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Most-download articles are from the articles published in 2022 during the last three month.

Review Articles
Treatment Strategies of Medication Overuse Headache
Mi-Kyoung Kang, Jong-Hee Sohn
Korean J Headache. 2023;24(2):33-38.   Published online December 31, 2023
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  • 36 Download
AbstractAbstract PDF
Medication overuse headache (MOH) is a common secondary headache disorder in which chronic headaches develop or worsen due to frequent and excessive intake of medications used for acute headache treatment. While the concept of MOH is widely recognized among headache specialists, ongoing debates exist regarding its causes, diagnostic criteria, and treatment strategies. Treating MOH has traditionally been challenging, and there is currently no universal consensus on how to effectively manage patients with MOH. Furthermore, a specific treatment approach based on well-powered randomized trials is still lacking. The treatment strategy for MOH typically involves several steps: patient education and counseling, withdrawal of overused medications, preventive drug therapy, and non-pharmacological prevention. It is recommended that all patients discontinue the overused medication, which can be carried out on an outpatient or inpatient basis. Additionally, topiramate, Botox, and anti-calcitonin gene-related peptide monoclonal antibodies have shown potential in reducing headache and migraine frequency, as well as acute drug consumption, even without active drug withdrawal. However, many aspects of MOH management require further investigation through properly designed and adequately powered randomized controlled trials.
Update on Cluster Headaches: From Genetic to Novel Therapeutic Approaches
Myun Kim, Je Kook Yu, Yoo Hwan Kim
Headache Pain Res. 2024;25(1):42-53.   Published online April 22, 2024
DOI: https://doi.org/10.62087/hpr.2024.0009
  • 321 View
  • 12 Download
AbstractAbstract PDF
Cluster headaches affect 0.1% of the population and are four times more common in males than in females. Patients with this condition present with severe unilateral head pain localized in the frontotemporal lobe, accompanied by ipsilateral lacrimation, conjunctival injection, nasal congestion, diaphoresis, miosis, and eyelid edema. Recently, the first genome-wide association study of cluster headaches was conducted with the goal of aggregating data for meta-analyses, identifying genetic risk variants, and gaining biological insights. Although little is known about the pathophysiology of cluster headaches, the trigeminovascular and trigeminal autonomic reflexes and hypothalamic pathways are involved. Among anti-calcitonin gene-related peptide monoclonal antibodies, galcanezumab has been reported to be effective in preventing episodic cluster headaches.
Original Article
Associations of Migraine and Tension-type Headache with Glaucoma
Jong-Ho Kim, Young-Suk Kwon, Sang-Hwa Lee, Jong-Hee Sohn
Headache Pain Res. 2024;25(1):54-62.   Published online March 29, 2024
DOI: https://doi.org/10.62087/hpr.2024.0002
  • 427 View
  • 12 Download
AbstractAbstract PDF
Purpose: It remains unclear whether primary headaches, particularly migraine, are associated with glaucoma. We investigated potential associations between primary headaches, including migraine and tension-type headache (TTH), and primary glaucoma, including open-angle glaucoma (OAG) and closed-angle glaucoma (CAG).
Methods
We used data from the Clinical Data Warehouse collected between 2008 and 2023 to investigate whether migraine and TTH influence the risk of primary glaucoma. We compared the prevalence of primary glaucoma, including OAG, CAG, other glaucoma, and total glaucoma (TG), among patients with migraine, those with TTH, and controls.
Results
This study analyzed 46,904 patients with migraine, 48,116 patients with TTH, and 455,172 controls. Controls were selected based on propensity score matching (PSM). After adjustment for covariates and PSM, the fully adjusted odds ratios (ORs) for patients with migraine were 1.83 for OAG (95% confidence interval [95% CI], 1.33–2.51; p<0.004) and 1.55 for TG (95% CI, 1.26–1.91; p<0.004) compared to controls. Furthermore, in patients with TTH, the ORs for CAG were 2.20 (95% CI, 1.40–3.47; p<0.004) compared to controls. Additionally, patients with migraine had fully adjusted ORs of 1.71 for OAG (95% CI, 1.24–2.36; p<0.004) and 1.41 for TG (95% CI, 1.15–1.73; p<0.004) compared to those with TTH.
Conclusion
Migraine is associated with primary glaucoma, particularly OAG.
Review Article
Application and Effectiveness of Dietary Therapies for Pediatric Migraine
Ji-Hoon Na
Headache Pain Res. 2024;25(1):34-41.   Published online April 17, 2024
DOI: https://doi.org/10.62087/hpr.2024.0007
  • 330 View
  • 11 Download
AbstractAbstract PDF
Migraine is a representative type of primary headache and a common chronic neurological disease that accounts for a large proportion of headaches in children, adolescents, and adults. Unlike migraine in adulthood, pediatric migraine occurs when brain development is not yet complete. This characteristic may require a new perspective for the treatment and management of pediatric migraine. Dietary therapies, mainly the ketogenic diet and its variants, can have positive effects on pediatric migraine. Several recent studies have revealed that dietary therapies, such as the classic ketogenic diet, modified Atkins diet, and low glycemic index diet, improve various neurological diseases by improving dysbiosis of microbiota, reducing proinflammatory cytokines, and increasing mitochondrial function. Nonetheless, the mechanism through which active dietary therapy affects pediatric migraine requires further research. To achieve this, an important role is played by the neuro-nutritional team, which can develop and manage tolerable diets for pediatric migraine patients through mutual collaboration among pediatric neurologists, nurses, and nutritionists.
Editorial
Migraine in Women: Inescapable Femaleness?
Soo-Kyoung Kim
Headache Pain Res. 2024;25(1):1-2.   Published online April 24, 2024
DOI: https://doi.org/10.62087/hpr.2024.0010
  • 166 View
  • 9 Download
PDF
Review Articles
COVID-19 Infection-related Headache: A Narrative Review
Yoonkyung Chang, Tae-Jin Song
Headache Pain Res. 2024;25(1):24-33.   Published online April 2, 2024
DOI: https://doi.org/10.62087/hpr.2024.0008
  • 396 View
  • 9 Download
AbstractAbstract PDF
Severe acute respiratory syndrome coronavirus 2 is the virus responsible for coronavirus disease 2019 (COVID-19), which caused a global pandemic and then became an endemic condition. COVID-19 infection may be associated with clinical manifestations such as respiratory symptoms and systemic diseases, including neurological disorders, notably headaches. Headaches are a common neurological symptom in individuals infected with COVID-19. Furthermore, with the transition to endemicity, COVID-19 infection-related headaches may reportedly persist in the acute phase of COVID-19 infection and in the long term after COVID-19 infection resolves. Persistent headaches after COVID-19 infection can be a significant concern for patients, potentially leading to disability. The present review discusses the clinical characteristics and potential underlying mechanisms of COVID-19 infection-related headaches.
Diagnosis and Treatment of Hemicrania Continua, Paroxysmal Hemicrania, Short-lasting Unilateral Neuralgiform Headache Attacks
Sang-Hwa Lee, Mi-Kyoung Kang, Soo-Jin Cho
Korean J Headache. 2023;24(2):39-44.   Published online December 31, 2023
  • 195 View
  • 16 Download
AbstractAbstract PDF
Chronic paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua are rare headache disorders characterized by severe unilateral headache accompanied by ipsilateral autonomic symptoms. Accurate diagnosis and specific treatment approaches for these conditions are crucial for appropriate management. This article covers the clinical features, diagnostic criteria, and treatment strategies of each disorder, aiming to differentiate them from other major headaches and provide targeted treatment strategies to improve patient outcomes.
Original Articles
Cluster Headache Characteristics and the Severity of Obstructive Sleep Apnea: Insights from Polysomnography Analysis
Yooha Hong, Mi-Kyoung Kang, Min Kyung Chu, Soo-Jin Cho, Hee-Jin Im
Headache Pain Res. 2024;25(1):63-71.   Published online April 16, 2024
DOI: https://doi.org/10.62087/hpr.2024.0001
  • 216 View
  • 7 Download
AbstractAbstract PDF
Purpose: Cluster headache (CH) is characterized by circadian rhythmicity of the attacks, and it is known to respond exceptionally well to oxygen therapy. Furthermore, obstructive sleep apnea (OSA) frequently co-occurs with CH, and both conditions may be parallel outcomes of hypothalamic dysfunction rather than being causally related. The aim of this study was to analyze the association between CH characteristics and polysomnographic factors stratified by the severity of OSA in patients diagnosed with CH and OSA.
Methods
We retrospectively analyzed the data of OSA patients with CH who were enrolled in the Korean Cluster Headache Registry and underwent polysomnography due to clinical suspicion of OSA. Basic demographic data, headache-related parameters, and polysomnographic parameters were analyzed according to the severity of OSA (apnea-hypopnea index: <15 or ≥15 per hour).
Results
Twelve CH patients with OSA were evaluated. The onset age of CH was higher (38.5 years vs. 19.0 years, p=0.010), and the maximal duration of cluster bouts was longer (156.5 days vs. 47.0 days, p=0.037) in the moderate-to-severe OSA group than in the mild OSA group. Unlike other polysomnographic parameters, the apnea-hypopnea index and respiratory arousal index during rapid eye movement (REM) sleep were comparable across different OSA severity levels.
Conclusion
The onset age and duration of cluster bouts were associated with the severity of OSA in CH patients. Additionally, the relatively high susceptibility to hypoxia during REM sleep in patients with mild OSA implies that interventions may be potentially advantageous, even in CH patients with mild OSA.
A Survey on Headache Education Curriculum in College of Dentistry
Jin Kyu Kang, Ji-Won Ryu, Seong-Taek Kim
Korean J Headache. 2023;24(2):66-69.   Published online December 31, 2023
  • 355 View
  • 12 Download
AbstractAbstract PDF
Background
Headache is a common pain condition encountered in clinical practice. Many patients visit a doctor or dentist complaining of headaches accompanied by toothaches or facial pain. However, it has been reported that education on headaches is insufficient in medical schools, which is believed to be a more serious problem in dental schools.
Methods
We surveyed the current status of headache education curriculum in 11 dental schools in Korea.
Results
In most dental schools, headache education was provided as part of orofacial pain course within the oral medicine program. Only two universities covered headache as an in-depth postgraduate course. Lectures were delivered by oral medicine faculty, and only one university included a neurologist as part of the team teaching. Dental textbooks still described headaches based on the 2nd edition of the International Classification of Headache Disorders.
Conclusion
Currently, headache education in dental schools in Korea is inadequate and outdated. Considering the specificity of dentists who are in charge of pain in oral and facial region, continuous discussions and mutual cooperation with the neurology department are necessary to ensure sufficient education related to headaches during the undergraduate course.
Review Article
Migraine and Stroke
Myoung-Jin Cha, Ha Yeun Oh, Jiyoung Kim
Korean J Headache. 2023;24(2):50-55.   Published online December 31, 2023
  • 231 View
  • 11 Download
AbstractAbstract PDF
The relationship between migraine and stroke is intricate and bidirectional. Migraine, a neurological disorder characterized by severe headaches and associated symptoms, exhibits some similarities in presentation with stroke. Conversely, stroke can at times mimic migraine symptoms. Migrainous infarction is directly associated with stroke. Specifically, migraine with aura has been linked to an increased risk of ischemic stroke. Migraine with aura and the frequency of headaches are considered risk factors for stroke. Moreover, migraine is associated with subclinical infarct-like brain lesions and white matter changes. Additionally, some genetic disorders predispose individuals to develop both migraine and stroke. In this review, we aim to investigate the relationship between migraine and stroke.
Reiview Article
Sleep Disorders in Headache Patients
Hye Jeong Lee, Hee-Jin Im, Soo-Jin Cho, Min Kyung Chu
Korean J Headache. 2023;24(1):1-10.   Published online June 30, 2023
  • 202 View
  • 29 Download
AbstractAbstract PDF
Headache disorders and sleep problems are common conditions with a high prevalence in the general population, and impose a considerable socio-economic burden. They show a close association with headache disorders through various relationship. The prevalence of sleep problems is elevated in individuals with headache, especially for migraine. In most headache disorders, sleep problems are accompanied by the deterioration of clinical characteristics of headache disorders. The sharing brain structures and neurotransmitters involved in the pathogenesis of headache disorders and sleep disorders may be an explanation for the close relationship between two disorders. In this article, we briefly review the relationship of headache disorders with sleep disorders including insomnia, sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders, parasomnias, and sleep related movement disorders.
Review Articles
Menstrual Migraine: A Review of Current Research and Clinical Challenges
Jong-Geun Seo
Headache Pain Res. 2024;25(1):16-23.   Published online April 22, 2024
DOI: https://doi.org/10.62087/hpr.2024.0004
  • 517 View
  • 5 Download
  • 1 Citations
AbstractAbstract PDF
The term “menstrual migraine” is commonly used to describe migraines that occur in association with menstruation, as distinct from other migraine types. A significant proportion of women of reproductive age experience migraine attacks related to their menstrual cycle. Menstrual migraine is characterized by migraine attacks occurring on day 1±2 (i.e., days −2 to +3) of menstruation in at least two out of three menstrual cycles. Although the reported prevalence of menstrual migraine varies considerably, population-based studies have found that menstrual migraine affects up to 60% of women with migraines. Several hypotheses have been proposed to explain the etiology of menstrual migraine, among which the estrogen withdrawal hypothesis is the most widely accepted. Women who experience menstrual migraines often face considerable disability due to perimenstrual attacks. Studies have reported that perimenstrual attacks are more severe and more difficult to manage. The principles of acute managing perimenstrual attacks are the same as those for managing nonmenstrual attacks. Short-term preventive therapy is needed to prevent menstrual migraines before they occur during the perimenstrual period. This review summarizes the prevalence, distinct clinical features, pathophysiological mechanisms, and management of menstrual migraine.

Citations

Citations to this article as recorded by  
  • Migraine in Women: Inescapable Femaleness?
    Soo-Kyoung Kim
    Headache and Pain Research.2024; 25(1): 1.     CrossRef
New Targeted Drugs for Acute Treatment of Migraine
Heui-Soo Moon, Pil-Wook Chung, Byung-Kun Kim
Korean J Headache. 2023;24(2):56-65.   Published online December 31, 2023
  • 138 View
  • 9 Download
AbstractAbstract PDF
Acute migraine treatments primarily aim to relieve headache pain and address accompanying symptoms such as photophobia, phonophobia, and nausea. Triptans have traditionally been the first-line treatment for moderate to severe migraine attacks. Nevertheless, they have several limitations, such as causing temporary vasoconstriction of blood vessels, contraindications in patients with cardiovascular issues, and distinctive side effects like chest tightness. Medication overuse is another concern with triptans, prompting research into new antimigraine drugs targeting calcitonin gene-related peptide (CGRP) or 5-HT1F receptors. Lasmiditan, an agonist at the 5-HT1F receptor, has emerged as a safe and effective option for abortive treatment in acute migraine attacks. It lacks the vasoconstrictive effects associated with triptans, making it a safer choice for individuals with contraindications to triptans. However, it may lead to central nervous system-related adverse effects, particularly dizziness and paresthesia. Gepants, which are CGRP antagonists, offer an innovative approach by targeting CGRP receptors which is believed to be central in migraine pathophysiology. These medications have demonstrated efficacy in alleviating migraine symptoms, providing alternatives to traditional treatments like triptans and ergots. Ubrogepant and rimegepant are the first approved oral gepants for acute migraine treatment, while Zavegepant is the first approved intranasal gepant. The most common treatment-related adverse events are gastrointestinal symptoms, including nausea. No vascular or hepatic concerns have emerged to date. In this review, we delve into the development of ditans and gepants for acute migraine treatment in adults and discuss their potential advantages and disadvantages in clinical use.
Migraines in Women: A Focus on Reproductive Events and Hormonal Milestones
Seonghoon Kim, Jeong Wook Park
Headache Pain Res. 2024;25(1):3-15.   Published online April 5, 2024
DOI: https://doi.org/10.62087/hpr.2024.0003
  • 220 View
  • 4 Download
  • 1 Citations
AbstractAbstract PDF
Migraine, a prevalent neurological disorder, is more common in women than in men. This sex difference is more pronounced after menarche and diminishes after menopause. Migraines in women are influenced by the menstrual cycle, pregnancy, and lactation, suggesting a connection to sex hormones, known as the estrogen withdrawal theory. Beyond endogenous hormonal changes accompanying reproductive events, exogenous hormonal factors such as contraceptives or hormone replacement therapy may also affect migraines. The hormonal influence cannot be explained simply by serum estrogen levels; instead, it involves a complex interplay of various factors. Here, we delineate aspects of migraines associated with endogenous and exogenous hormonal changes over the course of a woman’s life, exploring the mechanisms and contributing factors through which sex hormones influence migraines.

Citations

Citations to this article as recorded by  
  • Migraine in Women: Inescapable Femaleness?
    Soo-Kyoung Kim
    Headache and Pain Research.2024; 25(1): 1.     CrossRef
Updated Treatment of Trigeminal Autonomic Cephalalgias
So Youn Choi, Michelle Sojung Youn, Mi Ji Lee
Korean J Headache. 2023;24(2):45-49.   Published online December 31, 2023
  • 387 View
  • 8 Download
AbstractAbstract PDF
Trigeminal Autonomic Cephalalgia (TAC) encompasses cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks (SUNHA), and hemicrania continua. The treatment of cluster headache consists of acute therapy and preventive treatment. The available options for acute treatment in South Korea include high-flow O2 inhalation, zolmitriptan oral medication, and intranasal lidocaine spray. In the transitional phase of cluster headache, oral steroids and suboccipital steroid injections are commonly used. Verapamil and lithium have been widely used as preventive medications, but recently, galcanezumab, a monoclonal antibody targeting calcitonin gene-related peptide, has emerged as a recognized preventive treatment for cluster headache. In addition, neuromodulation techniques, such as noninvasive vagus nerve stimulation, sphenopalatine ganglion stimulation, occipital nerve stimulation, and deep brain stimulation, are also available for the treatment of cluster headache. Paroxysmal hemicrania and hemicrania continua are absolutely responsive to indomethacin; however, when indo methacin is contraindicated, alternative treatments are necessary. Reported alternatives include topiramate, vagus nerve stimulation, verapamil, and carbamazepine for paroxysmal hemicrania, and topiramate, gabapentin, and neurostimulation for hemicrania continua. Treatment options for SUNHA are limited, but short-term preventive approaches such as intravenous lidocaine, as well as the use of lamotrigine for preventive treatment, can be considered.

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