Headache and Pain Research

Volume 11(2); December 2010

자발두개내압저하와 요추천자후두통: Seok-Beom Kwon, Sung-Hee Hwang, Whi-Chul Choi; Korean J Headache. 2010;11(2):81-90. Published online December 31, 2010

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Abstract PDF: Spontaneous intracranial hypotension (SIH) is an uncommon but not rare cause of new onset daily persistent headaches in young and middle-aged individuals, but initial misdiagnosis is common. The underlying cause is a spontaneous spinal cerebrospinal fluid (CSF) leak. Typically the headache is orthostatic in nature but other headache patterns occur as well. Associated symptoms are common and include neck pain, a change in hearing, diplopia, facial numbness, cognitive abnormalities and even coma. The spectrum of clinical and radiographic manifestations is varied, with diagnosis largely based on clinical suspicion, cranial magnetic resonance imaging, and myelography. Numerous treatment options are available, but outcomes have been poorly studied and much remains to be learned about this disorder. Lumbar puncture is a frequently performed procedure in neurological emergencies and anaesthesia. The typical nature of headache after lumbar puncture is also orthostatic like that of SIH. This article also deals with some part of headache after lumbar puncture.

한국인 인구집단에서 고빈도 삽화성 긴장형두통의 영향: Soo-Jin Cho, Min Kyung Chu, Byung-Kun Kim, Jae-Myun Chung, Kwang Soo Lee; Korean J Headache. 2010;11(2):91-94. Published online December 31, 2010

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Abstract PDF: Background
Frequent episodic tension-type headache (ETTH) is a subtype of tension-type headache (TTH) based upon ICHD-2 criteria. ETTH is generally considered as mild primary headache disorder but the impact of frequent ETTH has not been evaluated separately from infrequent ETTH. Therefore, this study evaluated the impact of frequent ETTH. Method: For this study, a stratified random population sample of Koreans, over the age of 19, was selected and evaluated using a 12-item, semi-structured interview designed to identify headache type using ICHD-2 criteria. The burden of the headache was evaluated by the headache impact test-6 (HIT-6). Results: Among 1507 participants, 463 (30.7%) were diagnosed with TTH; 228 were diagnosed with frequent ETTH, 224 were infrequent ETTH, and 11 were chronic TTH. Thirty-two patients (6.9%) with TTH had substantial to severe impact in HIT-6 (≥56); 22 had frequent ETTH, 7 had infrequent TTH, and 3 had chronic TTH (p<0.01). Frequent TTH, severity of pain by visual analogue scales, aggravation with physical activity, moderate or severe intensity, and phonophobia influenced on total scores of HIT-6. Conclusion: Frequent ETTH is a common headache disorder and had significant impact, so medical and social attentions are promptly needed.

긴장형두통과 편두통에서 수면의 양상: Woo Ho Han, Jin Kuk Do, Dong Kuck Lee; Korean J Headache. 2010;11(2):95-100. Published online December 31, 2010

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Abstract PDF: Background
There is a clear association between headache and sleep disturbance. However, the mechanism and causes are complex and poorly understood. The aim of this study is to compare the sleep quality in tension-type headache and migraine patients. Methods: We enrolled 49 tension-type headache (TTH) and 27 migraine patients. Two groups underwent the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale, Beck Depression Inventory, and State trait anxiety inventory. We analyzed these sleep[C3] and other psychiatric parameters according to headache type and headache features. Results: Global PSQI scores [10.82±5.10 for TTH vs. 10.52±4.31 for migraine, p-value=0.79], BDI[C4] [18.86±8.55 for TTH vs. 21.19±9.48 for migraine, p-value=0.28] and STAI[C5] [state; 51.04±10.32 for TTH vs. 52.48±11.92 for migraine, p-value=0.58, trait; 53.92±10.32 for TTH vs. 55.33±12.09 for migraine, p-value=0.59] showed no significant difference between two groups.Chronic migraine (CM) sufferers revealed shorter sleep duration [2.40±0.74 hours for CM vs. 1.42 ±1.08 hours for episodic migraine (EM), p-value=0.01]and higher STAI score comparing from EM (state; 57.87±11.71 for CM and 45.75±8.52 for EM, trait; 59.87±12.08 for CM and 49.67±9.83 for EM). Conclusions: In our study, there were no significant difference in sleep related parameters including PAQI, ESS and STAI between tension-type headache and migraine patients group. CM patients reported higher ESS and STAI scores comparing to EM patients.

베체트병에서 편측 통증눈근육마비와 시신경병: Ju-Young Na, Meyung-Kug Kim, Bong-Goo Yoo; Korean J Headache. 2010;11(2):101-103. Published online December 31, 2010

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Abstract PDF: Behçet's disease, mainly characterized by relapsing oral and genital ulceration and uveitis, also involves other tissues. In previous reports, the neuro-ophthalmologic manifestations of Behçet's disease are internuclear ophthalmoplegia, abducens nerve palsy, homonymous hemianopia and papillitis. Painful unilateral ophthalmoplegia is most often traceable to an aneurysm, a tumor, or an inflammatory or granulomatous process in the anterior portion of the cavernous sinus or at the superior orbital fissure. Behçet's disease presenting with painful unilateral ophthalmoplegia and optic neuropathy has not been previously reported. We report a case of painful unilateral ophthalmoplegia and optic neuropathy associated with Behçet's disease.

급성 가쪽연수경색증으로 인한 만성 군발유사두통: Meyung-Kug Kim, Ji-Hyun Lee, Bong-Goo Yoo; Korean J Headache. 2010;11(2):104-107. Published online December 31, 2010

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Abstract PDF: Cluster-like headache has been described as a secondary to several intracranial pathology. More than half of patients with lateral medullary infarction develop headache, but headache associated with autonomic symptom is very rare. We report the case of a 61-year-old man with chronic cluster-like headache associated with acute lateral medullary infarction. Damage of lateral medulla leads to imbalance of the autonomic system. Activated trigemino-autonomic system might be contributing factors of this headache.

수막염과 유사하게 보이는 성인 인두 뒤 농양 1예: Hyun Jin Lee, Jun Hee Park, Dong Uk Kim, Hoo Won Kim, Jin Ho Kim, Seong Hwan Ahn; Korean J Headache. 2010;11(2):108-110. Published online December 31, 2010

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Abstract PDF: Neck stiffness is a classical sign of meningeal irritation, which suggests a meningitis or subarachnoid hemorrhage commonly. However, it is not always a pathognomic signs of intracranial disease. Retropharyngeal abscess is a rare deep neck infection in adults, which may cause severe headache. We report a case of retropharyngeal abscess which had unusually presented with meningism. In headache patients presented meningeal irritation signs with normal finding of cerebrospinal fluid, retropharyngeal infections must be considered as a disease of differential diagnosis.

보툴리눔 독소 A형 주사 후 호전된 군발 두통 1예: Hyeyun Kim, Go Un Kim, Dong Sun Kim, Hyun Jeong Han; Korean J Headache. 2010;11(2):111-114. Published online December 31, 2010

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Abstract PDF: Cluster headache (CH) is a severe primary headache syndrome associated with autonomic syndrome. Treatment of CH involves acute attack management such as oxygen, sumatriptan and preventive therapy with verapamil, oral steroid and ergotamine. For refractory to those treatment, botulinum toxins type A (BTX-A) has recently been studied as a new preventive treatment for patient with refractory CH, with limited success. A 33-year-old man presented with a 2.5-year history of excruciating headache in right frontal and periorbital areas. He was getting an average of two to three attacks per day, each lasting between 30 mins and 2 hours. The attack was sometimes associated with conjunctival congestion and nasal stuffiness on symptomatic side. His headaches were previously managed with ergotamine, oral steroid, verapamil, lithium for 2 years. However, his headache recurred and getting worse during several months. BTX-A was injected into the temporalis, glabellar area, occipitalis and trapezius muscles bilaterally. Four weeks after injection, He experienced improvement of headache and oral steroid was tapered off. We report a case of intractable CH who was successfully treated with BTX-A.

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