Volume 27(3); October 2026  
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Dear Colleagues,

We are pleased to present the second issue of the year, featuring four review articles (multimodal neuroimaging in RCVS, arterial dissection, and CVT; medication overuse and underuse in headache medicine; migraine in pilots; and trigeminal neuralgia), a guideline for cluster headache, and four original papers, including two articles on pediatric headache and dizziness.
Please find below the link to the table of contents and summaries of the esteemed articles.
Please enjoy, share and cite them.
Thank you for your support and assistance.

Office of Headache and Pain Research
Soo-Jin Cho, Editor-in-Chief; Soo-Kyoung Kim, Deputy Editor

Table of Contents Alert
Editorial

Pediatric Migraine in Korea: New Opportunities in the Era of Mechanism-Based Prevention
Sanghyo Ryu
DOI: http://doi.org/10.62087/hpr.2026.0026
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Review Articles

Glymphatic System Dysfunction in Migraine: From Cortical Spreading Depression to Migraine Chronification
Jeongwook Park
DOI: http://doi.org/10.62087/hpr.2026.0033
Migraine has traditionally been understood as a neurovascular and neuroinflammatory disorder, but the glymphatic system, a brain-wide waste-clearance network mediated by cerebrospinal fluid and interstitial fluid exchange, has been proposed as a contributor to migraine pathophysiology. This review synthesizes current evidence on the role of glymphatic system dysfunction in migraine onset and chronification, integrating findings from preclinical animal models and...
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Is There a Role for Muscle Relaxants in Migraine Management? A Narrative Review
Heba Banihani, Marta Waliszewska-Prosół, Christopher Robinson, Abdulrazaq S. Albilali, Jeannine Abrons, Kinga Gecse, Merve Kozak, Mario M. F. Peres, Sait Ashina
DOI: http://doi.org/10.62087/hpr.2026.0025
Migraine is a debilitating neurological condition that affects approximately 15% of the global population and frequently co-occurs with musculoskeletal conditions that add to its burden. Neck pain affects 73%–90% of patients and often prompts off-label prescribing of muscle relaxants to relieve perceived muscular contributions to headache. This narrative review examines the clinical evidence, pharmacological profiles, and safety considerations for centrally...
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Pediatric Headache: Children and Adolescents
Gepants for the Treatment of Migraine in Children and Adolescents: Acute and Preventive Roles, Current Evidence, and Ongoing Trials
Ji-Hoon Na
DOI: http://doi.org/10.62087/hpr.2026.0034
Migraine affects approximately 10% of children and adolescents and is often disabling, but evidence-based options for acute treatment and prevention remain limited. A high placebo response has also complicated pivotal pediatric trials. Therapies targeting the calcitonin gene-related peptide (CGRP) pathway have reshaped adult migraine care, and the approval of one CGRP monoclonal antibody for pediatric prevention has validated this target in pediatric patients. Gepants, small-molecule oral or intranasal CGRP receptor antagonists, are of particular interest because, unlike injectable antibodies, they offer acute or preventive treatment without vasoconstrictive activity. This review summarizes the pharmacology and adult evidence for the four approved gepants, their emerging pediatric use, and ongoing clinical trials. Depending on the agent, gepants have established efficacy for acute treatment or prevention in adults, with favorable long-term safety and no new hepatic or cardiovascular safety signals. Pediatric evidence is limited to small retrospective studies of off-label use in patients whose migraine is refractory to standard therapy. These reports suggest acceptable tolerability and possible benefit in some patients, but controlled trials are needed to determine efficacy. Phase 3 randomized trials are evaluating ubrogepant for acute treatment and atogepant and rimegepant for the prevention of episodic and chronic migraine in pediatric patients aged 6–17 years for acute treatment and episodic migraine prevention, and 12–17 years for chronic migraine prevention, with estimated completion expected between 2027 and 2032. Until controlled data become available, gepant use should be individualized and restricted to patients who have not responded to standard therapies. Pediatric dosing, long-term safety, and the lower age limit of benefit remain key questions.
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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
DOI: http://doi.org/10.62087/hpr.2026.0041
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...

Association between Psoriasis and Migraine in a Nationwide Cross-Sectional Study in Korea
Woo-Seok Ha, Soohyun Cho
DOI: http://doi.org/10.62087/hpr.2026.0031
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...
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Dynamic Changes in Interictal Burden During 3-Year Follow-Up for Medication Overuse Headache
Yooha Hong, Mi-Kyoung Kang, Soo-Jin Cho
DOI: http://doi.org/10.62087/hpr.2026.0039
Purpose: Treatment improves medication overuse headache (MOH), but interictal burden may persist. Limited longitudinal data leave uncertainty about whether residual burden reflects persistent impairment, recovery, or newly emerging burden. We investigated changes in interictal burden during the 3 years after MOH diagnosis. Methods: This single-center substudy of a nationwide prospective MOH registry enrolled 149 patients at baseline and assessed interictal burden...
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Preliminary Quantitative Electroencephalographic Evidence of Depression-Aligned Neurophysiological Patterns in Interictal Migraine: A Multi-Dataset Study
Dokyung Lee
DOI: http://doi.org/10.62087/hpr.2026.0022
Purpose: This study aimed to examine whether interictal migraine shows neurophysiological patterns aligned with an external major depressive disorder (MDD) reference dataset, using quantitative electroencephalography (qEEG) indices less sensitive to absolute amplifier gain. Methods: Three datasets were analyzed: ds005385 (normative reference, n=608; age-matched subset, 45–70 years, n=309), TDBRAIN (MDD, n=120; insomnia, n=30; healthy controls, n=47), and 25 patients with interictal migraine...
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Early Development of Spinal Cord Herniation in Spontaneous Intracranial Hypotension
Seung Ae Kim, Soyoun Choi, Kyunghoon Yang, Hye Jin Yoo, Ja-Young Choi, Mi Ji Lee
DOI: http://doi.org/10.62087/hpr.2026.0043
Purpose: Spinal cord herniation has been recognized as a very rare, late complication of spontaneous intracranial hypotension (SIH). This study examined the incidence and timing of early spinal cord herniation in SIH and the factors associated with its development. Methods: Data from a prospective cohort of patients with SIH at Seoul National University Hospital (2022–2024) were analyzed retrospectively. Eligible patients presented...
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Case Reports

Spontaneous Intracranial Hypotension Masquerading as Headache from an Unruptured Middle Cerebral Artery Aneurysm
Myoung-Jin Cha, Jiyoung Kim
DOI: http://doi.org/10.62087/hpr.2026.0040
Spontaneous intracranial hypotension (SIH) is characterized by neurological symptoms resulting from cerebrospinal fluid leakage or volume depletion. Although orthostatic headache is the hallmark symptom, SIH can also present with nausea, vomiting, dizziness, tinnitus, and other neurological symptoms. In this case, a cerebral aneurysm identified during evaluation of the headache was initially considered a potential cause, prompting a decision to treat...
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Pediatric Headache: Children and Adolescents
Early Infantile Onset of Presumed Recurrent Painful Ophthalmoplegic Neuropathy
Kristen M. Yang, Robert H. Fryer
DOI: http://doi.org/10.62087/hpr.2026.0032
Recurrent painful ophthalmoplegic neuropathy (RPON) is a rare recurrent cranial neuropathy that usually presents in childhood, most often before 10 years of age. Although RPON primarily affects pediatric patients, onset before 1 year of age is exceedingly rare. We report the case of a 10-month-old boy who presented with recurrent episodes of disconjugate gaze and left-sided ptosis, leading to a...
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Letters to the Editor

Comment on “Subjective Cognitive Decline Patterns in Patients with Migraine, with or without Depression, versus Non-depressed Older Adults”
Jong-Hee Sohn
DOI: http://doi.org/10.62087/hpr.2026.0023
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Response to Comments on “Subjective Cognitive Decline Patterns in Patients with Migraine, with or without Depression, versus Non-Depressed Older Adults
Sun Hwa Lee, Soo-Jin Cho
DOI: http://doi.org/10.62087/hpr.2026.0027
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Correction

Correction to “Alcohol-Induced Headache: A Narrative Review Based on Migraine Pathophysiology”
Woo-Seok Ha
DOI: http://doi.org/10.62087/hpr.2025.0027.e1
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Headache and Pain Research (Headache Pain Res; pISSN: 3022-9057, eISSN: 3022-4764) publishes original articles, review articles, case report, letter to the editor, editorial, and perspective on all aspects of Headache and Pain Research. The main topics include migraine, cluster headache, tension-type headache, intracranial hypotension, intracranial hypertension, reversible cerebral vasoconstriction syndrome, other primary or secondary headache disorders, and issues related headache and pain such as dizziness, psychological, and cognitive problems. Headache and Pain Research is the official journal of Korean Headache Society, and aims to grow into an international journal and welcomes outstanding editorial board members and submissions from all over the world.

It is an Open Access journal, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. There is no article processing charge. Headache and Pain Research is published 3 times (the last day of February, June, and October) a year.
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