Headache and Pain Research

Volume 8(2); December 2007

편두통과 우-좌단락: Kyungmi Oh, Chin-Sang Chung; Korean J Headache. 2007;8(2):61-68. Published online December 31, 2007

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Abstract PDF: The prevalence of migraine with aura in the general population is 12%, but was 3.5 times higher(42%) in patients with right-to-left shunt caused by patent foramen ovale, atrial septal defect, or pulmonary arteriovenous malformations. Many studies have reported the efficacy of percutaneous closure of shunt for reducing the prevalence of migraine with aura. However, a recent prospective controlled study did not show the efficacy of percutaneus shunt closure as a treatment of migraine. There are still many debating issues about this topic. The author would review that association of right-to-left shunt to migraine, relating phathophysiological mechanisms, and management of shunts in migraneurs.

편두통과 긴장형두통 환자에서의 자기공명영상 백질 이상: Nayoung Kim, Suntae Hwang, Ja-Seong Koo, Ohyun Kwon, Jong-Moo Park; Korean J Headache. 2007;8(2):69-72. Published online December 31, 2007

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Abstract PDF: Background
Several reports have documented a high frequency of white matter abnormalities by MRI in migraineurs. However, there have been few studies on MRI abnormalities in tension-type headache. The purpose of our study was to determine whether the incidence and distribution of MRI abnormalities in tension-type headache differ from those in migraine Methods: We analyzed consecutive magnetic resonance imaging findings of 121 patients with migraine and tension type headache under 50 years old. Of the 121 patients, 74 were diagnosed as having migraine and 47 were diagnosed as having tension-type headache. Clinical information was obtained from headache patients database. MRI was revie- wed with respect to location, number and volume of focal white matter hyperintensities in FLAIR image. The location of white matter abnormalities were classified into periventricular and subcortical lesions. Results: White matter abnormalities were observed in 23% of migraine patients and; 28% of tension-type headache. Among the migraineurs, white matter abnormalities were seen in 22% with migraine without aura and 33% with mi- graine with aura. There was no significant difference in incidence of white matter abnormalities between the patients with migraine and tension-type headache(p=0.67) and between the patients with migraine without aura and with aura (p=0.62). The white matter abnormalities were most frequently located in subcortical area in both groups. Conclusions: The incidence and distribution of white matter abnormalities in MRI was not significantly different between the patients with migraine and tension-type headache. These findings suggest that two disorders may share a common pathomechanism.

소아 반복성 두통 환자에서 뇌영상 검사: Joon-Woo Park, Konhee Lee; Korean J Headache. 2007;8(2):73-78. Published online December 31, 2007

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Abstract PDF: Background
To assess the utility of neuroimaging study in evaluation of children and adolescents with recurrent head- ache. Methods: We retrospectively reviewed medical records and neuroimages of patients with recurrent headache who visited the pediatric neurologic clinic at Kangnam Sacred Heart Hospital between January 2004 and June 2006. The diagnostic criteria of International Classification of Headache Disorders II were used in the classification of patient. Results: We included 164 children with a mean age of 9.1±2.9 years. There were 136(82.9%) patients with primary headache and 27(17.1%) patients with secondary headache. Of patients with primary headache, there were 41(30.2%) patients with migraine without aura, 21(15.4%) patients were migraine with aura, 43(31.6%) patients were episodic tension-type headache, and 31(22.8%) patients were chronic daily headache. Of the 136 patients with primary headache, 110(81.9%) were normal and 26(19.1%) showed benign abnormal findings. Abnormal findings included 14 cases of sphenoidal sinusitis, 4 cases of arachnoid cyst, 3 cases of leukomalacia, 2 cases of venous angioma, 2 cases of pineal cyst, and 1 case of sinus polyp. All the benign cases required no surgical treatment. Of the 28 patients with secondary headache, 23(82%) were showed benign abnormal finding. Benign abnormal findings included 16 cases of sphenoidal sinusitis, 2 cases of arachnoid cyst, and 1 case of hydrocephalus. There were 4 cases of sinister finding. 1 case of intracranial hemorrhage, 1 case of AV malformation, 1 case of craniopharyngioma, 1 case of Rathke's pouch cyst and all the cases required surgical treatment. Of 164 patients with recurrent headache, 49(29.8%) patients showed abnormal findings in neuroimaging study and 4(2.43%) cases were sinister. Duration of headache was found to have statistically significant association with neuroimaging finding with sinister disease. Conclusion: About 30% of pediatric patients with recurrent headache have abnormal findings, which included 2.4% sinister findings.

국내 한 여자대학교 의과 대학생들의 두통 유병률, 양상 및 치료 형태: Eun-Mi Park; Korean J Headache. 2007;8(2):79-83. Published online December 31, 2007

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Abstract PDF: Background
Headache has been known as a major health problem in medical students and frequency of headache is higher in women compared to men. However, prevalence of headache in medical students has not been studied in Korea. This study was performed to evaluate the prevalence, characteristics and management of headache in female medical students in a women‘s university in Korea. Methods: Subjects were students of medical college in Ewha Womans university, Seoul, Korea. Students were asked to complete a questionnaire consisted of demographic data, characteristics of headache and headache managements. Migraine and tension type headache were classified by the diagnostic criteria of the international headache society. Results: Three hundred four(87.6%) out of 347 students responded to the questionnaire. Mean age was 22.7 years. Lifetime overall prevalence of headache was 94.4% and last-year prevalence was 90.1%. The prevalence rate of migraine was 9.9% and that of tension type was 47.7%. Lack of sleep was the most common factor triggering headache. Self- medication with non-prescribed drugs was reported in 116(42.3%) students and the most commonly used drugs were simple analgesics. The number of students who had consulted physicians was 20(7.3%). Conclusions: The study shows that headache, especially tension type, is highly prevalent in female medical students compared to general Korean women. The reasons of high prevalence of headache are needed to be evaluated and appropriate managements for headache should be guided in this population.

자가편두통 선별 도구의 개발 및 타당도 평가 -한국 편두통 선별 설문-: Min-Kyung Chu, Byung Kun Kim, Sung Taek Kim, Jae-Moon Kim, Heui-Soo Moon, Jeong Wook Park, Kwang-Soo Lee, Kyung-Mi Oh, Jae-Myun Chung, Chin-Sang Chunge; Korean J Headache. 2007;8(2):84-91. Published online December 31, 2007

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Abstract PDF: Background
Migraine is a common and disabling illness. But substantial migraine sufferers were underdiagnosed or undiagnosed. To improve migraine diagnosis, Korean Migraine Screening Questionnaire(KMSQ) was developed and validated in outpatient setting. Methods: A total of 507 patients who visited out patient clinic for headache were recruited in 10 hospitals in Korea and asked 10-item questionnaire concerning headache. 487 completed and returned the questionnaire. All patients were evaluated for headache and diagnosed by headache experts. Migraine diagnosis was assigned on International Head- ache Society(IHS) criteria after completing semi-structured diagnostic interview. Results: Of ten diagnostic questions derived from IHS criteria and headache expert experience, three-item subsets were deduced. Combination of questions regarding nausea, pulsating quality and photophobia showed optimum perfor- mances. Any two from the three items showed a sensitivity of 0.74, a specificity of 0.80, a positive predictive value of 80.8 and a negative predictive value of 73.5. Conclusion: The three-item Korean Migraine Screening Questionnaire was a valid and reliable migraine screening instru- ment in outpatient setting. It could help in improvement of migraine diagnosis and enhance migraine management.

한국인 두통 환자에서 두통 발작 시 냄새공포증과 무전조편두통 대체 진단기준의 타당도 평가: Ji-Young Kim, Min-Kyung Chu, Kyung-Ho Yu, Hyeo-Il Ma, Yun Joong Kim, Joo-Yong Kim, Byung-Chul Lee; Korean J Headache. 2007;8(2):92-96. Published online December 31, 2007

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Abstract PDF: Background
Sensory system may be activated during migraine attacks. Visual and auditory system activation have been addressed and implicated as an item of ICHD-II migraine diagnostic criteria. Recently the activation of olfactory systems during migraine attack has been occasionally commented. The object of this study is to assess osmophobia and validation of alternative diagnostic criteria of migraine without aura in Korean headache patients Methods: One hundred eighteen headache patients who visited outpatient clinic from August 2007 to October 2007, were evaluated for characteristics and associated features of headache such as frequency, duration, location, quality of pain, nausea, vomiting, photophobia, phonophobia and osmophobia. Osmophobia was classified as hyperosmia, hyposmia and dysosmia. Results: Eighty patients(67.8%) were diagnosed as having migraine and twenty four patients(20.3%) were diagnosed as having tension-type headache according to ICHD-II. Six patients were diagnosed as having probable migraine, two patients were diagnosed as having probable tension-type headache, two patients were diagnosed as having cluster headache and four patients were diagnosed as other primary headache. Thirty one patients complained of osmophobia during headache(90.3% very frequently and 9.7% frequently). Thirteen of them reported hypersomia (41.9%), seventeen reported dysosmia(54.8%) and one reported hyposmia(3.3%). All patients who complained of osmophobia during headache attacks were migraneurs. According to alternative diagnostic criteria of migraine without aura, 61 patients were diagnosed as having migraine without aura. Sensitivity of alternative diagnostic criteria was 0.85(95% CI, 0.74- 0.91) and specificity was 1.00(95% CI, 0.93-1.00). Conclusions: Osmophobia was observed in around 40% of migraineurs and was specific to migraine. Alternative dia- gnostic criteria of migraine without aura may be a valid method of classification.

베타차단제로 호전을 보인 반복적이고 일시적인 한쪽 눈의 시각 이상 1례 - 망막편두통의 변형인가? -: Sung-Jin Kang, Jong Kuk Kim, Min-Jeong Kim, Bong-Goo Yoo, Kwang-Soo Kim, Myong-Jin Kang; Korean J Headache. 2007;8(2):97-99. Published online December 31, 2007

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Abstract PDF: Retinal migraine is a rare and poorly understood migraine variant. Vasospasm of the retinal or ophthalmic artery is thought to be the cause of the amaurosis of ocular migraine. Transient visual disturbance and headache fulfilling the criteria for migraine are essential for diagnosis. However, some cases were reported without classical headache attack. We report a case of recurrent transient monocular blindness without accompanying headache improved by beta-blocker.

Acyclovir로 유발된 가역적 후백질뇌병증 1례: Sang Uk Ha, Seong Jin Kang, Min Jeong Kim, Jong Kuk Kim, Bong-Goo Yoo, Kwang-Soo Kim; Korean J Headache. 2007;8(2):100-102. Published online December 31, 2007

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Abstract PDF: Acyclovir is an effective agent for the treatment of herpes simplex and herpes zoster infections. Encephalopathy induced by acyclovir is an infrequent but well recognized adverse effect of acyclovir. But reversible posterior leukoen- cephalopathy(RPLE) induced by acyclovir is much less frequent, and there has been no report in Korea. We report a patient who developed RPLE after parenteral acyclovir administration.

두통을 주소로 진단된 급성 반구간 경막하 출혈 2례: Ki Moo Hong, Sang Won Ha, Sang Eun Park, Jeong Seon Cho, Kyung Mo Ahn, Doo Eung Kim, Eun Kyoung Cho, Jeong Ho Han; Korean J Headache. 2007;8(2):103-105. Published online December 31, 2007

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Abstract PDF: Interhemispheric subdural hemorrhage(ISH) is a rare and distinct type of subdural hemorrhage because of their unusual location. The patients with ISH usually reported a sudden onset of painful headache with other neurological deficiencies. In this paper, we report unusual two cases of ISH presenting headache as the sole complaint. ISH should be considered among the diagnostic possibilities in elderly patients who present with headache as the sole symptom without other clinical features such as meningeal irritation signs, focal neurological defect and alteration of consciousness.

증례 : 방사선동위원소 뇌수조조영술을 위한 요추천자 후 경질막밑출혈의 악화를 보였던 자발두개내압저하 환자: Yong-Jin Cho, Keun-Sik Hong, Moon-Jun Son, Won-Joo Choe; Korean J Headache. 2007;8(2):106-109. Published online December 31, 2007

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Abstract PDF: The nature and clinical relevance of subdural hemorrhage(SDH) in patient with spontaneous intracranial hypotension (SIH) remain unclear. We report two cases of SIH with SDH, and suggest optimal procedure for diagnosis and treatment. Forty three and 31-year-old men presented with severe orthostatic headache, and cranial magnetic resonance imaging showed bilateral subdural hematomas and diffuse meningeal enhancement. There were no history of head trauma and lumbar puncture. Indium-111 Radioisotope cisternography through lumbar puncture showed multiple CSF leaks along the spinal axis. Orthostatic headache disappeared after treatment with epidural blood patch. However, those patients showed drowsy mentality in a few days. Brain CT revealed increased amount of SDH. Surgical removal of subdural hematoma was performed. Both patients were recovered and did not complain orthostatic headache any more. We suggest that additional epidural blood patch at the site of lumbar puncture could be helpful to prevent potential CSF leakage.

증례 : 뇌실염과 뇌농양이 합병된 전격적인 크렙시엘라 뇌막염 1례: Joong-Yang Cho, So-Young Park, Dong-Ha Lee, So-Young Seo, Yong-Jin Cho, Han-Joon Kim, Keun-Sik Hong; Korean J Headache. 2007;8(2):110-112. Published online December 31, 2007

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Abstract PDF: Klebsiella pneumoniae is a rare, but important cause of community-acquired meningitis. We report a case of fulminant Klebsiella pneumoniae meningitis complicated with ventricultis and brain abscess. A 65-year-old man admitted because of headache. He had a history of bacterial meningitis 6-months ago. The findings of CSF profile and culture was compatible with Klebsiella pneumoniae meningitis. Rapid progression of ventriculitis was found in a few days. Even though the ventriculitis improved, brain abscess developed in 25 days later.

서평: Korean J Headache. 2007;8(2):113-114. Published online December 31, 2007

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