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Original Article
- 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
- 55 View
- 3 Download
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Abstract
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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.
Review Article
- 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
- 17,564 View
- 161 Download
- 10 Citations
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Abstract
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- 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.
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Citations
Citations to this article as recorded by
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- Update on Treatment of Giant Cell Arteritis
- Mi-Kyoung Kang, Yoo Hwan Kim, Kyeong Min Son, Soo-Jin Cho, Jiyoung Kim, Jong-Hee Sohn, On behalf of the Hallym Headache Research Society
- Published online December 31, 2022
- 578 View
- 72 Download
- Crowned Dens Syndrome Mimicking Meningitis
- Na Hee Kim, Myun Kim, Chaery Jeon, Yoo Hwan Kim
- Published online June 30, 2022
- 560 View
- 51 Download
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