Headache and Pain Research

Volume 12(2); December 2011

원발벼락두통의 임상양상: Jiyeon Kim, Byung-Kun Kim, Gun-Sei Oh, Jae Myun Chung, Kyungmi Oh, Jeong Wook Park, Soo-Jin Cho; Korean J Headache. 2011;12(2):85-90. Published online December 31, 2011

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Abstract PDF: Objective: Thunderclap headache is a sign of a medical emergency such as a life-threatening subarachnoid hemorrhage (SAH). However, it also may occur in primary headache conditions such as cough, physical exertion, sexual activity and even without any provoking factors. International Headache Society classified thunderclap headache disorders into four different subtypes: (1) primary thunderclap headache(PTH); (2) primary cough headache(PCH); (3) primary exertional headache (PEH); and (4) primary headache associated with sexual activity(PSH). Subtypes of thunderclap headaches are reported to share many common characteristics, although studies on the clinical features and triggering factors of thunderclap headaches are limited. Methods: Seventy and two patients with thunderclap headache were prospectively enrolled from March 2008 to June 2010. The patients presented sudden severe headaches, reaching maximal intensity within 1 minute, without focal neu- rologic deficit. SAH and other organic disorders were excluded in this study. We described clinical features, triggering factors and vasospasm, and compared between the four subtypes of thunderclap headache. Results: Of the 72 recruited patients, PTH(n=25, 34.7%) was the most frequent thunderclap headache subtype, followed by PCH(n=23, 31.9%), PSH(n=15, 20.1%) and PEH(n=9, 12.5%). 49(68.1%) patients suffered recurrent thunderclap head- ache attacks at presentation. 49(68.1%) patients had more than one provoking factor. Defecation(n=13, 16.0%) was the most frequent provoking factor followed by sexual intercourse(n=11, 13.7%). Mean age was 45.1±12.6 years(range: 15-70). PEH group (36.6 years old) was younger than other groups. Overall male to female ratio in this study was 1:1.7. Mean duration of headache was 40.7±56.3 minutes(range: 0.17-720). The headache duration was shorter in PEH(25.2±14.2 minutes) than other groups. Vasospasm was documented in 10 patients(13.9%). Conclusions: More than two-thirds of patients with thunderclap headache have more than one provoking factor at presentation. Contrary to the previous studies, vasospasm was associated in small proportion of patients.

한국인구집단에서 편두통환자의 냄새공포증과 편두통 대체진단기준의 타당도 평가: Yeo Jin Kim, Soo-Jin Cho, Byung-Kun Kim, Kwang-Soo Lee, Byung-Chul Lee, Min Kyung Chu; Korean J Headache. 2011;12(2):91-96. Published online December 31, 2011

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Abstract PDF: Objective: Osmophobia, intolerance to smell, is often reported by migraine patients during headache attack and is included as an item of alternative diagnostic criteria for migraine in the appendix of ICHD-2. Most of previous reports on osmo- phobia were hospital-based studies and osmphobia of migraineurs across population sample was not reported yet. The aims of this study are to assess osmophobia in migraineurs across Korean populationand to assess validity of alternative diagnostic criteria of migraine. Methods: We used data of Korean Headache Survey(KHS), a population-based study by a stratified random sampling in Korean population over age 19, and totally 1,507 were evaluated. Demographic profile, headache characteristics and impact of headache were assessed with a 12-item semi-structured interview. Headache type was identified according to ICHD-2. We assessed osmophobia by a question ‘Do you feel changes in your sense of smell during headache?(stronger or differently)’. Results: Prevalence for migraine was 6.1%. 50.5% of migraineurs reported osmophobia during migraine attack. Mig- raineurs with osmophobia had more headache aggravation by routine physical activity, phonophobia and higher HIT-6 score than migraineurs without osmophobia. There were no significant difference in unilaterality of pain, pain intensity in VAS score, pulsating quality and photophobia between migraineurs with osmophobia and migraineurs without osmo- phobia. The sensitivity of alternative criteria was 0.95[95% confidence interval(CI), 0.87-0.98] and specificity was 0.99(95% CI, 0.98-0.99). Conclusions: Approximately half of migraineurs across Korean population sample reported osmophobia. Alternative criteria showed good specificity and sensitivity.

성인 뇌수막염에서 C-단백의 유용성: Shin-Hye Baek, Sung-Hyun Lee, Healim Lee, Jeawon Shin, Jin-Hwi Kang, Hyung-Suk Lee, Ji-Sun Kim, Dong-Ick Shin, Sang-Soo Lee; Korean J Headache. 2011;12(2):97-100. Published online December 31, 2011

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Abstract PDF: Objective: C-reactive protein(CRP), an acute phase serum globulin, is produced by hepatocytes in response to various nonspecific stimuli such as microbial infection, tissue necrosis, or neoplasm. The aim of this study was to clarify to what extent bacterial meningitis could be distinguished from aseptic or other infectious meningitis through CRP levels in adults. Methods: A total of 113 adult cases(aged 15-98 years), includingpatients with bacterial meningitis(n=14), aseptic meningitis(n=84), and tuberculous(Tb) meningitis(n=15), were retrospectively analyzed based on data from the initial examination. Results: Nine out of 14 patients with bacterial meningitis showed blood CRP levels ≥10mg/dl, whereas CRP levels <10mg/dl were observed in all patients with aseptic or Tb meningitis. Using a CRP level of ≥10mg/dl as a positive discriminatory factor for bacterial meningitis resulted in positive and negative predictive values of 0.91 and 1.0, respectively. To better discriminate bacterial from nonbacterial meningitis, we analyzed changes in CRP and cerebrospinal fluid(CSF) levels using one-way analysis of variance(ANOVA) and concluded that blood CRP is statically significant indicator which is differentiates bacterial meningitis from other meningitis or encephalitis at admission. Conclusion: This study suggests that serum CRP analysis, which is both simple and inexpensive, is helpful to differentiate bacterial meningitis from other aseptic or subacute meningitis.

감마나이프 방사선 수술로 치료된 증상성 삼차신경통: Sang-Jun Lee, Young-Chul Choi, Soo-Joo Lee, Gun-Se Oh, Moon-Sun Park, Youngchai Ko; Korean J Headache. 2011;12(2):101-104. Published online December 31, 2011

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Abstract PDF: A 62-year-old woman complained of facial pain. She was diagnosed with trigeminal neuralgia(TN) and had persistent symptoms despite adequate medication. After two years, she was admitted with acute stroke and magnetic resonance image revealed an enhanced solid mass in the left cerebellopontine angle(CPA). The CPA tumor was suggested as possible cause of intractable TN and the pain was relieved after Gamma-knife radiosurgery. We suggest that the comprehensive evaluation of etiology in patients with intractable TN should be recommended. And Gamma-knife radiosurgery can be an alternative treatment option.

뇌정맥혈전증과 소뇌농양에 대한 두통 1례: Young Hyo Kim, Kyu-sung Kim, Dong Wook Lim, Hoseok Choi; Korean J Headache. 2011;12(2):105-108. Published online December 31, 2011

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Abstract PDF: A 37-year-old man with left cervical tenderness was found to have chronic otitis media and extensive thrombophlebitis of the left transverse and sigmoid sinus by computed tomography(CT) and angiography. Because there was no improvement in symptoms in spite of medical treatment, the thrombi of the left internal jugular vein, which were found later, were removed by surgical procedure. Ten days after the initial operation, the patient suffered from severe headache in his occipital area, and accompanied by fever, dizziness, nausea and spontaneous nystagmus. The brain magnetic resonance images revealed the cerebellar abscess on the left side. After CT-guided stereotaxic aspiration of the brain abscess, headaches disappeared imme- diately. There has been no sign of any recurrence with headaches until 7 months after the aspiration of the abscess.

제1형 헤르페스바이러스로 유발된 뇌간 뇌염: Jung-Gon Lee, Duk-Hyun Heo, Do-Eui Kim, Jae-Young Seo, Il-Mi Jang, Kyung-Bok Lee, Hak-Jae Roh, Moo-Young Ahn; Korean J Headache. 2011;12(2):109-112. Published online December 31, 2011

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Abstract PDF: Herpes simplex virus encephalitis generally has a predilection for the frontal or temporal lobes, but isolated brainstem lesion has been rarely reported. A 32-year-old man was presented with headache, fever, dizziness and dysarthria. On admission, truncal ataxia, dysarthria and psychomotor slowing were observed. Brain MRI showed hyperintensities at pons and left thalamus in T2 weighted images. HSV PCR study was positive for HSV type 1. This patient was impro- ved during the course of anti-viral therapy. Brain lesion at follow-up MRI and neurologic deficits disappeared after 2 weeks.

급성 A형 간염에 병발한 무균수막염: Ju-Young Na, Meyung-Kug Kim, Bong-Goo Yoo, Byung-Cheol Yun; Korean J Headache. 2011;12(2):113-115. Published online December 31, 2011

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Abstract PDF: Acute hepatitis A is a self-limited disease that does not cause a chronic hepatitis. Hepatitis A may develop an atypical courses or complications. The neurological complications including Guillain-Barre syndrome, acute transverse myelitis, acute disseminated encephalomyelitis, meningoencephalitis and aseptic meningitis are rarely accompanied. We report a 42-year-old man with aseptic meningitis associated with acute hepatitis A infection. Screening for hepatitis A infec- tion may be considered in the work-up of aseptic meningitis.

전이성 종양에 의한 후두관절융기 증후군 2례: Hye Jin Cho, Kang Seok Kim, Dong Won Lee, Yeo Jin Kim, Joon Hyun Shin; Korean J Headache. 2011;12(2):116-118. Published online December 31, 2011

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Abstract PDF: Occipital condyle syndrome(OCS) consists of unilateral pain on occipital region and ipsilateral hypoglossal nerve palsy. OCS should be distinguished from hypoglossal nerve palsy without pain, because it could be due to metastasis of cancer to skull base. We experienced 2 patients with OCS, 74 year old man caused by metastasis of hepatocelluar carcinoma and 53 year old woman with sigmoid colon cancer.

안근마비편두통 1례: Joo Hyung Park, Hye Jin Kim, Won Kyung Cho, Sang Yong Kim, Dae Chul Jeong, Seung Yun Chung; Korean J Headache. 2011;12(2):119-121. Published online December 31, 2011

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Abstract PDF: Ophthalmoplegic migraine(OM) is a rare disorder characterized by recurrent episodes of migraine-like headaches associated with extrinsic ocular musculature palsy. The oculomotor nerve is the most common cranial nerve affected. We present a 10 year-old girl with throbbing frontal headache, eyeball pain and oculomotor nerve palsy on the right side. T1-weighted, gadolinium-enhanced MRI showed focal thickening and enhancement of the right oculomotor nerve, which were compatible with an OM. After steroid treatment, symptoms completely resolved 2 month later. Ten month later, on the recurrent state of OM, repeated MRI revealed abnormal findings of partially resolved enhancement and persistent thickening of the right oculomotor nerve.

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