Headache and Pain Research

Original Articles

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 Pain Res. 2026;27(1):52-63. Published online February 24, 2026; DOI: https://doi.org/10.62087/hpr.2025.0029

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Abstract PDF Supplementary Material: Purpose: Altered cerebrovascular reactivity has been reported in migraine; however, longitudinal changes during preventive treatment remain unclear. This observational study aimed to describe and compare longitudinal cerebrovascular responses derived from functional near-infrared spectroscopy (fNIRS) during a breath-holding test between patients treated with a calcitonin gene-related peptide (CGRP) monoclonal antibody and those receiving oral preventive medications.
Methods
Twenty-four patients with migraine were enrolled (CGRP group, n=12; oral group, n=12). fNIRS over the prefrontal cortex was performed at baseline and after 3 months during a standardized breath-holding protocol. Oxygenated (HbO), deoxygenated, and total hemoglobin signals were used to derive breath-holding and recovery indices. Clinical outcomes included monthly headache days, acute medication days, disability, mood scales, and Patient Global Impression of Change.
Results
Monthly headache days decreased in both groups (CGRP: Δ=–2.00, p=0.26; oral: Δ=–1.50, p=0.48), with no between- group difference (p=0.85). Acute medication days were significantly reduced only in the CGRP group (Δ=–7.00, p=0.03). Migraine Disability Assessment (MIDAS) scores improved significantly in the CGRP group (Δ=–21.25, p=0.02), with no significant between-group differences. During breath-holding, HbO increased across channels in both groups and was followed by a gradual decline during the recovery phase. Longitudinal analyses demonstrated group-dependent differences in temporal change patterns, with a treatment×time interaction reaching significance at the uncorrected level in a representative channel (Channel 6: F(1,16)=8.448, p=0.010), but not after multiple-comparison correction (p=0.155).
Conclusion
fNIRS with a breath-holding challenge enables longitudinal assessment of cerebrovascular responses during migraine preventive treatment. The observed differences should be interpreted descriptively in terms of temporal change patterns. Larger studies are needed to clarify clinical significance.

Validity of Migraine Diagnoses in Korean National Health Insurance Claims Data: Yoonkyung Chang, Soyoun Choi, Byung-Su Kim, Tae-Jin Song; Headache Pain Res. 2025;26(2):154-161. Published online June 19, 2025; DOI: https://doi.org/10.62087/hpr.2025.0004

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Purpose: Accurate case identification using administrative datasets relies on diagnostic coding, yet these codes’ accuracy for migraine remains uncertain. This study aimed to validate the diagnostic accuracy of International Statistical Classification of Diseases and Related Health Problems 10th Revision (International Classification of Diseases, ICD-10) codes for migraine, migraine without aura (MOA), and migraine with aura (MA) in the Korean National Health Insurance Service database.
Methods
We retrospectively reviewed the electronic medical records of 500 patients (migraine [G43.X], 200; MOA [G43.0], 200; MA [G43.1], 100) from secondary and tertiary hospitals between January 2019 and December 2024. Diagnoses confirmed by headache specialists using the International Classification of Headache Disorders, third edition served as the gold standard. Validation metrics included the positive predictive value (PPV), negative predictive value, sensitivity, specificity, and the kappa statistic. Diagnostic accuracy was assessed based on ICD-10 claim frequency and improved by combining diagnostic codes with prescriptions for migraine medications.
Results
A single ICD-10 claim had a PPV of 74.00%. Accuracy improved significantly with increased claim frequency (≥3 claims: PPV, 81.14%; sensitivity, 98.61%; specificity, 28.26%), particularly when combined with medication prescriptions (≥3 claims with medication: PPV, 94.96%; sensitivity, 91.87%; specificity, 85.37%). MOA (≥3 claims with medication: PPV, 95.20%) and MA (≥3 claims with medication: PPV, 93.65%) showed similar trends. Excellent inter-rater reliability was observed (kappa, 0.806–0.951), with no significant accuracy differences between hospitals.
Conclusion
Employing multiple claims and prescriptions improved the accuracy of migraine diagnoses using ICD-10 codes, supporting the use of this method in epidemiological studies and health policy decisions.

Citations

Citations to this article as recorded by

Toward Precision Migraine Care: Genetics, Symptoms, and Big-Data-Driven Approaches
Soo-Jin Cho
Headache and Pain Research.2025; 26(3): 171. CrossRef

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