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Original Articles
- Feasibility and Safety of Elexir, an External Trigeminal Nerve Electrical Stimulator for the Acute Treatment of Migraine
- Soo-Im Jang, Soohyun Cho, Mi Ji Lee
- Headache Pain Res. 2026;27(3):193-203. Published online October 30, 2026
- DOI: https://doi.org/10.62087/hpr.2026.0041
- 587 View
- 9 Download
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Abstract
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Supplementary Material - Purpose: External trigeminal nerve stimulation (eTNS) is a noninvasive neuromodulation technique used to treat migraine. This study evaluated the feasibility and safety of Elexir®, a newly developed eTNS device, for the acute treatment of migraine at home.
Methods
This prospective, randomized, sham-controlled postmarketing study enrolled participants with migraine who reported 2–8 attacks per month. Participants were assigned 1:1 to verum or sham stimulation and instructed to use Elexir® at home for 60 minutes during an eligible migraine attack. Feasibility of home use was assessed in terms of per-protocol use and treatment completion at both the participant and session levels; session completion was defined by 60 (±5)-minute stimulation recorded in the device log. Assessments also included adverse events (AEs) and exploratory efficacy outcomes: changes in pain intensity, pain freedom and relief, and resolution of associated symptoms.
Results
Of the 100 randomized participants, 79 formed the home-use population. Within this population, 78 (98.7%; 95% confidence interval [CI], 93.2%–99.8%) used Elexir® during an eligible migraine attack, and 75 (94.9%; 95% CI, 87.7%–98.0%) completed at least one session. Of the 139 treatment sessions conducted at home, 103 (74.1%; 95% CI, 66.2%–80.7%) were completed within the protocol-defined duration. Ten participants (10.0%) reported AEs and eight participants (8.0%) reported device-related AEs. No serious device-related AEs were observed. The groups did not differ significantly in exploratory efficacy outcomes.
Conclusion
These findings support the feasibility of using Elexir® for the acute treatment of migraine; no serious device-related AEs were observed. Further studies are required to support efficacy.
- Association between Psoriasis and Migraine in a Nationwide Cross-Sectional Study in Korea
- Woo-Seok Ha, Soohyun Cho
- Headache Pain Res. 2026;27(3):204-210. Published online October 30, 2026
- DOI: https://doi.org/10.62087/hpr.2026.0031
- 390 View
- 4 Download
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Abstract
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- Purpose: Psoriasis and migraine are common chronic disorders that may share neuroimmune mechanisms, although the biological basis of their association remains uncertain. This study investigated the association between psoriasis and migraine, focusing on psoriasis severity and migraine subtypes, using a large population-based database.
Methods
This population-based cross-sectional study used data from the Korean National Health Insurance Service database. We identified 329,363 adults who underwent national health screening in 2019, including 8,892 patients with psoriasis and 320,471 individuals without psoriasis. Psoriasis severity was classified according to the use of systemic or biologic agents, and migraine was categorized according to the presence of aura. Multiple logistic regression analyses were performed with adjustment for age, sex, comorbidities, body mass index, smoking status, alcohol consumption, income, and residential area.
Results
In the fully adjusted model, patients with psoriasis had higher odds of prevalent migraine than individuals without psoriasis (odds ratio [OR], 1.172; 95% confidence interval [CI], 1.102–1.246). This association was observed in both mild psoriasis (OR, 1.167) and moderate-to-severe psoriasis (OR, 1.190). Psoriasis was also significantly associated with non-aura-coded migraine (OR, 1.171; 95% CI, 1.100–1.246), whereas migraine with aura was not significantly associated with psoriasis.
Conclusion
Psoriasis was cross-sectionally associated with higher odds of prevalent migraine, including non-aura-coded migraine, after adjustment for measured demographic, clinical, and lifestyle factors. Longitudinal studies are needed to determine temporality and address potential detection bias related to healthcare utilization.
- 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
- 5,229 View
- 100 Download
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Abstract
PDFSupplementary 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
- Gepants for Migraine: An Update on Long-Term Outcomes and Safety Profiles
- Soohyun Cho, Kimoon Chang
- Headache Pain Res. 2025;26(3):184-192. Published online October 21, 2025
- DOI: https://doi.org/10.62087/hpr.2025.0012
- 23,908 View
- 283 Download
- 7 Citations
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Abstract
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- Calcitonin gene-related peptide receptor antagonists, also referred to as gepants, represent a transformative advancement in migraine pharmacotherapy, providing both acute and preventive treatment options without the vasoconstrictive limitations of triptans. Since their initial approval in 2019, gepants have gained widespread clinical adoption, necessitating comprehensive evaluation of their long-term safety and efficacy. This review synthesizes current evidence on four calcitonin gene-related peptide receptor antagonists (rimegepant, atogepant, ubrogepant, and zavegepant) derived from pivotal trials, open-label extension studies, and real-world observational data. Rimegepant demonstrates sustained efficacy and minimal adverse events over 52 weeks, with no evidence of medication-overuse headaches or hepatotoxicity. Atogepant maintains progressive clinical benefits and favorable tolerability for up to 1 year, exhibiting low rates of treatment-emergent adverse events and discontinuation. Ubrogepant remains effective and well-tolerated during long-term intermittent use, with no clinically significant safety signals over extended exposure. Zavegepant, the first intranasal gepant, shows promising long-term tolerability, with the most frequently reported localized adverse event being transient dysgeusia. No consistent hepatic, cardiovascular, or serious systemic toxicity has emerged for any of the agents, and discontinuation rates due to adverse events remain consistently low. Current evidence supports gepants as safe and effective therapies for long-term migraine management, although ongoing surveillance and extended-duration studies remain essential to fully characterize their safety profile, particularly in high-risk populations and combination therapy scenarios. In conclusion, gepants offer a well-tolerated, non-vasoconstrictive alternative for migraine patients who require sustained treatment, representing a significant therapeutic advancement in migraine.
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Citations
Citations to this article as recorded by
- Does Route of Administration Matter for Gepant Safety? A Comparative Disproportionality Analysis of Intranasal Zavegepant Using the FDA Adverse Event Reporting System
Martina Giacon, Salvatore Terrazzino
Journal of Pharmaceutical Innovation.2027;[Epub] 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 - Exosomes from mesenchymal stem/stromal cells and their therapeutic role in osteoarthritic pain
Dimitrios Kouroupis, Stanislava Jergova, Jacqueline Sagen, Thomas M. Best
Journal of Experimental Orthopaedics.2026;[Epub] CrossRef - Real-world effectiveness and safety of CGRP monoclonal antibodies in elderly migraine patients: a Korean multicenter study
Soohyun Cho, Mi-Kyoung Kang, Heui-Soo Moon, Mi Ji Lee, Soo-Kyoung Kim, Hong-Kyun Park, Woo-Seok Ha, Min Kyung Chu, Young-Eun Gil, Byung-Su Kim, Soo-Jin Cho
The Journal of Headache and Pain.2026;[Epub] CrossRef - Gepants for the Treatment of Migraine in Children and Adolescents: Acute and Preventive Roles, Current Evidence, and Ongoing Trials
Ji-Hoon Na
Headache and Pain Research.2026; 27(3): 246. CrossRef - Three-year safety, tolerability, clinical efficacy, and functional outcomes of atogepant for the preventive treatment of migraine: Final results from a phase 3, open-label extension study
Messoud Ashina, Sait Ashina, Cristina Tassorelli, Peter J. Goadsby, Soo-Jin Cho, Rebeka Man, Hua Guo, Eric B. Cohen, Krisztian Nagy, Pranav Gandhi, Jonathan H. Smith
Cephalalgia.2026;[Epub] CrossRef - Integrative Migraine Therapy: From Current Concepts to Future Directions—A Plastic Surgeon’s Perspective
Cristian-Sorin Hariga, Eliza-Maria Bordeanu-Diaconescu, Andrei Cretu, Dragos-Constantin Lunca, Catalina-Stefania Dumitru, Cristian-Vladimir Vancea, Florin-Vlad Hodea, Stefan Cacior, Vladut-Alin Ratoiu, Andreea Grosu-Bularda
Medicina.2025; 62(1): 50. CrossRef
- Does Route of Administration Matter for Gepant Safety? A Comparative Disproportionality Analysis of Intranasal Zavegepant Using the FDA Adverse Event Reporting System
- 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
- 31,576 View
- 119 Download
- 4 Citations
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Abstract
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- 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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Citations
Citations to this article as recorded by- 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
- Unlocking Relief: Botulinum Toxin’s Role in Conquering Rare Primary Headaches- A Narrative Exploration
- Clinical Characteristics of Reversible Cerebral Vasoconstriction Syndrome: A Large Korean Multicenter Study
- Soohyun Cho, Byung-Kun Kim, Mi Ji Lee
- Published online December 31, 2022
- 1,112 View
- 50 Download
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