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Volume 25(2); October 2024
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Editorials
When Should Headache Specialists Hold a Needle? The Role of Botulinum Toxin Injections and Occipital Nerve Blocks
Soo-Jin Cho
Headache Pain Res. 2024;25(2):73-74.   Published online October 17, 2024
DOI: https://doi.org/10.62087/hpr.2024.0020
  • 344 View
  • 8 Download
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Nutritional Approaches to Managing Pediatric Migraine
Hye Eun Kwon
Headache Pain Res. 2024;25(2):75-76.   Published online October 24, 2024
DOI: https://doi.org/10.62087/hpr.2024.0027
  • 289 View
  • 6 Download
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Review Articles
What a Neurologist Should Know about Functional Anatomy for Botulinum Toxin Injections in the Head, Face, and Neck: A Practical Perspective
So Ra Kim, Vittorio Favero, Alec Hyung Kim, SeongTaek Kim
Headache Pain Res. 2024;25(2):77-85.   Published online July 22, 2024
DOI: https://doi.org/10.62087/hpr.2024.0005
  • 583 View
  • 35 Download
  • 1 Citations
AbstractAbstract PDF
Since botulinum toxin (BoNT) was approved by the US Food and Drug Administration as a prophylactic treatment for chronic migraines in 2010, subsequent studies have shown that BoNT is effective in the management of chronic migraines due to its pain-relieving effects. Therefore, neurologists are increasingly utilizing BoNT as a therapeutic tool for chronic migraine. It is crucial to thoroughly understand the functional anatomy in the head, face, and neck regions to successfully administer BoNT injections in these areas. This review describes the complexity of muscles and their associated target nerves in the frontal, temporal, and occipital areas and serves as a resource for essential functional anatomy, with the goal of providing clinicians with a practical perspective on utilizing BoNT injections.

Citations

Citations to this article as recorded by  
  • When Should Headache Specialists Hold a Needle? The Role of Botulinum Toxin Injections and Occipital Nerve Blocks
    Soo-Jin Cho
    Headache and Pain Research.2024; 25(2): 73.     CrossRef
Understanding the Connection between the Glymphatic System and Migraine: A Systematic Review
Myoung-Jin Cha, Kyung Wook Kang, Jung-won Shin, Hosung Kim, Jiyoung Kim
Headache Pain Res. 2024;25(2):86-95.   Published online July 31, 2024
DOI: https://doi.org/10.62087/hpr.2024.0014
  • 1,167 View
  • 39 Download
AbstractAbstract PDF
The glymphatic system is a brain-wide perivascular pathway that functions similarly to the lymphatic system in the periphery of the body, playing a crucial role in removing waste from the brain. Although impaired glymphatic function has a well-known relationship with neurodegenerative diseases through abnormal protein accumulation, it is also associated with migraine. While still in its nascent phase, research on the glymphatic system in migraine patients is gradually increasing. This systematic literature review focuses on studies investigating the glymphatic system in migraineurs. Furthermore, it examines the methods used to evaluate the glymphatic system in these studies and their main findings.
Original Articles
Side Shift of Attacks in Cluster Headache: A Prospective Single-center Study
Michelle Sojung Youn, Jun Pyo Kim, Mi Ji Lee
Headache Pain Res. 2024;25(2):96-102.   Published online August 28, 2024
DOI: https://doi.org/10.62087/hpr.2024.0013
  • 227 View
  • 6 Download
AbstractAbstract PDF
Purpose: Although strict unilaterality is a characteristic of cluster headache (CH), side shift of attacks has been reported. We aimed to assess the prevalence and patterns of side shifts, as well as their correlations with clinical characteristics and treatment response in CH patients.
Methods
We prospectively recruited and followed up CH patients at a university hospital. Patients with two or more lifetime CH bouts were interviewed about their side shift history using a structured questionnaire. The demographics and disease characteristics were collected at baseline, and the treatment response at 2- to 4-week follow-up examinations was compared between patients with versus without side shifts.
Results
Out of 124 CH patients, 26 (21.0%) experienced side shifts. Sixteen (61.5%) experienced shifts between bouts, 13 (50.0%) within a bout, and four (15.4%) within an attack, with none (0%) reporting bilateral pain during an attack. Among patients who experienced shifts between bouts, six (37.5%) reported a single shift during the entire disease course, while 10 (62.5%) reported multiple shifts between bouts. The demographics, characteristics, and treatment response did not significantly differ according to the history of side shift.
Conclusion
In our study, the prevalence and pattern of side shifts were comparable to the results from earlier studies. The presence of side shifts did not show significant association with a specific clinical profile and their incidence did not impact the treatment response. These findings suggest that side-shifting CH is not a distinct entity or migraine variant, but rather within the spectrum of CH.
Subjective Cognitive Decline Patterns in Patients with Migraine, with or without Depression, versus Non-depressed Older Adults
Sun Hwa Lee, Soo-Jin Cho
Headache Pain Res. 2024;25(2):103-110.   Published online October 24, 2024
DOI: https://doi.org/10.62087/hpr.2024.0022
  • 118 View
  • 4 Download
AbstractAbstract PDF
Purpose: Cognitive decline is a common complaint in young patients with migraine, especially those with depression. Independent of psychiatric factors such as depression, subjective cognitive decline (SCD) is associated with an elevated risk of progression to dementia. This study aimed to investigate patterns of subjective cognitive complaints between migraineurs with or without depression and non-depressed older adults.
Methods
This retrospective study included 331 outpatients with SCD (293 from a headache clinic and 38 from a memory clinic). SCD was diagnosed as “yes” based on two questions about SCD. The Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to assess cognitive function. The SCD Questionnaire (SCD-Q) with three subdomains was analyzed to compare SCD between groups.
Results
Among patients with SCD, significant differences in duration of education were found among the groups—specifically, migraineurs with depression (12.39 years) had longer education than non-depressed older adults (10.50 years) and shorter education than migraineurs without depression (14.28 years). The total MMSE and MoCA scores did not differ between migraineurs with and without depression. Regarding SCD-Q scores, migraineurs with depression showed higher scores overall and in all cognitive domains than migraineurs without depression, with no significant difference compared to non-depressed older adults.
Conclusion
Although the depressed migraineurs with SCD were younger and more educated than the non-depressed older adults with SCD, both groups reported similarly high levels of SCD. Higher levels of surveillance for cognitive decline are warranted for migraineurs with depression who have SCD.
Bilateral Greater Occipital Nerve Block for Preventing the OnabotulinumtoxinA Wear-off Phenomenon in the Treatment of Chronic Migraine: A Case Series of 12 Patients
Sanghyun Kim, Jae Young An, Dae Woong Bae
Headache Pain Res. 2024;25(2):111-116.   Published online October 23, 2024
DOI: https://doi.org/10.62087/hpr.2024.0021
  • 124 View
  • 9 Download
  • 1 Citations
AbstractAbstract PDF
Purpose: OnabotulinumtoxinA is widely used to treat chronic migraines; however, the wear-off phenomenon before the next scheduled dose has emerged as a challenge. This study suggests a new strategy for preventing the wear-off phenomenon using bilateral greater occipital nerve block.
Methods
We conducted a retrospective review of patients diagnosed with chronic migraine who were treated with onabotulinumtoxinA and bilateral greater occipital nerve block at St. Vincent Hospital from January 2023 to December 2023. Twelve chronic migraine patients with a history of the wear-off phenomenon received a greater occipital nerve block 8 weeks after the initial onabotulinumtoxinA injection for two sessions. Responses to treatment were evaluated with regular follow-ups and daily headache diaries.
Results
All patients who had previously experienced the wear-off phenomenon with conventional onabotulinumtoxinA treatment did not experience the wear-off phenomenon during two sessions with an additional greater occipital nerve block administered 8 weeks after each onabolulinumtoxinA injection.
Conclusion
Bilateral greater occipital nerve block administered 8 weeks after the initial onabotulinumtoxinA injection effectively prevents the wear-off phenomenon, enabling sustained therapeutic benefits in chronic migraine patients. Further research is needed to confirm these findings in larger cohorts.

Citations

Citations to this article as recorded by  
  • When Should Headache Specialists Hold a Needle? The Role of Botulinum Toxin Injections and Occipital Nerve Blocks
    Soo-Jin Cho
    Headache and Pain Research.2024; 25(2): 73.     CrossRef
Case Reports
Primary Headache Associated with Sexual Activity Presenting with Persistent Genital Arousal Disorder: A Case Report
Woo-Seok Ha, Hye-Kyung Baek
Headache Pain Res. 2024;25(2):117-121.   Published online September 2, 2024
DOI: https://doi.org/10.62087/hpr.2024.0012
  • 172 View
  • 4 Download
AbstractAbstract PDF
Persistent genital arousal disorder (PGAD) is characterized by unwanted and distressing genital sensations that are not associated with concomitant sexual interest or thoughts. Several etiologies have been proposed, but the underlying mechanism of the condition remains unclear. In this report, we describe a case of PGAD presenting with primary headache associated with sexual activity (PHASA). A 57-year-old female with no history of headache experienced recurrent, unwanted episodes of genital arousal lasting 3 to 5 days for 4 years. One day, she began to experience intense genital arousal that she had never experienced before. On the fourth day of arousal, while attempting intercourse with her partner, she experienced an abrupt explosive headache, which was repeated during another session of intercourse a week later. The patient underwent laboratory tests, as well as brain magnetic resonance imaging (MRI) and magnetic resonance angiography, all of which showed normal findings. She was referred to a sexual medicine specialist and prescribed amitriptyline, escitalopram, and propranolol with a diagnosis of PGAD. Her sexual arousal gradually diminished, and when she stopped all medications 3 months later, all symptoms had disappeared. On further investigation, spinal MRI revealed a Tarlov cyst. She has been in remission for three years. This case illustrates the co-occurrence of PHASA and PGAD and suggests a possible common pathophysiology shared between these two rare disorders.
Mechanical Thrombectomy in Cerebral Venous Thrombosis Caused by Spontaneous Intracranial Hypotension: A Case Report with Novel Pathological Findings of Fibrin/Platelet-predominant Thrombus
Min Kyoung Kang, Eun Young Kim, Hye-Rim Shin
Headache Pain Res. 2024;25(2):122-127.   Published online October 2, 2024
DOI: https://doi.org/10.62087/hpr.2024.0016
  • 120 View
  • 4 Download
AbstractAbstract PDF
This case report presents pathological findings in a rare case of cerebral venous thrombosis (CVT) caused by spontaneous intracranial hypotension (SIH) that was treated successfully with mechanical thrombectomy. The etiologies and prognosis of CVT vary, and CVT resulting from SIH is particularly uncommon and challenging to diagnose and manage. In this case, magnetic resonance imaging revealed signs consistent with both SIH and CVT, which contributed to the patient’s worsening weakness. The patient was treated with a combination of endovascular thrombectomy and epidural blood patch, followed by anticoagulation therapy, and recovered without any complications. A pathological analysis of the retrieved thrombus using hematoxylin and eosin staining showed a high proportion of fibrin and platelets, which could shed light on the mechanism of CVT induced by SIH under conditions of low blood flow due to venous engorgement.

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