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- Volume 10(1); June 2009
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- 두통의 진단과 분류
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Jae-Moon Kim
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Korean J Headache. 2009;10(1):1-13. Published online June 30, 2009
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- Most of headache is primary headache and optimal diagnosis needs proper and time consuming history taking. Information attained by thorough history taking and additional physical and neurological examination should be fit to the diagnostic criteria of each headache disorders. Laboratory tests or imaging studies are usually necessary in the patients with atypical symptoms or neurologic abnormalities, and intractable or progressive headache in spite of optimal treatment. After the long debate of headache classification, currently using IHS(international headache society) classification made correct diagnosis and sharing information possible in the field of headache. As headache is one of the common illnesses that significantly impair quality of life in human, even primary physician should be acquainted with this classification and diagnostic criteria.
- 편두통 치료: 급성기 치료
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Kyungmi Oh
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Korean J Headache. 2009;10(1):14-18. Published online June 30, 2009
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- Migraine is a lifelong disabling recurring primary headache disorder. The ideal aims of acute therapy of migraine are rapid relief of pain and associating symptoms, no side effects, and no recurrence. Doctors should educate their patients to understand migraine before starting treatment. Furthermore, patients and doctors should discuss about their lifelong plan for migraine therapy. Many different medications have been used for acute therapy of migraine. But, only some drugs among them have sufficient evidence for use. I tried to review the strategies for acute treatment of migraine and introduce various medications for reducing migraine pain.
- 편두통 예방치료
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Jae-Myun Chung, Min-Kyung Chu
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Korean J Headache. 2009;10(1):19-34. Published online June 30, 2009
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- Migraine is a chronic recurrent headache disorder that is common in general population. Its burden of socioeconomical aspect as well as personal psychologic aspect makes migraine as one of the most disabling disorders. In addition to acute treatment of migraine, preventive treatment is required in those with frequent or disabling attacks of migraine to minimize the disability, to prevent medication overuse, and to improve the quality of life. In this review, we discuss the principles of migraine prevention, and clinical applications of medications for this purpose which include beta blockers, calcium channel blockers, antidepressants and anticonvulsants as well as newly emerging drugs such as angiotensin-converting enzyme inhibitor, angiotensin-receptor blocker, coenzyme Q10, riboflavin and magnesium. Nonpharmacologic management for migraine prevention is an another important treatment strategy. Considering underdiagnosis and undertreatment of migraine, the knowledge about applying appropriate preventive management is essential for any physician irrespective of specialty.
- 긴장형 두통
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Jin Young Ahn, Byung Kun Kim
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Korean J Headache. 2009;10(1):35-46. Published online June 30, 2009
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- Tension-type headache (TTH) is the most common type of primary headache disorder. However TTH is an ill-defined and heterogeneous syndrome, which is diagnosed mainly be the absence of features of other headache disorders especially migraine. Despite the high prevalence and impact, knowledge about pathogenesis of TTH is still limited. Peripheral myofascial mechamism and central pain processing mechanism are implicated but their role in pathogenesis of TTH varies with the frequency of headache and among patients. Chronic tension type headache differs from episodic form in frequency, lack of response to treatment, more medication overuse, and more impact on quality of life.
- 삼차자율신경두통의 진단과 치료
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Jin Kuk Do
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Korean J Headache. 2009;10(1):47-58. Published online June 30, 2009
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- The trigeminal autonomic cephalalgias (TACs) are a group of primary headache syndromes which are characterized unilateral recurrent severe headache with autonomic dysfunction. 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). Cluster headache is the most common of this headache syndrome, while others(paroxysmal hemicranias, and SUNCT) are rarer. Cluster headache has the longest attack duration and relatively low attack frequency. Paroxysmal hemicranias have intermediate duration and frequency. SUNCT have the shortest attack duration and the highest frequency. These headache syndromes typically are marked by very severe pain and if not treated correctly can produce lifelong disability. This review gives an overview for TACs, recent pathophysiological findings and recognized treatments.
- 만성매일두통: 변형편두통, 만성긴장형두통, 약물과용두통
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Chin-Sang Chung
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Korean J Headache. 2009;10(1):59-65. Published online June 30, 2009
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- About one out of 25 adults suffers headache almost everyday, which is called chronic daily headache (CDH). The term ‘CDH’ represents a combination of various kinds of headache disorders, including primary chronic migraine or transformed migraine, chronic tension-type headache, new daily persistent headache, hemicrania continua, and so on. The patients are usually refractory to standard treatments and have a strong tendency to overuse or abuse medications. To provide an updated insight on CDH, the author has reviewed the pathomechanisms, clinical diagnosis and general and specific principles of management of the individual types of CDH.
- 벼락두통을 포함한 응급두통
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Soo-Jin Cho
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Korean J Headache. 2009;10(1):66-71. Published online June 30, 2009
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- Headache is a common complaint encountered in the emergency room and can be caused by life threatening serious diseases. After history taking & examination, brain imaging and/or spinal fluid examination are mandatory for patients with first ever severe headache or abnormal neurological findings. In addition, the physician’s roles in the emergency department are to control the pain and to refer these patient to follow up visits to start effective therapy for future recurrence. Thunderclap headache is a headache that begins suddenly and is maximum in intensity at onset. A lot of intracranial illnesses cause thunderclap headache. For example, there are subarachnoid hemorrhage, cerebral venous sinus thrombosis, stroke, spontaneous intracranial hypotension, and reversible cerebral vasoconstriction syndrome. However, more than half of those with thunderclap headache have normal imaging and cerebrospinal fluid examination and primary thunderclap headache can be suspected in case with prolonged symptom. Primary cough headache and exertional headache is suspected in the cases with recurrent headaches in a special situation.
- 기타 원발두통
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Jun Hyun Shin, Hong Ki Song
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Korean J Headache. 2009;10(1):72-78. Published online June 30, 2009
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- Other primary headache includes primary stabbing headache, primary cough headache, primary exertional headache, primary headaches associated with sexual activity, hypnic headache, primary thunderclap headache, hemicrania continua and new daily persistent headache. Compared to migraine and tension type headache, they are less common in incidence and their pathogenesis is also less clearly documented. To diagnose and proper management of primary headahce, first we should exclude the possibility of secondary cause of headache.
- 측두하악장애와 두통의 연관성
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Young Joo Shim, Seong Taek Kim
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Korean J Headache. 2009;10(1):79-83. Published online June 30, 2009
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- Temporomandibular disorders (TMD) is a collective term embracing a number of clinical problems that involving the masticatory musculature, the TMJ and associated structures, or both. Both headache and TMD are highly prevalent in the general population. These conditions can be disabling and might represent a real contemporary health problem. Although the published estimates of the prevalence of headache and TMD vary widely, some authors have proposed that headache and TMD may related. Among the TMD, myofascial pain has been reported the most common disorder that related to headache. In the previous studies, the central sensitization following continuous nociceptive input of myofascial pain may play a important role in the pathogenesis of migraine and the mechanisms probably involves activation of N-Methyl-DAspartate (NMDA) receptors and production of Nitric Oxide (NO). Therefore the therapy for myofascial pain enhancing central inhibition through pharmacological management or behavioral interventions and simultaneously reducing peripheral inputs through physical therapies, orthopedic appliances and trigger point injections, can be considered as an effective treatment.
- 두통의 해부학 및 생리학
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Gun-Sei Oh, Hee-Jun Park
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Korean J Headache. 2009;10(1):84-95. Published online June 30, 2009
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- Understanding the anatomy and physiology of pain transmission system is important for the pain management. Some types of headaches, including migraine, are caused by activity in nociceptive afferents that innervate the cranial meninges, particularly the dura mater encephali and large intracerebral blood vessels. Pain can be evoked by electrical, mechanical, thermal, or chemical stimulation of dural blood vessels and sinuses or large intracerebral arteries. Importantly, the painful sensations were referred to the trigeminal dermatomes where typically headaches are localized. This article reviews the transmission of a nociceptive or pain impulse from the site of stimulus in the trigeminal nervous system to the central nervous system. The basic anatomic pathways of nociceptive transmission and of descending nociceptive modulations are described. The studies reviewed here likely apply more to acute pain than to chronic pain. It is now widely believed that stimulation of a primary afferent neuron in the peripheral nervous system results in activation of neurons in the dorsal horn of the spinal cord or the trigeminal brain stem nuclear complex, and then in transmission rostrally to the brain.
- 트립탄 투여 후 발생한 뇌경색이 없는 지속조짐 1예
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Ka Young Choi, Kon Hee Lee
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Korean J Headache. 2009;10(1):96-99. Published online June 30, 2009
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- Persistent aura without infarction (PAWOI) is diagnosed when aura symptoms persist for more than 1 week without radiographic evidence of infarction and unaccounted for another condition at the patient with migraine with aura. We report a case of PAWOI aggravated by triptans. Fifteen years-old girl had severe headaches which started 2 years ago, which was more frequently occurred from 9 month ago. Nausea, vomiting, photophobia and phonophobia were accompanied with her headache. She frequently saw flashing lights just before beginning of headache. On the first visit of our clinic, she was diagnosed with migraine with visual aura and was prescribed with sumatriptan 50mg twice a day for PRN use. Shortly after taking sumatriptan, she experienced sensory changes and weakness of four extremities, which caused paralysis of lower extremities, especially right side. Laboratory findings were normal in CSF study, brain MRI and MRA, SPECT, EMG and NCV. Careful history taking revealed that she had various focal neurologic symptoms such as hypercusia, tinnitus, loss of consciousness, vertigo, diplopia, visual symptoms and weakness. She was diagnosed with basilar-type migraine, sporadic hemiplegic migraine and PAWOI provoked by triptan. After 21 days, she was fully recovered. On discharge she was received topiramate and verapamil for prophylaxis. Two years later, she was admitted for persistent sensory symptoms and losing strength in her right leg after taking naratriptan 2.5 mg twice a day from another clinics. She was discharged after 3 weeks with full recovery. PAWOI is uncommon, but one should be cautious to use triptans for basilar-type migraine or hemiplegic migraine in adolescents.
- 수영과 관련되어 발생한 두통 1예
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Hak Young Rhee, Sung Hun Kim, Sang-Beom Kim, Won-Chul Shin
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Korean J Headache. 2009;10(1):100-102. Published online June 30, 2009
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- 시대상에 따른 두통 개념의 변천
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Korean J Headache. 2009;10(1):103-104. Published online June 30, 2009
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- 대한두통학회 회칙
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Korean J Headache. 2009;10(1):109-111. Published online June 30, 2009
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- 대한두통학회-보령학술상에 대한 포상규정
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Korean J Headache. 2009;10(1):112-112. Published online June 30, 2009
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