Headache and Pain Research

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

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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.

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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
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Varicella Zoster Meningitis with Multiple Cranial Neuropathies: A Case Report and Literature Review: Il-Joong Whang, Yun Jeong Hong, Kyung Won Lee, Si Baek Lee, Seong Hoon Kim, Yun Sang Oh, Myung-Ah Lee, Jeong Wook Park; Published online December 31, 2022

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Abstract PDF: 다발성 뇌신경마비를 동반한 대상포진 바이러스 뇌수막염: 증례 보고 및 문헌 고찰

Diagnosis of Cervicogenic Headache: Dae Woong Bae, Ko-Eun Choi, Seonghoon Kim, Jeong Wook Park; Published online June 30, 2021

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Abstract PDF: 경부인성 두통의 진단

Sleep Deprivation and Headache: Seonghoon Kim, Dae-Woong Bae, Ju Hee Oh, Jeong Wook Park; Published online December 31, 2020

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Abstract PDF: 수면 박탈과 두통

Headache Attributed to CNS Relapse of Acute Lymphoblastic Leukemia Mimicking Meningitis with Intracranial Hypertension: Seong hoon Kim, Young-Do Kim, Taewon Kim, Jeong Wook Park; Published online June 30, 2018

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Abstract PDF: 두개내압상승을 동반한 뇌수막염으로 오인된 급성림프모구백혈병의 중추신경계 재발에 기인한 두통

The Frequency and Characteristics of Other Primary Headache Disorders in First-Visit Headache Patients in Korea: A Multicenter Study: Myoung-Jin Cha, Byung-Kun Kim, Byung-Su Kim, Jong-Hee Sohn, Soo-Kyoung Kim, Heui-Soo Moon, Tae-Jin Song, Jae-Moon Kim, Jeong Wook Park, Min Kyung Chu, Kwang-Yeol Park; Published online December 31, 2017

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Abstract PDF: 신경과 외래를 방문한 두통 초진 환자에서 기타 원발두통의 빈도와 특징 - 다기관 연구

A Case of Spontaneous Intracranial Hypotension Mimicking Primary Cough Headache: Seong Hoon Kim, Young-Do Kim, Jeong Wook Park, Si Ryung Han; Published online June 30, 2015

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Abstract PDF: 원발기침두통으로 오인된 자발두개내압저하에 기인한 두통

The Characteristics of Mild Headache in Migraineurs: Is it Tension Type Headache or Mild form Migraine?: Seong Hoon Kim, Hae-Eun Shin, Seeback Lee, Jeong Wook Park; Published online December 31, 2014

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Abstract PDF: 편두통 환자에서 발생하는 경도의 두통의 특성: 긴장형 두통인가 경증의 편두통인가?

Experimental Approach in Headache Disorders.: Seong-Hoon Kim, Jeong Wook Park; Published online December 31, 2014

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Abstract PDF: 두통 질환에 대한 실험실적 접근.

원발벼락두통의 임상양상: Jiyeon Kim, Byung-Kun Kim, Gun-Sei Oh, Jae Myun Chung, Kyungmi Oh, Jeong Wook Park, Soo-Jin Cho; Korean J Headache. 2011;12(2):85-90. Published online December 31, 2011

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Abstract PDF: Objective: Thunderclap headache is a sign of a medical emergency such as a life-threatening subarachnoid hemorrhage (SAH). However, it also may occur in primary headache conditions such as cough, physical exertion, sexual activity and even without any provoking factors. International Headache Society classified thunderclap headache disorders into four different subtypes: (1) primary thunderclap headache(PTH); (2) primary cough headache(PCH); (3) primary exertional headache (PEH); and (4) primary headache associated with sexual activity(PSH). Subtypes of thunderclap headaches are reported to share many common characteristics, although studies on the clinical features and triggering factors of thunderclap headaches are limited. Methods: Seventy and two patients with thunderclap headache were prospectively enrolled from March 2008 to June 2010. The patients presented sudden severe headaches, reaching maximal intensity within 1 minute, without focal neu- rologic deficit. SAH and other organic disorders were excluded in this study. We described clinical features, triggering factors and vasospasm, and compared between the four subtypes of thunderclap headache. Results: Of the 72 recruited patients, PTH(n=25, 34.7%) was the most frequent thunderclap headache subtype, followed by PCH(n=23, 31.9%), PSH(n=15, 20.1%) and PEH(n=9, 12.5%). 49(68.1%) patients suffered recurrent thunderclap head- ache attacks at presentation. 49(68.1%) patients had more than one provoking factor. Defecation(n=13, 16.0%) was the most frequent provoking factor followed by sexual intercourse(n=11, 13.7%). Mean age was 45.1±12.6 years(range: 15-70). PEH group (36.6 years old) was younger than other groups. Overall male to female ratio in this study was 1:1.7. Mean duration of headache was 40.7±56.3 minutes(range: 0.17-720). The headache duration was shorter in PEH(25.2±14.2 minutes) than other groups. Vasospasm was documented in 10 patients(13.9%). Conclusions: More than two-thirds of patients with thunderclap headache have more than one provoking factor at presentation. Contrary to the previous studies, vasospasm was associated in small proportion of patients.

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

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

위험한 두통: 경고징후와 진단적 검사: Jeong Wook Park; Korean J Headache. 2007;8(1):12-15. Published online June 30, 2007

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Abstract PDF: Headache is a very common patient complaint but secondary causes for headache are unusual. But appropriate selection of patients with headache for neuroimaging and other various studies to look for secondary causes is very important. Most patients with intracranial pathology have clinical features that would raise a "red flag". Red flags act as screening tools to help in identifying those patients presenting with headache who would benefit from prompt diagnostic work up for serious intracranial pathology, and may increase the yield. This paper was written with the aim to determine the clinical features that identify those patients who should undergo further evaluation of serious intracranial pathology and provide useful tool for doctor in making diagnostic decisions in the management of patients of headache.

종설 : 편두통과 도파민: Jeong Wook Park; Korean J Headache. 2006;7(2):65-70. Published online December 31, 2006

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Abstract PDF: This review summarized the contribution of dopamine in the pathophysiology in migraine from multiple investigators who had reported alteration in dopaminergic neurotransmission in migraine patients. A reduction in frequency and severity of attacks in migraine has been observed after they developed Parkinson‘s disease, and serum levels of dopamine was increased in patients with migraine without aura. The clinical trials involving treatment with dopamine receptor anta- gonists for migraine provide strong evidence for the involvement of dopamine. The accompanying symptoms during a migraine attack, such as nauea, vomiting, dizziness and orthostatic faintness may be related to dopaminergic activa- tion. Recent genetic association studies have addressed the possible genetic role of the dopaminergic system in migraine. The studies investigating dopamine-related candidate genes have revealed some interesting but as yet inconclusive.

만성 긴장형두통 환자들에서 두통으로 인한 활동 무능에 기여하는 인자들에 관한 연구: Jeong Wook Park, Kwang Soo Lee; Korean J Headache. 2006;7(1):31-36. Published online June 30, 2006

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Abstract PDF: Objective: To evaluate the impact of headache variables, such as frequency, intensity, duration of attack episode and demographics on functional disability in chronic tension-type headache patients. Background: Chronic tension-type headache does not reduce life expectancy, but it can have considerable impact on functional disability and socioeconomic status. R eduction of headache related disability is one of the m ain treatm ent goals in the m anagement of headaches. Therefore, it is essential to understand w hich headache characteristics contribute to headache related disability.
Methods
D ata from patients w ith chronic tension-type headache (n = 109) were used to evaluate the relationship between headache variables (frequency, pain intensity, duration of attack), headache related demographics (age, duration of headache illness, analgesics consumption) and headache related functional disability. The patients w ere divided into different groups based on each variable. Headache related functional disability was assessed as scores on the activity interference scale of three aspects of daily living and m issing days due to headache.
Results
In this study, higher average pain intensity w as significantly associated w ith m ore severe headache related disability. A lthough there was a tendency for patients w ith the higher frequency, longer duration attack of headache to show severe disability, these w ere not statistically significant. M ultiple regression analysis revealed that average pain intensity is only significant predictor of headache related disability.
Conclusions
For chronic tension-type headache, headache intensity appears to be a major determinant of headache related disability, while headache frequency w as not clearly related to disability. A ccording to our findings, effective symptomatic medication that can stop headache before it reaches high intensity would have great potential to reduce headache related disability and headache attacks w ith severe intensity should not be underestimated even if they are infrequent. Korean Journal of Headache 7(1):31-30, 2006

일반연제-Catechol-O-methyltransferase Gene polymorphism of Migraine Without Aura in Korean Population: Jeong Wook Park , Kwang Soo Lee; Korean J Headache. 2005;6(1):107-107. Published online June 30, 2005

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Abstract PDF: Background
Following the first clinical and pharmacological suggestion of altered dopaminergic neu- rotransmission in migraine, recent genetic association studies have addressed the possible genetic role of the dopaminergic system in migraine. COMT(Catechol-O-methyltransferase) is an enzyme which play a crucial role in the metabolism of dopamine. This genetic polymorphism is associated with 3～4 fold variation of enzymatic activity. So change in their activity could participated in migraine pathogenesis and its clinical phenotype. Objectives: We assessed the role of the COMT enzyme polymorphism in the genetic susceptibility to migraine and their phenotypical expression in Korean population. Methods: The 77 migraine without aura and 94 healthy volunteers were included in the study. The analysis of COMT polymorphism was performed using PCR. After amplifying COMT genes by PCR and assessed genotype and allele by restriction fragment length polymorphism(RFLP). Results: Result of chi-square statistical analysis indicated that the genotype frequency and allele distri- bution was not different between migraine without aura and control group. Compared to individuals with H/H genotype, migraineurs with L allele showed more severe pain intensity(p=0.001) and over represen- ted the associated nausea/vomiting symptom during migraine attack(94% vs 75%: p=0.031) compared those without L allele. Conclusion: Altered dopaminergic activity due to polymorphism of COMT gene may be one of the mechanisms involved in the contribution to the pain intensity of attack and dopamine related symptom although this polymorphism does not appear to be involved in a genetic predisposition to development of migraine without aura.

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