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- Volume 12(1); June 2011
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- 통증의 해부학 및 생리학
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Gun-Sei Oh
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Korean J Headache. 2011;12(1):1-15. Published online June 30, 2011
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Abstract
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- Acute, nociceptive pain results from the complex convergence of many signals traveling up and down the neuraxis and serves to warn us of impending harm. Recently, considerable advances have been made in knowledge of nocicep- tive transmission. It is now widely believed that stimulation of primary afferent neurons in the peripheral nervous system results in activation of neurons in the dorsal horn of the spinal cord and then in transmission rostrally to the brain. This article reviews the transmission of a nociceptive or pain impulse from the site of stimulus in the peripheral to the central nervous system. The basic anatomic pathways of nociceptive transmission and descending nociceptive modula- tions are described. Some of the basics of physiology also are discussed. The studies reviewed here is likely apply more to acute pain than to chronic pain, because most of the experimental paradigms used are more closely analogous to the injury of acute pain than chronic pain.
- 보툴리눔 독소 A의 통증 완화 기전
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Gyoung Im Suh, Jung Wook Park
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Korean J Headache. 2011;12(1):16-20. Published online June 30, 2011
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- The aim of this paper is to review mechanism of action of botulinum toxin A in pain relief. Botulinum toxin A used as treatment for various conditions related to excessive muscle spasm. However, desirable effect of botulinum toxin for pain has been detected in a way to treat disease with myogenic condition and now it has been tried for management of myofascial pain, low back pain and various types of headaches, including migraine. Recent studies suggested possibility of botulinum toxin in pain reduction through central pathway.
- 보툴리눔 독소의 두통 치료
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Heui-Soo Moon
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Korean J Headache. 2011;12(1):21-26. Published online June 30, 2011
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Abstract
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- Clinical data and experience to date have demonstrated that botulinum toxin is an effective and well-tolerated therapy for several headaches, especially chronic migraine(CM). CM is a severely disabling condition and has been showed to significantly reduce patients’ quality of life. Current treatment of CM may be complicated by the frequent use of acute headache pain medications such as analgesics, triptans, or ergots. Botulinum toxin reduced headache and migraine days and frequency of moderate to severe headache days with botulinum toxin, which in turn reduced the burden of illness in patients with disabling CM. Further investigations will define the accurate pathophysiologic mechanisms of botulinum toxin in the headache management. Further studies are needed in order to compare the efficacy of botulinum toxin with other prophylactic drugs.
- 보툴리눔 치료의 주사방법
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Kwang-Soo Lee, Yoon-Sang Oh
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Korean J Headache. 2011;12(1):27-30. Published online June 30, 2011
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- Chronic migraine is a prevalent and disabling neurological disorder. Preventive treatments are designed to reduce the fre- quency, severity, or duration of migraine attacks. Preventive agents include beta-adrenergic blockers, antidepressants, calcium channel antagonists, serotonin antagonists and anticonvulsants. Although daily oral prophylactic treatments have proven effective, issues such as lack of compliance with daily dosing regimens and adverse effects have limited their usefulness and resulted in a search for other modalities and agents, including botulinum neurotoxin. At 2010, the phase III research evaluating migraine prophylaxis therapy(PREEMPT) paradigm for injecting onabotulinumtoxin A has been shown to be safe, well tolerated, and effective in well designed, controlled clinical trials and was approved by USA, England and Korean FDA.
- 치과 임상에서 보툴리눔 독소의 적용
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Young Gun Kim, Ji Hee Song, Seong Taek Kim
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Korean J Headache. 2011;12(1):31-37. Published online June 30, 2011
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- Botulinum toxin type A(BTX-A), a potent neurotoxin that reversibly blocks presynaptic acetylcholine release, has been applied successfully to treat facial spastic conditions such as blepharospasm, strabismus and cervical dystonia. Since the first reported application in dentistry in 1994, BTX-A has been used with great success to use in the orofacial region to help treat masticatory and facial muscle spasm, hypertrophy of the masticatory muscles, severe bruxism, temporomandibular pain and orofacial neuropathic pain. This review addresses the application of BTX-A in clinical dentistry that expands the indication recently.
- 편두통, 난원공개존증, 뇌졸중
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Soo-Jin Cho
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Korean J Headache. 2011;12(1):38-41. Published online June 30, 2011
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- Traditional concepts of migraine as a benign recurrent headache have been challenged. Recent epidemiologic studies suggest that migraine is related to white matter hyperintensities or silent infarcts. The relation between silent infarcts is more evident in migraine with aura. The risks of symptomatic ischemic or hemorrhage stroke and cardiovascular disease are also increased in migraine in some epidemiologic studies. Although, there are some critics about the possible error in classification of headache or exaggeration of small burden, the association between migraine and vascular disease looks like more than causal. Patent foramen ovale is the possible mediator of the association. Patent foramen ovale is frequently detected in migraine patient, especially in migraine with aura. Empirical data have suggested that closure of patent foramen ovale was effective in improving symptoms of migraine. Although a recent randomized controlled trial failed to prove this hypothesis, microembolisation through right-left shunt can evoke migraine attack and silent infarcts in some experi- mental studies. Therefore, the concept of migraine as a chronic or progressive disorder may highlight the importance of proper management and preventive therapy of migraine.
- 소아청소년에서 편두통과 간질
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Young-il Rho
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Korean J Headache. 2011;12(1):42-48. Published online June 30, 2011
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- Migraine and epilepsy are two of the most common disorders observed in child neurology. Migraines are certainly more commonly seen in children than epilepsy. Epilepsy is a relatively less common condition in children and adoles- cents with a prevalence of about 0.5%, which is approximately 20 times less common than migraine. Peri-ictal heada- ches are very common and migralepsy is very rare because the threshold required for seizure onset and propagation is higher than that of migraine onset. Both entities that share many clinical features, arise from the cerebral cortex modulated by subcortical connections. Although sharing similar clinical features, there are distinguishing historic aspects that may help define one condition from the other. However, the clinical distinction between migraine and epilepsy can be difficult and diagnosis problematic. Anticonvulsants that are designed for epilepsy are typically also efficacious in the prevention of migraine and when used can often reduced the frequency of events and improve quality of life. Therefore, it is important for the practi- tioner to ask about headaches in epileptic patients and to consider about epileptic events in headache patients.
- 심도의 편두통관련 장애와 관계된 인자
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Hye-Lim Kim, Mi-Sun Oh, Kyung-Ho Yu, Hyeo-Il Ma, Joo-Yong Kim, Byung-Chul Lee, Min-Kyung Chu
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Korean J Headache. 2011;12(1):49-56. Published online June 30, 2011
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- Background
Migraine is a heterogeneous condition that results in a spectrum of disability among individuals. Under- standing factors associated with severe disability of migraine is an important step towards optimizing interventions. Objective: To describe factors associated with severe migraine-related disability. Methods: We assessed factors of severe disability in univariate and multivariate analyses. Multivariate analyses were adjusted for demographic factors, clinical features, headache severity and frequency. Results: One hundred and ninety migraine patients were enrolled in this study. In the unadjusted univariate analyses, severe pain was associated with severe disability compared to mild pain. Aggravation by routing physical activity, pho- tophobia, visual aura and eyeball pain were associated with severe disability of migraine. Taking less than 4 headache days per month as the reference, ≥15 headache days per month was associated with severe disability. In the adjusted multivariate analyses, aggravation by routine physical activity, visual aura and ≥15 headache days per month were associated with severe migraine-related disability. Conclusions: These results demonstrated that a significant proportion of migraine sufferers had severe disability and there are specific factors associated with severe disability.
- 한국인 인구집단에서 교육수준이 긴장형두통의 유병률에 미치는 영향
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Dong-Won Lee, Yang-Ki Minn, Min Kyung Chu, Kyung-Mi Oh, Byung-Kun Kim, Kwang Soo Lee, Soo-Jin Cho
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Korean J Headache. 2011;12(1):57-60. Published online June 30, 2011
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- Objective: Education reflects socioeconomic status and may influence pain modulation or thresholds in primary headache disorders. Tension-type headache(TTH) is the most common type of primary headache and the influence of education on the prevalence of TTH has not been well evaluated. The aims of this study were to evaluate the asso- ciation between education level and the prevalence of TTH and the influence of other contributors. Methods: For this study, a stratified random population sample of Koreans, over the age of 19, was selected and evalua- ted using a 12-item, semi-structured interview designed to identify headache type using ICHD-2 criteria. Education levels were classified into college, high school, and middle school or below. Household income and occupation were evaluated as contributors. Results: Among 1507 participants, 463(30.7%) were diagnosed with TTH; 228 were frequent episodic TTH, 224 were infrequent episodic TTH, and 11 were chronic TTH. College level was associated with a lower prevalence of tension-type headache(25.8% vs 33.8% in high school, 32.9% in middle school or below, p=0.006). Prevalence of frequent episodic TTH was lower in college graduate(p=0.002). After adjusting age, gender, and income, education level is the significant contributor for prevalence of TTH. Conclusions: Among variables of socioeconomic status, education is the important modulator of TTH, especially in women.
- 소아 단기지속두통
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Joon Woo Baek, Young Suk Shim, Sung Koo Kim, Kon-Hee Lee
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Korean J Headache. 2011;12(1):61-67. Published online June 30, 2011
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- Objective: In children primary recurrent headaches mainly consist of migraine and tension-type headache. Durations of them are 1 to 72 hours, 30 minutes to 7 days respectively. Short-lasting headache(SLH), which durations of headache are less than 30 minutes, could also be rarely found in children. This study aims to assess clinical characteristics, treatment and prognosis of pediatric SLH. Methods: Between October 2006 and July 2009, there were 480 recurrent headache patients in pediatric headache clinic at Kangnam Sacred Heart Hospital of Hallym University. Among them, the number of patients with SLH was 27(5.6%) and they were evaluated with headache questionnaires, imaging studies and viral tests etc. After treatment, follow-up survey was conducted via telephone interview about headaches and the effect on timing of treatment was compared in pediatric SLH. Results: The majority of SLH patients(81.5%) were school age children. Their mean age was 9.3±3.3 years old. Head- ache duration was less than 3 minutes in 85.2%. In 81.5% of patients the frequency of headaches was less than 10 times per week, and most patients(85.2%) had moderate or severe pain. Most patients(85.2%) were treated for 48±55 days(2-36 months). After treatment, headaches almost disappeared or reduced mildly. In addition the early treatment was more effective than late treatment for controlling headaches of pediatric SLH. Conclusion: SLH could also occur in children, although they were not diagnosed correctly as adults by ICHD-2 criteria. Most of their age was more than 6 years old, the pain lasted less than 3 minutes. Although the intensity of the pain was more than moderate degree it had good responses for the treatment. We need a better understanding and further study of pediatric SLH.
- 무균뇌수막염이 선행된 조직구 괴사림프절염
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Woo Ho Han, Dong Kuck Lee, Doo Hyeuk Kwon, Yoon Ho Kim
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Korean J Headache. 2011;12(1):68-70. Published online June 30, 2011
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- Histiocytic necrotizing lymphadenitis is a benign disease of the lymph node and spontaneously recovered within 4 to 6 months. Involvement of central nervous system rarely occurs as a form of aseptic meningitis. A 20 year-old woman presented with fever and headache. CSF studies revealed pleocytosis and elevated protein levels. Her symptoms were improved without specific management, but after several days generalized edema, multiple arthralgia and painful lymph node swelling with leukopenia were developed. A cervical lymph node biopsy disclosed necrotizing lymphadenitis. We report a patient with necrotizing lymphadenitis followed by aseptic meningitis.
- 망막편두통과 유사한 고혈당성 단안시각증상
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Ji-Hyun Lee, Woo-Joo Choi, Yoo-Kyung Kim, Min-Woo Ku, Yang-Ki Minn, Ki-Han Kwon, Soo-Jin Cho
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Korean J Headache. 2011;12(1):71-73. Published online June 30, 2011
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- Retinal migraine is a rare subtype of migraine characterized by recurrent monocular visual symptoms(MVS). Severe hyperglycemia can cause chorea, seizure, or coma, but its association with retinal migraine has rarely been reported. A 54-year-old migraineur with diabetes mellitus complained of bright light in his left eye. MVS lasted from 2 to 3 minutes, recurred 5 to 50 times a day, and sometimes were followed by severe right-side headaches. Three years ago, he had had recurrent MVS associated with a colorful rainbow in the left eye, after discontinuing oral hypogly- cemic agents by his own volition. Hyperglycemia (613 mg/dl) and elevated glycosilated haemoglobin(10.5%) were detected. Initial and second EEGs, brain MRIs and MR angiography did not reveal any significant abnormalities. MVS decreased with improved glycemic and headache control and finally ceased in 3 weeks. MVS can develop due to hyperglycemia, and may be related to neuronal hyperexcitability or spreading depression.
- 비출혈을 동반한 편두통 2례
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Jun-Beom Lee, Kwang-Hoon Kim, Ki-Hun Baek
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Korean J Headache. 2011;12(1):74-76. Published online June 30, 2011
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- We report two cases of migraine accompanying epistaxis. These attacks of epistaxis are not explained by reasons other than migraine attack. A 49-year-old woman had migraine with epistaxis for 6 years. She had nasal plastic surgery 15 years ago but rhinoscopy revealed no focal bleeding focus on Kisselbach plexus. Blood tests including platelet count and coagulation factors were normal. We prescribed her daily dose of acetaminophen 975mg along with dichloral- phenazone 300mg and isometheptene mucate 195mg. The incidence and severity of migraine reduced and epistaxis did not relapse. A 19-year-old woman had migraine attack once every one or two days for one month and experienced accompanying epistaxis one third of the frequency of headache attacks. Brain computed tomography, rhinoscopy, platelet count and coagulation factor tests were normal. Epistaxis following migraine attacks did not relapse after daily dose of acetaminophen 1,875mg. These cases suggest that migraine with epistaxis shares same pathophysiology.
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