop in later life in some patients.

군발두통과 기타 원발두통의 진단과 치료 - 증례 중심 접근 -: Jin Kuk Do; Korean J Headache. 2009;10(2):137-140. Published online December 31, 2009

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Abstract PDF: Cluster headache is the most unique and painful of the primary headache disorders. The trigeminal-autonomic cepha- lalgias(TACs) are a group of primary headache syndromes which are characterized unilateral recurrent severe headache with cranial autonomic symptoms. The individual attack involves activation of the trigeminal-autonomic reflex. The TACs include cluster headache, paroxysmal hemicranias and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing(SUNCT). They can be differentiated by attack duration and frequency. Cluster headache has the longest attack duration and relatively low attack frequency. These headache syndromes should be differentiated because of different management. Headache associated with sexual activity can occur with primary exertional headache and migrainous headache. We should consider comorbid conditions for specific management of other primary headaches.

Depression as a Predictor of Cognitive Impairment in Patients with a Long History of Migraine: Sun-Young Kim, Yang-Ha Hwang, Ho-Won Lee, Chung-Kyu Suh, Sung-Pa Park; Korean J Headache. 2009;10(2):141-149. Published online December 31, 2009

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Abstract PDF: Background
Cognitive impairment has been documented in patients with migraine. Predictors were frequency, dura- tion, and intensity of headaches and a long history of suffering with migraine. However, neuropsychological conse- quences such as cognitive profiles or mood states of a long history of migraine are still debatable. To clarify cognitive outcomes in patients with a long history of migraine and to examine significant contributory predictors. Methods: We compared the cognitive performances of patients with a history of migraine at least 10 years with healthy controls using various neuropsychological tests. We measured mood states to assess the effect of mood on cognitive performances. We acquired demographic and migraine-associated variables through a headache questionnaire. We correlated cognitive outcomes with migraine variables, including mood states, and then examined predictors by mul- tiple regression analyses. Results: Cognitive performances of long-term migraineurs were significantly worse compared to controls. The age of migraine onset was a predictor of performance on list learning, immediate, and delayed word recall tasks. Depre- ssion was a predictor for performance on list learning and Digit Span Backward. Conclusion: Cognitive impairment is elucidated in patients with a long history of migraine. Treatment plans for depre- ssion should be evaluated based on the potential improvement of cognitive functioning.

비기질적 수면장애를 동반한 편두통 환자의 수면 특징: Chang Hyo Yoon, Jin Kuk Do, Dong-Kuck Lee; Korean J Headache. 2009;10(2):150-155. Published online December 31, 2009

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Abstract PDF: Background
There is a clear association between headache and sleep disturbances. However, the mechanism and causes are complex and poorly understood. The aim of this study is to investigate the clinical characteristics of sleep disturbance between migraineurs with insomnia and non-organic insomniacs. Methods: We enrolled 20 migraineurs with insomnia and 22 controls(non-organic insomniacs). Two groups underwent the battery of four sleep tests, such as the Pittsburgh Sleep Quality Index(PSQI), the Stanford Sleepiness Scale(SSS), the Epworth Sleepiness Scale(ESS), and the Insomnia Severity Index(ISI). The Beck Depression Inventory(BDI) and State Trait Anxiety Inventory(STAI) were also performed for evaluating associated comorbid conditions such as depression and anxiety tendency. Results: In the comparison, Migraineurs with insomnia group and control group were statistically differed in the scores of the battery of sleep tests. In the PSQI, the average score of migraineurs with insomnia was 9.95 as compared with 16.55 in control group(p<0.05). Furthermore, the SSS was 2.75 vs. 3.50(p<0.05) and ISI was 12.05 vs. 22.68(p< 0.05). The ESS provided exceptional adverse average scores such as 6.80 vs. 5.41 but the difference was not statistically significant(p>0.05). In the logistic regression, the PSQI was the only significant prospective factor(odds ratio=2.15, p<0.05). The difference of the BDI and STAI was not statistically significant(p>0.05). Conclusions: In this study, migraineurs with insomnia have less sleep complaints than non-organic insomniacs. Depre- ssion and anxiety tendency does not affect on the result.

응급실에 방문한 일차 두통환자의 현황: Bohm-Nam Kim, Ji-Ee Kim, Min-Kun Park, Kyung-Mo Gu, Ki-Chul Yoo, Ki-Hoon Choi, Yang-Ki Minn, Ki-Han Kwon, Soo-Jin Cho; Korean J Headache. 2009;10(2):156-159. Published online December 31, 2009

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Abstract PDF: Background
Primary headaches such as migraine is tend to be neglected by a physician in the emergency department (ED) due to limited resources and low priority. In this study, the frequency of primary headache patients in the ED is figured and evaluates current management status for primary headache in the ED. Methods: We retrospectively selected 137 non-traumatic headache patients were presented to the ED of Hospital in 2008, based on diagnosis by a physician in the ED at discharge. Among the patients with non-traumatic headache, patients with secondary headaches were excluded. Evaluation of demographic characteristics, previous history, ED management and status of non-traumatic primary headaches patient those who visit out-patient clinic after discharge Emergency Department were included. Results: Out of 137 non-traumatic headache patients, 80 patients(58.4%) were diagnosed of primary headaches: 73.8% were women and the mean age was 40±15.7 years. Forty-two patients(52.5%) had previous history of headache. Fifty- eight patients(72.5%) were prescribed simple analgesics or anti-emetics in the ED and 17(21.2%) visited out-patient clinic after their discharge. Presumed diagnoses at the ED were migraine in 20 patients, tension type headache in 29, cluster headache in 1, trigeminal neuralgia in 2 and unclassified in 28 patients. Conclusion: Primary headaches are common in the patients presenting to the ER with non-traumatic headaches. Hence, in order to get specific diagnosis or to consider preventive therapy, visits to out-patient clinic might be recommended.

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