Headache and Pain Research

Original Articles

Diagnostic Spectrum of Orthostatic Intolerance and Otologic Diseases in Pediatric Patients with Primary Headache and Dizziness: A Single-Center Retrospective Study: Hey-Joon Son, Kon-Hee Lee; Headache Pain Res. 2026;27(2):158-164. Published online June 30, 2026; DOI: https://doi.org/10.62087/hpr.2026.0021

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Abstract PDF: Purpose: Dizziness frequently coexists with headache in children and adolescents, but its diagnostic significance is often underrecognized. Orthostatic intolerance (OI) and otologic diseases are major causes of pediatric dizziness, yet distinguishing among these conditions remains clinically challenging. This study examined the diagnostic distribution of OI and otologic diseases in pediatric patients with primary headache-associated dizziness.
Methods
We retrospectively reviewed 310 patients aged 7–18 years who presented with both headache and dizziness; patients with secondary headache disorders were excluded. OI was assessed using head-up tilt testing and was classified primarily as orthostatic hypotension (OH) or postural orthostatic tachycardia syndrome (POTS). Otologic diseases, mainly peripheral vestibular disorders, were identified by otolaryngologists. Statistical analyses included the chi-squared test and one-way analysis of variance.
Results
The most common headache subtypes were migraine without aura (42.9%), vestibular migraine (15.8%), and tension- type headache (15.2%). OI was identified in 63.9% of patients, including OH in 40.6% and POTS in 23.2%; otologic diseases were present in 20.0%. The distributions of OI and otologic diseases did not differ significantly by headache subtype. OI was significantly associated with age and sex, with the POTS group having the highest mean age and a marked female predominance. Age also differed significantly across otologic disease subtypes.
Conclusion
In pediatric patients with headache and dizziness, OI and otologic diseases were common but were not associated with headache subtype. Instead, diagnostic patterns were more closely related to age and sex, suggesting that developmental and demographic factors should be considered when evaluating headache-associated dizziness in this population.

Pediatric Headache: Children and Adolescents

Serum Triglyceride Levels in Pediatric Migraine and Tension-Type Headache: A Retrospective Study: Ki Taek Oh; Headache Pain Res. 2026;27(2):154-157. Published online June 30, 2026; DOI: https://doi.org/10.62087/hpr.2026.0016

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Abstract PDF Supplementary Material: Purpose: Migraine and tension-type headache (TTH) are the most common primary headache disorders in children. However, potential metabolic differences between these conditions remain incompletely understood.
Methods
This retrospective study included pediatric patients diagnosed with migraine or TTH. Clinical characteristics and laboratory parameters were compared between the groups. Serum triglyceride (TG) levels were analyzed using multivariable linear regression adjusted for age and sex. Additional analyses included body mass index (BMI)-adjusted models and logarithmically transformed TG analyses.
Results
In total, 139 patients were included: 85 with migraine and 54 with TTH. Serum TG data were available for 101 patients. Mean TG levels were significantly higher in patients with TTH than in those with migraine (130.7±80.4 mg/dL vs. 92.1±42.4 mg/dL, p=0.006). This association remained significant after adjustment for age and sex (β=36.61 mg/dL, p=0.004), after logarithmic transformation (p=0.006), and in the BMI-adjusted subgroup analysis (β=42.84 mg/dL, p=0.040).
Conclusion
This exploratory retrospective study identified higher serum TG levels in pediatric patients with TTH than in those with migraine. Given the retrospective design and potential for residual confounding, these findings should be considered hypothesis- generating and require confirmation in prospective studies.

Guideline for the Treatment of Cluster Headache: A Clinical Practice Guideline from the Korean Headache Society: Byung-Su Kim, Pil-Wook Chung, Hong-Kyun Park, Mi Ji Lee, Jae Myun Chung, Kyung Min Kim, Jiyoung Kim, Heui-Soo Moon, Dae-Woong Bae, Jong-Hee Sohn, Tae-Jin Song, Wonwoo Lee, Soohyun Cho, Myoung-Jin Cha, Yun-Ju Choi, Miyoung Choi; Headache Pain Res. 2026;27(2):124-144. Published online June 30, 2026; DOI: https://doi.org/10.62087/hpr.2026.0011

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Abstract PDF Supplementary Material: Purpose: This clinical practice guideline (CPG) was developed by the Korean Headache Society (KHS) to provide evidence- based recommendations for the acute and preventive treatment of cluster headache (CH).
Methods
The CPG Committee of the KHS identified key clinical questions regarding the acute and preventive treatment of CH through a systematic literature review. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the quality of evidence and determine the strength of the evidence-based recommendations.
Results
For acute treatment, subcutaneous sumatriptan, intranasal zolmitriptan, intranasal sumatriptan, oral zolmitriptan, and oxygen are strongly recommended based on moderate-quality evidence. For preventive treatment, suboccipital steroid injection, oral corticosteroids, and galcanezumab (specifically for episodic CH) are strongly recommended based on moderate- quality evidence. Despite the low quality of evidence, verapamil is also strongly recommended, whereas lithium is recommended with a weaker strength of recommendation. Other oral triptans, NSAIDs, ergot derivatives, subcutaneous octreotide, intranasal lidocaine, and non-invasive vagus nerve stimulation (nVNS; specifically for episodic CH) are recommended for acute treatment based on expert consensus. For preventive treatment, topiramate, valproic acid, melatonin, and nVNS (as adjunctive therapy specifically for chronic CH) are recommended, whereas sphenopalatine ganglion stimulation, occipital nerve stimulation, and deep brain stimulation are recommended for patients with refractory chronic CH based on expert consensus.
Conclusion
This CPG provides evidence-based recommendations for the treatment of CH. In addition, the authors recommend the use of expert consensus-based treatments to bridge the gap between the available evidence and real-world clinical practice.

Review Articles

Temporal Evolution and Multimodal Neuroimaging in Reversible Cerebral Vasoconstriction Syndrome, Arterial Dissection, and Cerebral Venous Thrombosis: Young-Eun Gil; Headache Pain Res. 2026;27(2):76-95. Published online June 18, 2026; DOI: https://doi.org/10.62087/hpr.2026.0018

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Abstract PDF: Cerebrovascular disorders are important secondary causes of headache, but diagnosis can be challenging because headache may be the earliest or only presenting symptom and initial neuroimaging findings are often normal or nonspecific. This review provides a systematic, imaging-focused discussion of three representative cerebrovascular headache disorders: reversible cerebral vasoconstriction syndrome (RCVS), cervical and intracranial artery dissection, and cerebral venous thrombosis (CVT). For each condition, we describe characteristic findings across relevant imaging modalities, including computed tomography, computed tomography angiography, magnetic resonance imaging (MRI), magnetic resonance angiography, vessel wall (VW)-MRI, and susceptibility-sensitive sequences. We also discuss the temporal evolution of imaging findings, which underlies several common diagnostic pitfalls. In RCVS, angiographic vasoconstriction propagates centripetally from distal to proximal vessels, and contrast-enhanced fluid-attenuated inversion recovery imaging can detect blood–brain barrier disruption before vasoconstriction becomes angiographically apparent. In arterial dissection, VW-MRI can show mural features that confirm the diagnosis and may help stratify ischemic risk. In CVT, susceptibility-weighted imaging improves detection of cortical vein thrombosis, a subtype that can be missed on conventional venography. Across all three conditions, single-time-point imaging may be misleading, and serial imaging is often needed to increase diagnostic certainty because interval changes may reveal findings not present on the initial study. By integrating modality-specific findings with their temporal dynamics, this review proposes a practical imaging framework for the early and accurate diagnosis of cerebrovascular secondary headache disorders.

Finding the Sweet Spot between Medication Overuse and Underuse in Headache Medicine: Hong-Kyun Park; Headache Pain Res. 2026;27(2):96-107. Published online June 15, 2026; DOI: https://doi.org/10.62087/hpr.2026.0012

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Abstract PDF: Medication-overuse headache (MOH) is a well-recognized secondary headache caused by the frequent use of acute symptomatic medications, particularly among patients with underlying primary headache disorders such as migraine. Medication-underuse headache (MUH) is a recently proposed conceptual framework describing the suboptimal use of indicated treatments, including underuse, delayed administration, poor adherence, or premature discontinuation, all of which may contribute to headache progression or chronification. Both conditions share pathophysiological substrates, including central sensitization, impaired descending pain modulation, and dysfunctional reward processing, which are rooted in dopaminergic mesocorticolimbic dysregulation and trigeminovascular sensitization. MUH may arise from fear of side effects, fear of withdrawal, poor adherence, or inadequate access to care and may lead to an escalating headache burden and increased reliance on acute treatments, potentially predisposing patients to MOH. Conversely, managing MOH without addressing underuse-related barriers may contribute to treatment resistance or relapse. Recent evidence suggests that calcitonin gene-related peptide (CGRP)-targeted monoclonal antibodies can achieve clinically meaningful improvement in MOH even without mandatory medication withdrawal, challenging the traditional assumption that detoxification is required for treatment response. MOH is also increasingly viewed as a multidimensional neurological and biobehavioral disorder, with preliminary neuroimaging data indicating that mindfulness-based interventions can modulate pain- and reward-related brain networks. This narrative review summarizes the clinical features and mechanisms of MOH and MUH and proposes a comprehensive management framework integrating patient education, structured lifestyle and mindfulness-based interventions, early initiation of preventive therapy, and CGRP-targeted treatments, with the aim of achieving therapeutic balance—not too much, not too little—and improving long-term outcomes.

Trigeminal Neuralgia: Pathophysiology, Clinical Features, and Therapeutic Management: Ekene Nnagha, Chidubem Adi, Daniel Akpan; Headache Pain Res. 2026;27(2):117-123. Published online June 4, 2026; DOI: https://doi.org/10.62087/hpr.2026.0005

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Abstract PDF: Trigeminal neuralgia (TN) is a severe, disabling neuropathic facial pain disorder classified among cranial neuralgias within headache medicine. Despite well-established diagnostic criteria, TN remains frequently misdiagnosed, particularly in dental and primary care settings. This review provides a clinically focused overview of the epidemiology, pathophysiology, classification, diagnostic approach, and contemporary management of TN, with relevance to headache and pain research and clinical practice. Neurovascular compression with focal demyelination at the trigeminal nerve root entry zone is considered the predominant mechanism in classical TN. Diagnosis is primarily clinical and guided by International Classification of Headache Disorders, 3rd edition criteria, with magnetic resonance imaging essential for excluding secondary and idiopathic causes. Carbamazepine and oxcarbazepine remain first-line therapies, whereas microvascular decompression and minimally invasive neurosurgical procedures provide effective options for medically refractory disease. TN requires accurate diagnosis and individualized management. Advances in pharmacological and interventional treatments have improved outcomes and underscore the importance of multidisciplinary care within headache and pain medicine.

Original Article

Natural Diagnostic Classes of Headache Disorders: Latent Class Analysis of a Population-Based Study: Wonwoo Lee, Seok-Jae Heo, Jungyon Yum, Min Kyung Chu; Headache Pain Res. 2026;27(1):30-42. Published online February 26, 2026; DOI: https://doi.org/10.62087/hpr.2026.0004

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Abstract PDF Supplementary Material: Purpose: The International Classification of Headache Disorders, 3rd edition (ICHD-3), defines headache diagnoses based on combinations of clinical symptoms. Diagnostic overlap is common, and symptom variability complicates diagnostic classification. We evaluated natural classes of headache disorders using a statistical approach and compared these classes with ICHD-3 diagnostic categories.
Methods
Data from a nationwide, population-based web survey on headache and sleep conducted in South Korea (n=3,030) were analyzed. Participants who reported headache within the past year (n=1,938) were included. Latent class analysis was performed using categorical ICHD-3 diagnostic criteria to identify distinct classes. The characteristics of each class and the distribution of ICHD-3 primary headache diagnoses were examined.
Results
Nine classes were identified, comprising 626, 54, 248, 148, 187, 143, 79, 61, and 392 individuals. Three classes were tension-type headache (TTH)–like: Class 1 was male-dominant mild bilateral TTH, Class 8 represented classic, severe TTH, and Class 9 was mild unilateral TTH. Class 4 showed a typical migraine phenotype and contained most migraine cases. Classes 5 and 6 were dominated by probable migraine (PM) and differed mainly in sensory sensitivity and disability, which were higher in Class 6. Classes 2, 3, and 7 were categorized as “other headache.” Class 2 had the highest prevalence of medication-overuse headache (MOH), whereas Class 3 was characterized by mild headache with nausea. Class 7 showed a mixed-type profile with prominent photophobia. Severity and central sensitization markers were key classifiers.
Conclusion
Latent class analysis identified nine clinically distinct headache classes. PM was clearly distinct from both TTH and migraine. One subtype within the “other headache” class showed the highest MOH burden.

Review Articles

Headache and Stroke: A Review: Jong S. Kim; Headache Pain Res. 2026;27(1):7-12. Published online February 24, 2026; DOI: https://doi.org/10.62087/hpr.2025.0028

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Abstract PDF

Headache is a common disorder that is usually unaccompanied by focal neurological dysfunction. Less commonly, headache may be associated with central nervous system diseases such as stroke. Headache can occur at the time of stroke onset, but it may also precede or follow the onset of stroke. Nevertheless, headaches associated with stroke have not been sufficiently studied, in part because stroke physicians are primarily focused on diagnosis, risk factors, pathophysiological mechanisms, imaging findings, and treatment (e.g., thrombolysis and endovascular therapy) rather than on headache. In this narrative review, I describe the frequency and characteristics of headache across various stroke subtypes, including ischemic stroke, transient ischemic attack, intracerebral hemorrhage, subarachnoid hemorrhage, and other miscellaneous conditions such as venous infarction, arterial dissection, and reversible cerebral vasoconstriction syndrome.

Citations

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Primary or Secondary Headache Disorders in Moyamoya Disease and Cerebral Infarction: Clinical Challenges and the Potential Role of Non-Vasoconstrictive Migraine Therapies
Soo-Jin Cho
Headache and Pain Research.2026; 27(1): 1. CrossRef
Temporal Evolution and Multimodal Neuroimaging in Reversible Cerebral Vasoconstriction Syndrome, Arterial Dissection, and Cerebral Venous Thrombosis
Young-Eun Gil
Headache and Pain Research.2026; 27(2): 76. CrossRef

Alcohol-Induced Headache: A Narrative Review Based on Migraine Pathophysiology: Woo-Seok Ha; Headache Pain Res. 2026;27(1):21-29. Published online February 23, 2026; DOI: https://doi.org/10.62087/hpr.2025.0027

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Abstract PDF: Alcohol-induced headache (AIH) is one of the most common headache experiences and is associated with a substantial socioeconomic burden; however, its pathophysiological mechanisms and clinical classification remain inadequately defined. Accumulating evidence indicates that AIH shares key biological pathways with migraine, particularly involving activation of the trigeminovascular system and calcitonin gene-related peptide (CGRP) signaling. Although currently available hangover remedies are supported by limited high-quality evidence, anti-CGRP treatments have emerged as a biologically plausible option for the situational prevention and acute treatment of AIH. A phenotype-based approach is therefore essential for achieving accurate diagnosis and effective management of alcohol-related headaches. Future well-designed clinical trials focusing on CGRP antagonists are warranted to address this common yet neglected disorder.

Original Articles

Pediatric Headache: Children and Adolescents

Adult-Onset versus Pediatric-Onset Episodic Cluster Headaches: Results from the Korean Cluster Headache Registry: Pil-Wook Chung, Byung-Su Kim, Jeong-Wook Park, Jong-Hee Sohn, Mi Ji Lee, Byung-Kun Kim, Min Kyung Chu, Tae-Jin Song, Soo-Kyoung Kim, Heui-Soo Moon, Kyungmi Oh, Soo-Jin Cho; Headache Pain Res. 2026;27(1):64-70. Published online February 13, 2026; DOI: https://doi.org/10.62087/hpr.2025.0021

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Abstract PDF: Purpose: This study aimed to compare clinical characteristics between pediatric-onset and adult-onset cluster headache (CH) using data from the Korean Cluster Headache Registry, a nationwide, prospective, multicenter registry.
Methods
This cross-sectional observational study analyzed data collected over a 4-year period from a prospective multicenter registry. A total of 337 patients aged ≥19 years with episodic CH were included. Participants were classified as having pediatric-onset CH (onset≤18 years) or adult-onset CH (onset>18 years). Demographic and clinical features, smoking status, and psychiatric comorbidities were compared between groups.
Results
Pediatric-onset CH was reported in 24.6% of patients (n=83). The diagnostic delay was significantly longer in the pediatric-onset group compared with the adult-onset group (10.1 years vs. 6.2 years, p<0.001). Patients with pediatric-onset CH experienced more severe headache attacks (numerical rating scale 9.2 vs. 8.9, p=0.025), although attack duration, frequency, and other clinical features were similar between groups. Smoking exposure was lower in the pediatric-onset group, suggesting potential differences in environmental risk factors. No significant differences were observed in psychiatric comorbidity or headache-related disability.
Conclusion
Pediatric-onset CH is relatively common and shares most clinical features with adult-onset CH, apart from greater attack severity and lower smoking exposure. The longer diagnostic delay in pediatric-onset cases highlights the need for improved awareness and earlier recognition. Further research is warranted to elucidate the underlying pathophysiological mechanisms and long-term outcomes in pediatric-onset CH.

Trigeminal Autonomic Cephalalgias Following Unilateral Dorsolateral Medullary Infarction: A Case Series and Literature Review: Jae-Myung Kim, Hak-Loh Lee, You-Ri Kang, Joon-Tae Kim, Seung-Han Lee; Headache Pain Res. 2025;26(3):218-225. Published online October 22, 2025; DOI: https://doi.org/10.62087/hpr.2025.0013

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Abstract PDF

Purpose: Secondary trigeminal autonomic cephalalgias (TACs) are typically associated with posterior fossa abnormalities, such as tumors and vascular malformations. However, TACs following brainstem infarctions are rarely reported. This study aimed to characterize the clinical and anatomical features of TACs after unilateral dorsolateral medullary infarction.
Methods
We analyzed four patients with dorsolateral medullary infarction who developed secondary TACs, diagnosed using the International Classification of Headache Disorders, third edition criteria. All patients underwent detailed neurological examinations and neuroimaging, including diffusion-weighted magnetic resonance imaging and magnetic resonance angiography. Additionally, five published cases were identified through a literature review and analyzed in conjunction with our cohort.
Results
All patients exhibited stabbing or electric shock-like pain in the ipsilateral periorbital, hemifacial, and temporal regions. Headaches developed weeks to months post-stroke with brief attacks (1–2 minutes) occurring 1–5 times daily. Lacrimation and conjunctival injection were common. Three patients were diagnosed with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), while a fourth had short-lasting unilateral neuralgiform with cranial autonomic symptoms (SUNA). Each patient, as well as four of the five from the literature, exhibited ipsilateral facial sensory loss, suggesting involvement of the trigeminal spinal tract and nucleus. Delayed headache onset was more frequent in persistent cases.
Conclusion
Headache characteristics were more consistent with SUNCT/SUNA than with typical cluster headaches. Careful neurological examination is essential to detect focal signs and guide neuroimaging for identifying secondary causes. Clinicians should consider secondary TACs in patients with new-onset SUNCT/SUNA and focal brainstem signs.

Citations

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Primary or Secondary Headache Disorders in Moyamoya Disease and Cerebral Infarction: Clinical Challenges and the Potential Role of Non-Vasoconstrictive Migraine Therapies
Soo-Jin Cho
Headache and Pain Research.2026; 27(1): 1. CrossRef

Review Articles

Headache as a Somatic Symptom in Pediatrics: Diagnosis and Integrated Management: Hye Eun Kwon; Headache Pain Res. 2025;26(3):193-199. Published online October 20, 2025; DOI: https://doi.org/10.62087/hpr.2025.0016

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1 Citations

Abstract PDF

Somatization—the expression of psychological distress through physical symptoms—presents a frequent and complex challenge in pediatric practice. Headache and dizziness are among its most common manifestations. This review addresses the diagnostic challenge of determining whether these symptoms indicate a primary headache disorder or reflect somatic symptom presentations. The difficulty becomes particularly evident when conditions manifest in severe or persistent forms, such as chronic primary headache (CPH) and somatic symptom and related disorders (SSRD), where clinical overlap is considerable and coexistence may occur. We first explore the shared pathophysiological mechanisms, emphasizing central sensitization as a unifying process. We then propose a clinical framework for differential diagnosis that includes careful evaluation of predisposing risk factors and contrasts the defined diagnostic criteria of CPH with the maladaptive psychological responses frequently observed in SSRD. Management strategies diverge pharmacologically but converge on key non-pharmacological approaches. For primary headaches, pharmacotherapy is primarily used for prophylaxis, although its efficacy remains limited in pediatric trials. In contrast, for somatic presentations, medication typically serves as an adjunctive treatment targeting comorbidities, while psychotherapy (particularly cognitive behavioral therapy [CBT]) functions as the cornerstone of care. Non-pharmacological interventions such as CBT and biofeedback are essential for improving functioning across both conditions. Therefore, effective management relies on a framework of comprehensive psychoeducation, holistic assessment, and integrated interdisciplinary care.

Citations

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Pediatric Headache in Korea: Beyond a Common Complaint to a Chronic Neurological Condition
Yun Jin Lee
Headache and Pain Research.2026; 27(1): 4. CrossRef

A Practical Approach to Headache in Moyamoya Disease: Mi-Yeon  Eun, Jin-Man Jung, Jay Chol Choi; Headache Pain Res. 2025;26(3):173-183. Published online October 17, 2025; DOI: https://doi.org/10.62087/hpr.2025.0011

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Abstract PDF

Moyamoya disease (MMD) is a progressive steno-occlusive cerebrovascular disorder of the intracranial internal carotid arteries characterized by fragile collateral vessel formation. Although ischemic and hemorrhagic strokes are the most widely recognized manifestations of MMD, headaches are common, often disabling, and remain underacknowledged. Epidemiological studies report headache in 17%–85% of MMD patients, with particularly high rates among pediatric patients. Clinically, headache phenotypes are diverse and include migraine-like headaches with or without aura, tension-type, cluster, and hemiplegic variants. These presentations often overlap with primary headache disorders, complicating the diagnosis and sometimes delaying the recognition of underlying MMD. The pathophysiology of MMD-related headaches is multifactorial, involving vascular stenosis, abnormal collateral circulation, altered hemodynamics, and neurogenic inflammation. Chronic hypoperfusion may lower the threshold for cortical spreading depression, contributing to migraine-like or aura-associated symptoms. Surgical revascularization has been reported to alleviate headaches in both pediatric and adult patients, but persistent or new headaches may occur postoperatively, and long-term outcomes remain inconsistent. Management often involves general analgesics such as acetaminophen and non-steroidal anti-inflammatory drugs, but vasoconstrictive agents (e.g., triptans and ergotamines) should be avoided. Lasmiditan, a non-vasoconstrictive 5-HT1F agonist, may represent a safer option for acute treatment, while the efficacy of other pharmacological agents remains unclear due to limited evidence. In conclusion, headaches in MMD are not only a frequent source of disability but also a potential clinical marker of disease activity. Wider recognition of their epidemiology, phenotypes, and mechanisms may improve the diagnosis, guide individualized treatment, and ultimately enhance quality of life for patients.

Citations

Citations to this article as recorded by

Characteristics of sleep disturbance in Moyamoya disease
Mudassar Ahmad, James P. Klaas, Giuseppe Lanzino, Lorenzo Rinaldo, Stuart J. McCarter, Virend K. Somers, Erik K. St Louis, Diego Z. Carvalho
Sleep Medicine.2026; 138: 108684. CrossRef
Cerebrovascular Hemodynamic Responses to Breath-Holding in Migraine: A Longitudinal Functional Near-Infrared Spectroscopy Study Comparing a Calcitonin Gene-Related Peptide Monoclonal Antibody and Oral Preventive Treatment
Dong A. Yea, Jong Kwan Choi, Yoo Hwan Kim
Headache and Pain Research.2026; 27(1): 52. CrossRef
Headache and Stroke: A Review
Jong S. Kim
Headache and Pain Research.2026; 27(1): 7. CrossRef
Primary or Secondary Headache Disorders in Moyamoya Disease and Cerebral Infarction: Clinical Challenges and the Potential Role of Non-Vasoconstrictive Migraine Therapies
Soo-Jin Cho
Headache and Pain Research.2026; 27(1): 1. CrossRef

Original Article

Availability, Accessibility, and Utilization of Diagnostics and Therapeutics for Spontaneous Intracranial Hypotension in Asia: Soyoun Choi, Woo-Seok Ha, Soo-Jin Cho, Aynur Özge, Betül Baykan, Esme Ekizoglu, Kiratikorn Vongvaivanich, Koichi Hirata, Linh Tuyen Nguyen, Mamoru Shibata, Min Kyung Chu, Otgonbayar Luvsannorov, Ryotaro Ishii, Shengyuan Yu, Shih-Pin Chen, Shuu-Jiun Wang, Takao Takeshima, Tsubasa Takizawa, Vinh Khang Nguyen, Wei-Ta Chen, Yen-Feng Wang, Soo-Kyoung Kim, Mi Ji Lee; Headache Pain Res. 2025;26(2):142-153. Published online June 16, 2025; DOI: https://doi.org/10.62087/hpr.2025.0005

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Abstract PDF Supplementary Material

Purpose: Recent advances in imaging techniques have significantly enhanced the diagnosis of spontaneous intracranial hypotension (SIH). However, these developments have been reported mostly in Europe and the United States. This study aimed to evaluate the availability and utilization of diagnostic and treatment modalities for SIH in Asia, through a survey of regional headache specialists.
Methods
A literature search was conducted using PubMed, and members of the Asian Regional Consortium for Headache were contacted. Participants completed a two-step survey evaluating the availability, accessibility, and frequency of SIH diagnostic and treatment methods in their countries and institutions. Descriptive statistics were used to analyze the data.
Results
Twenty physicians from eight countries completed both rounds of the survey. Lumbar puncture, brain magnetic resonance imaging (MRI), and spinal MRI are widely available across Asia, but real-time imaging techniques—such as dynamic computed tomography myelography and digital subtraction myelography—that precisely localize cerebrospinal fluid leaks are less accessible. Blind or semi-targeted epidural blood patches (EBPs) are available at most centers, but are easily accessible in only about half of cases. Surgical interventions are rarely available.
Conclusion
Most diagnostic methods for SIH are available in Asia, despite some regional disparities. The utilization of EBP and surgical interventions remains somewhat limited. This highlights the need for greater awareness and standardization of diagnostic methods in Asia.

Citations

Citations to this article as recorded by

Temporal and regional trends in the diagnosis and treatment of spontaneous intracranial hypotension: a systematic review
Woo-Seok Ha, Soyoun Choi, Mi-Kyoung Kang, Hye Yun Kim, Soo-Jin Cho, Soo-Kyoung Kim, Mi Ji Lee
The Journal of Headache and Pain.2026;[Epub] CrossRef
Diagnostic Value of Flow-Void Sign for Localizing Ventral Dural Defects in Spine MRI
Soo-Im Jang, Soyoun Choi, Seung Ae Kim, Hoe Jong Jeong, Ja-Young Choi, Mi Ji Lee
Journal of Clinical Neurology.2026; 22(3): 364. CrossRef
Current Concepts in the Diagnosis and Management of Spontaneous Intracranial Hypotension
Woo-Seok Ha, Min Kyung Chu
Journal of the Korean Neurological Association.2026; 44(2): 110. CrossRef
Surgical Treatment of Spontaneous Intracranial Hypotension: Clinical Characteristics and Outcomes in a Surgically Treated Cohort of Type 1 and Type 3 Leaks
Woo-Seok Ha, Hyun Woong Mun, Soomi Cho, Chang Kyu Lee, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Min Kyung Chu, Yoon Ha
Journal of Clinical Medicine.2026; 15(13): 4972. CrossRef

Review Articles

Does Atogepant Offer a Safe and Efficacious Option for Episodic Migraine Prophylaxis? A Systematic Review and Meta-analysis: Ahmed Mostafa Amin, Abdallah Abbas, Samar Ahmed Amer, Hoda Awad, Mahmoud Tarek Hefnawy, Anas Mansour, Mohamed El-Moslemani, Haneen Sabet, Aynur Ozge; Headache Pain Res. 2025;26(1):21-37. Published online February 17, 2025; DOI: https://doi.org/10.62087/hpr.2024.0030

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Abstract PDF Supplementary Material

Migraine, a chronic neurological disorder, imposes a significant burden on individuals and healthcare systems globally. This systematic review and meta-analysis evaluated the efficacy and safety of atogepant in preventing episodic migraine (EM) in adults. A systematic search was conducted in four major databases (PubMed, Scopus, Web of Science, and Cochrane CENTRAL) up to June 2024. The inclusion criteria targeted randomized controlled trials (RCTs) comparing atogepant to placebo or standard care in patients with EM. Statistical analyses were performed using Review Manager (RevMan) software. Four RCTs with 2,018 patients receiving atogepant and 761 patients receiving placebo or standard care were included. Atogepant significantly reduced monthly migraine days compared to placebo at 10 mg daily (mean difference [MD], –1.16 days; 95% confidence interval [95% CI], –1.60 to –0.73), 30 mg daily (MD, –1.15 days; 95% CI, –1.64 to –0.66), 60 mg daily (MD, –1.48 days; 95% CI: –2.36 to –0.61 days), 30 mg twice daily (MD, –1.30 days; 95% CI, –2.17 to –0.43), and 60 mg twice daily (MD, –1.20 days; 95% CI, –1.90 to –0.50). A ≥50% reduction in migraine days was frequently significantly achieved with atogepant across all dosages. Atogepant was generally well tolerated, though it was associated with higher incidence rates of constipation and nausea compared to placebo. Atogepant is an effective and well-tolerated option for preventing EM, offering patients a noninvasive oral alternative to injectable therapies. Further research is warranted to explore its long-term safety and efficacy in diverse patient populations and refine its role in this field.

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Formulation and Development of Atogepant-loaded Mucoadhesive Buccal Films for Improved Bioavailability
Vaishnavi Vijay Shirsath, Mahesh Hari Kolhe, Payal Sopan Gawali, Pratibha Sudhakar Bhalerao, Rajashree Dadasaheb Ghogare, Gaurao Subhash Damre
BioNanoScience.2026;[Epub] CrossRef
Tension-Type Headache and Primary Stabbing Headache: Primary Headaches Beyond Migraine
Mi-Kyoung Kang
Headache and Pain Research.2025; 26(2): 89. CrossRef
The role of Atogepant in migraine prevention: a systematic review and meta-analysis
Naresh Kumar Ladhwani, Priya Bai, Rohan Lal, Aresha Masood Shah, Sheela Bai, Ghazi Uddin Ahmed, Rimsha Zameer, Varisha Fatima Shaikh, Arsalan Hyder, Sikander Ali, Muhammad Hamza Beg, Maheen Adeeb, Mahir Tesfaye
BMC Neurology.2025;[Epub] CrossRef
Gepants for Migraine: An Update on Long-Term Outcomes and Safety Profiles
Soohyun Cho, Kimoon Chang
Headache and Pain Research.2025; 26(3): 184. CrossRef

Morning Headaches: An In-depth Review of Causes, Associated Disorders, and Management Strategies: Yooha Hong, Mi-Kyoung Kang, Min Seung Kim, Heejung Mo, Rebecca C. Cox, Hee-Jin Im; Headache Pain Res. 2025;26(1):66-79. Published online January 17, 2025; DOI: https://doi.org/10.62087/hpr.2024.0023

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3 Citations

Abstract PDF

Morning headaches, which are defined by occurrence upon or shortly after waking up in the morning, range from mild discomfort to severe pain and significantly impact an individual’s quality of life. Although morning headaches are a prevalent and potentially debilitating condition, the criteria for defining these headaches vary. The lack of universally accepted diagnostic criteria complicates understanding their etiology, associated factors, and potential interventions. The causes of morning headaches are multifaceted, including primary headache disorders like migraines and cluster headaches, and secondary causes such as sleep disorders, hypertension, abnormal intracranial pressure, and brain parenchymal diseases. Psychological factors, including anxiety and depression, as well as substance use, further complicate the clinical presentation, often requiring a multidisciplinary approach for effective diagnosis and treatment. This review provides a comprehensive overview of morning headaches, examining their various aspects and possible treatment options, with the goal of enhancing clinicians’ understanding and management of this common yet often overlooked condition.

Citations

Citations to this article as recorded by

Looking into the Night: The Clinical Significance of Morning Headache
Soo-Kyoung Kim
Headache and Pain Research.2026; 27(2): 73. CrossRef
Comments on “Morning Headaches: An In-Depth Review of Causes, Associated Disorders, and Management Strategies”
Seong Taek Kim
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Sleep Bruxism as a Contributing Factor to Morning Headache: A Response to Recent Commentary
Yooha Hong, Hee-Jin Im
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Update on Tension-type Headache: Hye Jeong Lee, Soo-Jin Cho, Jong-Geun Seo, Henrik Winther Schytz; Headache Pain Res. 2025;26(1):38-47. Published online December 30, 2024; DOI: https://doi.org/10.62087/hpr.2024.0025

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Abstract PDF

Tension-type headache (TTH) is the most common type of headache, characterized by mild to moderate intensity, bilateral, with a pressing or tightening (non-pulsating) quality. Migraine and TTH can occur in the same person, and their risk factors and treatments can overlap. However, TTH receives less attention than migraine. Furthermore, despite the expanding market for migraine treatments targeting calcitonin gene-related peptide (CGRP) mechanisms, the lack of evidence regarding mechanisms related to CGRP-related mechanisms in TTH continues to be neglected. There remains a need to develop effective preventive treatments for chronic TTH, which imposes a very high burden of disease. From this perspective, this review aims to provide the latest evidence on TTH.

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Ghislain Armel Mpandzou, Dinah Happhia Motoula Latou, Amedna Madh Beny Koukat, Prince Eliot Galiéni Sounga Bandzouzi, Josué Euberma Diatewa, Yacouba Kaba, Karen Lise Obondzo Aloba, Paul Macaire Ossou-Nguiet
World Journal of Neuroscience.2026; 16(01): 57. CrossRef
Natural Diagnostic Classes of Headache Disorders: Latent Class Analysis of a Population-Based Study
Wonwoo Lee, Seok-Jae Heo, Jungyon Yum, Min Kyung Chu
Headache and Pain Research.2026; 27(1): 30. CrossRef
Regional and Extraregional Pressure Pain Threshold Patterns in Tension-Type Headache and Low Back Pain: A Cross-Sectional Comparative Study
Aleksandar Kopitovic, Filip Katanic, Sandro Kalember, Nina Vico Katanic, Teodora Katanic, Aleksandra Lucic, Ivica Lalic, Svetlana Simic
Journal of Clinical Medicine.2026; 15(14): 5368. CrossRef
Tension-Type Headache and Primary Stabbing Headache: Primary Headaches Beyond Migraine
Mi-Kyoung Kang
Headache and Pain Research.2025; 26(2): 89. CrossRef
Hallmarks of primary headache: part 2– Tension-type headache
Li-Ling Hope Pan, Yu-Hsiang Ling, Shuu-Jiun Wang, Linda Al-Hassany, Wei-Ta Chen, Chia-Chun Chiang, Soo-Jin Cho, Min Kyung Chu, Gianluca Coppola, Adriana Della Pietra, Zhao Dong, Esme Ekizoglu, Charl Els, Fatemeh Farham, David Garcia-Azorin, Woo-Seok Ha, F
The Journal of Headache and Pain.2025;[Epub] CrossRef
Trends in the Burden of Headache Disorders in Europe, 1990–2021: A Systematic Analysis from the Global Burden of Disease Study 2021
Terry Jung, Yoonkyung Chang, Moon-Kyung Shin, Sohee Wang, Seyedehmahla Hosseini, Joonho Kim, Min Kyung Chu, Tae-Jin Song
Journal of Clinical Medicine.2025; 14(19): 6966. CrossRef
Interoception Accuracy Differences in Patients with Chronic Tension-type Headache
İnan Özdemir, Güllüşah Üstün, Serkan Aksu, Semai Bek, Gülnihal Kutlu
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Results of the observational program CITOTREK (use of the drug CITOflavin in Tablets) in patients with tension headaches against the backgRound of asthenic syndromE taKing into account comorbidity
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S.S. Korsakov Journal of Neurology and Psychiatry.2025; 125(10): 104. CrossRef

Advances in Primary Stabbing Headache: Diagnostic Criteria, Epidemiological Insights, and Tailored Treatment Approaches: Ayush Chandra, Avinash Chandra, Soohyun Cho; Headache Pain Res. 2025;26(1):80-87. Published online September 2, 2024; DOI: https://doi.org/10.62087/hpr.2024.0018

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Abstract PDF

Primary stabbing headache (PSH), characterized by sudden, localized stabbing headache pain, is a recognized primary headache disorder with evolving diagnostic criteria. Epidemiological studies show a wide range of prevalence, influenced by various factors. PSH is more common in females, frequently occurring in conjunction with migraine, and can manifest in children. Recent diagnostic criteria have changed the definition of sharp stabbing pain, which is no longer restricted to the first division of the trigeminal nerve. In addition, the criterion of “no accompanying symptoms” has been refined to “no cranial autonomic symptoms” specifically. These changes have increased the sensitivity for capturing PSH. Although it is generally considered benign, stabbing headache can be associated with secondary causes. Clinical red flag signs can be helpful in distinguishing secondary headaches from PSH. A recent prospective study has proposed the monophasic, intermittent, and chronic patterns as subtypes, and this division may be helpful for predicting the prognosis. Pharmacological treatment is typically not required for PSH, although indomethacin and other alternating agents can be used. The treatment should be selected based on individual clinical features and comorbidities. This review aims to highlight the necessity of recognizing the distinctive clinical profile of PSH and of tailoring treatment approaches to patients’ individual needs.

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Unlocking Relief: Botulinum Toxin’s Role in Conquering Rare Primary Headaches- A Narrative Exploration
Reza Mosaddeghi-Heris, Nasrin Forghani, Hadi Sahrai, Duha Yahya, Ali Norouzi, Paolo Martelletti, Sima Osouli Meinagh
SN Comprehensive Clinical Medicine.2026;[Epub] CrossRef
Tension-Type Headache and Primary Stabbing Headache: Primary Headaches Beyond Migraine
Mi-Kyoung Kang
Headache and Pain Research.2025; 26(2): 89. CrossRef
Two-year prognosis of primary stabbing headache and its associated factors: a clinic-based study
Soohyun Cho, Byung-Kun Kim
The Korean Journal of Pain.2025; 38(3): 332. CrossRef
Hallmarks of primary headache: part 4 – rare headache syndromes
Gabriele Sebastianelli, Woo-Seok Ha, Roberta Messina, Li-Ling Hope Pan, Alejandro Labastida-Ramirez, Eloisa Rubio-Beltran, Doga Vuralli, William Wells-Gatnik, Sophie Merve Yener, Paolo Martelletti
The Journal of Headache and Pain.2025;[Epub] CrossRef

Case Report

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

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32 Download
2 Citations

Abstract 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.

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Early nimodipine treatment in reversible cerebral vasoconstriction syndrome: A serial transcranial Doppler study
Soohyun Cho, Minjung Seong, Mi Ji Lee
Headache: The Journal of Head and Face Pain.2025; 65(9): 1617. CrossRef
Hallmarks of primary headache: part 4 – rare headache syndromes
Gabriele Sebastianelli, Woo-Seok Ha, Roberta Messina, Li-Ling Hope Pan, Alejandro Labastida-Ramirez, Eloisa Rubio-Beltran, Doga Vuralli, William Wells-Gatnik, Sophie Merve Yener, Paolo Martelletti
The Journal of Headache and Pain.2025;[Epub] CrossRef

Original Article

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

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Abstract 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.

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Diagnostic delay, lateralisation and changing demographics in a belgian monocentric cluster headache cohort: a retrospective study
Joris De Moor, Evelien Tuerlinckx, Tim Kelderman, Jan Versijpt
Acta Neurologica Belgica.2026; 126(2): 619. CrossRef
Pain Lateralization in Cluster Headache and Associated Clinical Factors
Soohyun Cho, Mi Ji Lee, Min Kyung Chu, Jeong Wook Park, Heui-Soo Moon, Pil-Wook Chung, Jong-Hee Sohn, Byung-Su Kim, Daeyoung Kim, Kyungmi Oh, Byung-Kun Kim, Soo-Jin Cho
Journal of Clinical Neurology.2025; 21(3): 220. CrossRef

Review Articles

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

24,046 View
207 Download
12 Citations

Abstract 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.

Citations

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Natural Diagnostic Classes of Headache Disorders: Latent Class Analysis of a Population-Based Study
Wonwoo Lee, Seok-Jae Heo, Jungyon Yum, Min Kyung Chu
Headache and Pain Research.2026; 27(1): 30. CrossRef
Adult-Onset versus Pediatric-Onset Episodic Cluster Headaches: Results from the Korean Cluster Headache Registry
Pil-Wook Chung, Byung-Su Kim, Jeong-Wook Park, Jong-Hee Sohn, Mi Ji Lee, Byung-Kun Kim, Min Kyung Chu, Tae-Jin Song, Soo-Kyoung Kim, Heui-Soo Moon, Kyungmi Oh, Soo-Jin Cho
Headache and Pain Research.2026; 27(1): 64. CrossRef
Exercise as an abortive treatment for cluster headaches: Insights from a large patient registry
Mi‐Kyoung Kang, Yooha Hong, Soo‐Jin Cho
Annals of Clinical and Translational Neurology.2025; 12(1): 149. CrossRef
Morning Headaches: An In-depth Review of Causes, Associated Disorders, and Management Strategies
Yooha Hong, Mi-Kyoung Kang, Min Seung Kim, Heejung Mo, Rebecca C. Cox, Hee-Jin Im
Headache and Pain Research.2025; 26(1): 66. CrossRef
Does Laterality Matter? Insights Into Unilateral Pain in Cluster Headache
Tae-Jin Song
Journal of Clinical Neurology.2025; 21(3): 157. CrossRef
Pain Lateralization in Cluster Headache and Associated Clinical Factors
Soohyun Cho, Mi Ji Lee, Min Kyung Chu, Jeong Wook Park, Heui-Soo Moon, Pil-Wook Chung, Jong-Hee Sohn, Byung-Su Kim, Daeyoung Kim, Kyungmi Oh, Byung-Kun Kim, Soo-Jin Cho
Journal of Clinical Neurology.2025; 21(3): 220. CrossRef
Subtype shift, relapse rate and risk factors of frequent relapse in cluster headache: A multicenter, prospective, longitudinal observation
Mi Ji Lee, Soo-Kyoung Kim, Min Kyung Chu, Jae Myun Chung, Heui-Soo Moon, Pil-Wook Chung, Jeong Wook Park, Byung-Kun Kim, Kyungmi Oh, Yun-Ju Choi, Jong-Hee Sohn, Byung-Su Kim, Dae Woong Bae, Daeyoung Kim, Tae-Jin Song, Kwang-Yeol Park, Soo-Jin Cho
Cephalalgia.2025;[Epub] CrossRef
Inverse association of obesity with bout periodicity in episodic cluster headache: a multicenter cross-sectional study
Byung-Su Kim, Mi Ji Lee, Byung-Kun Kim, Jong-Hee Sohn, Tae-Jin Song, Min Kyung Chu, Soo-Kyoung Kim, Jeong Wook Park, Heui-Soo Moon, Pil-Wook Chung, Soo-Jin Cho
The Journal of Headache and Pain.2025;[Epub] CrossRef
Trigeminal Autonomic Cephalalgias Following Unilateral Dorsolateral Medullary Infarction: A Case Series and Literature Review
Jae-Myung Kim, Hak-Loh Lee, You-Ri Kang, Joon-Tae Kim, Seung-Han Lee
Headache and Pain Research.2025; 26(3): 218. CrossRef
Isolated Dental and Lower-Facial Pain Mimicking Trigeminal Neuropathy: An Indirect Carotid-Cavernous Fistula
Byoungchul Choi, Chulho Kim, Sung-Hwan Kim, Jong-Hee Sohn
Headache and Pain Research.2025; 26(3): 226. CrossRef
Side Shift of Attacks in Cluster Headache: A Prospective Single-center Study
Michelle Sojung Youn, Jun Pyo Kim, Mi Ji Lee
Headache and Pain Research.2024; 25(2): 96. CrossRef
Reduction of neck pain severity in patients with medication-overuse headache
Yooha Hong, Hong-Kyun Park, Mi-Kyoung Kang, Sun-Young Oh, Jin-Ju Kang, Heui-Soo Moon, Tae-Jin Song, Mi Ji Lee, Min Kyung Chu, Soo-Jin Cho
The Journal of Headache and Pain.2024;[Epub] CrossRef

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

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9 Citations

Abstract 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.

Citations

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Recent Advances in the Pathogenesis and Treatment of Pediatric Migraine
家骏马
Advances in Clinical Medicine.2026; 16(01): 1127. CrossRef
Gut microbiota dysbiosis and metabolic reprogramming in pediatric migraine: a multi-omics analysis revealing diagnostic biomarkers
Ning Tian, Min Liu, Yuan Zhao, Yufei Lian, Mei Jin, Fan Yang
The Journal of Headache and Pain.2026;[Epub] CrossRef
Short-duration migraine without aura in children: a retrospective cohort study of attack duration and prognosis
Jiajun Ma, Zhiwei Yu, Xin Li, Tianyi Li, Li Jiang
Frontiers in Neurology.2026;[Epub] CrossRef
Episodic Migraine in the Pediatric Population: Behavioral Therapies and other Non-Pharmacological Treatment Options
Parisa Gazerani
Current Pain and Headache Reports.2025;[Epub] CrossRef
Current Trends in Pediatric Migraine: Clinical Insights and Therapeutic Strategies
Adnan Khan, Sufang Liu, Feng Tao
Brain Sciences.2025; 15(3): 280. CrossRef
Clinical Efficacy and Safety of the Ketogenic Diet in Patients with Genetic Confirmation of Drug-Resistant Epilepsy
Ji-Hoon Na, Hyunjoo Lee, Young-Mock Lee
Nutrients.2025; 17(6): 979. CrossRef
Clinical profile and treatment outcomes of idiopathic intracranial hypertension: a multicenter study from Korea
Kyung-Hee Cho, Seol-Hee Baek, Sung-Hee Kim, Byung-Su Kim, Jong-Hee Sohn, Min Kyung Chu, Mi-Kyoung Kang, Hee Jung Mo, Sang-Hwa Lee, Hong-Kyun Park, Soohyun Cho, Sun-Young Oh, Jong-Geun Seo, Wonwoo Lee, Ju-Young Lee, Mi Ji Lee, Soo-Jin Cho
The Journal of Headache and Pain.2024;[Epub] CrossRef
Nutritional Approaches to Managing Pediatric Migraine
Hye Eun Kwon
Headache and Pain Research.2024; 25(2): 75. CrossRef
Reduction of neck pain severity in patients with medication-overuse headache
Yooha Hong, Hong-Kyun Park, Mi-Kyoung Kang, Sun-Young Oh, Jin-Ju Kang, Heui-Soo Moon, Tae-Jin Song, Mi Ji Lee, Min Kyung Chu, Soo-Jin Cho
The Journal of Headache and Pain.2024;[Epub] CrossRef

Original Article

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

7,213 View
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5 Citations

Abstract 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.

Citations

Citations to this article as recorded by

Comments on “Brain Glymphatic and Lymphatic Systems in Migraine: Mechanistic Insights and Neuromodulation Perspectives with an Emphasis on Ultrasound-Based Approaches”
Soo-Jin Cho
Headache and Pain Research.2026; 27(2): 169. CrossRef
Looking into the Night: The Clinical Significance of Morning Headache
Soo-Kyoung Kim
Headache and Pain Research.2026; 27(2): 73. CrossRef
Morning Headaches: An In-depth Review of Causes, Associated Disorders, and Management Strategies
Yooha Hong, Mi-Kyoung Kang, Min Seung Kim, Heejung Mo, Rebecca C. Cox, Hee-Jin Im
Headache and Pain Research.2025; 26(1): 66. CrossRef
Inverse association of obesity with bout periodicity in episodic cluster headache: a multicenter cross-sectional study
Byung-Su Kim, Mi Ji Lee, Byung-Kun Kim, Jong-Hee Sohn, Tae-Jin Song, Min Kyung Chu, Soo-Kyoung Kim, Jeong Wook Park, Heui-Soo Moon, Pil-Wook Chung, Soo-Jin Cho
The Journal of Headache and Pain.2025;[Epub] CrossRef
Subtype shift, relapse rate and risk factors of frequent relapse in cluster headache: A multicenter, prospective, longitudinal observation
Mi Ji Lee, Soo-Kyoung Kim, Min Kyung Chu, Jae Myun Chung, Heui-Soo Moon, Pil-Wook Chung, Jeong Wook Park, Byung-Kun Kim, Kyungmi Oh, Yun-Ju Choi, Jong-Hee Sohn, Byung-Su Kim, Dae Woong Bae, Daeyoung Kim, Tae-Jin Song, Kwang-Yeol Park, Soo-Jin Cho
Cephalalgia.2025;[Epub] CrossRef

Review Article

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

11,675 View
53 Download
5 Citations

Abstract 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.

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Unclosing Clinical Criteria and the Role of Cytokines in the Pathogenesis of Persistent Post-COVID-19 Headaches: A Pilot Case-Control Study from Egypt
Ahmed Abualhasan, Shereen Fathi, Hala Gabr, Abeer Mahmoud, Diana Khedr
Clinical and Translational Neuroscience.2025; 9(1): 5. CrossRef
Exploring Secondary Headaches: Insights from Glaucoma and COVID-19 Infection
Soo-Kyoung Kim
Headache and Pain Research.2025; 26(1): 3. CrossRef
Calcitonin Gene-Related Peptide Monoclonal Antibody Treatment in Nine Cases of Persistent Headache Following COVID-19-Infection
Soyoun Choi, Yooha Hong, Mi-Kyoung Kang, Tae-Jin Song, Soo-Jin Cho
Journal of Korean Medical Science.2025;[Epub] CrossRef
A Prospective Multicenter Study on the Evaluation of Frequency of Idiopathic Intracranial Hypertension in Korea
Byung-Su Kim, Soo-Jin Cho, Kyung-Hee Cho, Seol-Hee Baek, Jong-Hee Sohn, Tae-Jin Song, Wonwoo Lee, Hong-Kyun Park, Soohyun Cho, Junhee Han, Soolienah Rhiu, Myoung-Jin Cha, Mi Ji Lee, Min Kyung Chu
Journal of Korean Medical Science.2025;[Epub] CrossRef
Global, regional, and national burden of headache disorders, 1990–2021, with forecasts to 2050: A Global Burden of Disease study 2021
Tissa Wijeratne, Jiyeon Oh, Soeun Kim, Yesol Yim, Min Seo Kim, Jae Il Shin, Yun-Seo Oh, Raon Jung, Yun Seo Kim, Lee Smith, Hasan Aalruz, Rami Abd-Rabu, Deldar Morad Abdulah, Richard Gyan Aboagye, Meysam Abolmaali, Dariush Abtahi, Ahmed Abualhasan, Rufus A
Cell Reports Medicine.2025; 6(10): 102348. CrossRef

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

8,244 View
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4 Citations

Abstract 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.

Citations

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The association between migraine and glaucoma diseases: A retrospective cohort study
Matan Bar, Ido Peles, Gal Ifergane, Erez Tsumi, Assaf Kratz
Headache: The Journal of Head and Face Pain.2026; 66(1): 144. CrossRef
Exploring Secondary Headaches: Insights from Glaucoma and COVID-19 Infection
Soo-Kyoung Kim
Headache and Pain Research.2025; 26(1): 3. CrossRef
Association between migraine and primary open-angle glaucoma: A two-sample Mendelian randomization study
Dima L Chaar, Aliya Yakubova, Chen Jiang, Thomas J Hoffmann, Alice Pressman, Denis Plotnikov, Hélène Choquet
Cephalalgia Reports.2025;[Epub] CrossRef
Subjective Cognitive Decline Patterns in Patients with Migraine, with or without Depression, versus Non-depressed Older Adults
Sun Hwa Lee, Soo-Jin Cho
Headache and Pain Research.2024; 25(2): 103. CrossRef

Case Report

Unilateral Retro-orbital Headache Secondary to Septic Cavernous Sinus Thrombosis: A Case Report: Sumin Kim, Sorae Lee, Jun-Sang Sunwoo; Korean J Headache. 2023;24(2):80-83. Published online December 31, 2023

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Abstract PDF: Septic cavernous sinus thrombosis (SCST) is a rare but fatal central nervous system infectious disease affecting the cavernous sinuses. Here, we report a case of 51-year-old woman presenting with new-onset unilateral retro-orbital headache lasting for 3 weeks and subsequent ipsilateral abducens nerve palsy. Brain magnetic resonance imaging revealed enlargement of the cavernous sinus with dural enhancement and ring-enhancing abscess in the adjacent temporal lobe. Although blood and cerebrospinal fluid cultures were negative, the patient was successfully treated with empirical antibiotic therapy. Although SCST is a possible cause of painful ophthalmoplegia, it should be kept in mind that in the early stage it may present only with headache without ocular symptoms.

Review Article

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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Abstract 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.

Original Articles

Secular Trend of Sex Ratio in Participants under Randomized Controlled Trials for Cluster Headache: Pil-Wook Chung, Heui-Soo Moon; Korean J Headache. 2023;24(2):70-76. Published online December 31, 2023

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Abstract PDF: Background
Although cluster headache (CH) is well known as a disorder of predominantly young males, the male to female ratio decreased from 5-7:1 before 1980s to -2:1 in the 2000s and afterward in Western observational studies. It is unclear whether this represents a true rise of CH in women or better recognition of CH in women. We sought to assess whether the sex ratio of CH were changing or not in randomized controlled trials (RCTs) over time in accordance with observational studies.
Methods
We included RCTs regarding pharmacologic medication, as well as procedural and surgical treatment, devices. Time trend of sex ratio was compared among 3 different publication era (1985-2000 vs 2001-2010 vs 2011-). Sex ratio between different cluster headache type (Episodic vs Chronic) was also compared.
Results
22 acute treatment trials and 25 preventive treatment trials were initially selected for inclusion. 5 acute treatment trials and 10 preventive treatment trials were excluded due to small sample size (n<20) and/or no demographic information. All studies were underwent in western countries. Of 32 trials finally included, 10 studies were published between 1985 to 2000 (1^st era), 8 studies from 2001 to 2010 (2^nd era), 14 studies after 2010 (3^rd era). Of the 2,476 patients, 80% were male. Secular tendency of decreasing male predominance was shown over time. 542 of 623 patients (87%) were male in 1^st era, while 83% were male in 2^nd era, and 75.3% were male in 3^rd era (p<0.001). Male to female ratio was 6.7:1 in 1^st era, 4.9:1 in 2^nd era, and 3:1 in 3^rd era. In chronic CH, 28% of subjects were female, while in episodic CH, 14.6% were female (p<0.001)
Conclusions
As suggested by observational and registry data, the population enrolled in the RCT also exhibited a decreasing trend in male predominance over time in CH.

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

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Abstract 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 2^nd 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

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

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Abstract 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.

Case Report

Spontaneous Intracranial Hypotension after Airplane Travel: Ho Jin Hwang, Jiyun Park, Sun Jae Moon, Dong Hyun Hwang, Kyongha Baek, Young Seo Kim; Korean J Headache. 2023;24(2):77-79. Published online December 31, 2023

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Abstract PDF: Spontaneous intracranial hypotension usually manifests orthostatic headache caused by cerebrospinal fluid leakage without procedure or trauma to meninges. There was temporal relationship between intracranial hypotension and various precipitating factors such as positional changes, valsalva maneuver, minor trauma and only rarely airplane travel. Here, we report the first korean case of spontaneous intracranial hypotension after airplane travel. A 37-year-old woman presented with orthostatic headache after airplane travel. Her cerebrospinal fluid pressure is 55 mmCSF and cervical spinal level of cerebrospinal fluid leakage confirmed by cisternography. Her symptoms resolved after the epidural blood patch and she was later discharged without any complications.

Review Articles

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

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Abstract 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.

Diagnosis and Exclusion of Dangerous Headache in Headache Clinic Patients: Jiyoung Kim, Kyoung Jin Hwang; Korean J Headache. 2023;24(1):11-16. Published online June 30, 2023

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Abstract PDF: There are many different types of headaches, but they can be broadly classified as primary and secondary headaches. The Diagnosis of Headaches involves understanding the epidemiology of headaches, identifying the signs of secondary headaches, and applying the diagnostic criteria outlined in the International Classification of Headache Disorders. Clinicians should have a clear understanding of SNNOOP10 to indicate secondary headache. Furthermore, the evaluation of patients who present with a thunderclap headache should be conducted with great care and detail.

Case Report

Paradoxical Postural Headache in Spontaneous Intracranial Hypotension with Infratentorial Superficial Siderosis: Dae Woong Bae, Min Seung Kim, Soo-Jin Cho; Korean J Headache. 2023;24(1):20-23. Published online June 30, 2023

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Abstract PDF: Spontaneous intracranial hypotension is characterized by orthostatic headache caused by cerebrospinal fluid (CSF) leakage. However, clinical presentation of SIH is variable, and normal or high intracranial pressure in CSF study is not uncommon. Infratentorial superficial siderosis (ISS) shares similar pathomechanism with SIH, as developed after chronic CSF leakage, whilst several years of latency after SIH onset. Here, we report a 47-year-old male patient who had experienced prominent orthostatic headache twenty years before, and presented reverse-orthostatic headache in this time, accompanying with radiological features of SIH and ISS in brain magnetic resonance imaging (MRI). CSF leakage was confirmed by spinal MRI and MR myelography, and his headache was aggravated after epidural blood patch.

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