두통클리닉을 방문하는 두통 환자의 진단과 위험한 두통의 배제

김지영,황경진 대한두통학회 2023 두통 Vol.24 No.1

There are many different types of headaches, but they can be broadly classified as primary and secondary headaches. The Diagnosis of Headaches involves understanding the epidemiology of headaches, identifying the signs of secondary headaches, and applying the diagnostic criteria outlined in the International Classification of Headache Disorders. Clinicians should have a clear understanding of SNNOOP10 to indicate secondary headache. Furthermore, the evaluation of patients who present with a thunderclap headache should be conducted with great care and detail.

군발두통 무작위대조시험에서의 남녀 성비율의 변화에 대한 연구

정필욱,문희수 대한두통학회 2023 두통 Vol.24 No.2

Background: Although cluster headache (CH) is well known as a disorder of predominantly young males, the male to female ratio decreased from 5-7:1 before 1980s to -2:1 in the 2000s and afterward in Western observational studies. It is unclear whether this represents a true rise of CH in women or better recognition of CH in women. We sought to assess whether the sex ratio of CH were changing or not in randomized controlled trials (RCTs) over time in accordance with observational studies. Methods: We included RCTs regarding pharmacologic medication, as well as procedural and surgical treatment, devices. Time trend of sex ratio was compared among 3 different publication era (1985-2000 vs 2001-2010 vs 2011-). Sex ratio between different cluster headache type (Episodic vs Chronic) was also compared. Results: 22 acute treatment trials and 25 preventive treatment trials were initially selected for inclusion. 5 acute treatment trials and 10 preventive treatment trials were excluded due to small sample size (n<20) and/or no demographic information. All studies were underwent in western countries. Of 32 trials finally included, 10 studies were published between 1985 to 2000 (1st era), 8 studies from 2001 to 2010 (2nd era), 14 studies after 2010 (3rd era). Of the 2,476 patients, 80% were male. Secular tendency of decreasing male predominance was shown over time. 542 of 623 patients (87%) were male in 1st era, while 83% were male in 2nd era, and 75.3% were male in 3rd era (p<0.001). Male to female ratio was 6.7:1 in 1st era, 4.9:1 in 2nd era, and 3:1 in 3rd era. In chronic CH, 28% of subjects were female, while in episodic CH, 14.6% were female (p<0.001) Conclusions: As suggested by observational and registry data, the population enrolled in the RCT also exhibited a decreasing trend in male predominance over time in CH.

지속반두통, 돌발반두통, 단기지속편측신경통형두통발작의 진단과 치료

이상화,조수진 대한두통학회 2023 두통 Vol.24 No.2

Chronic paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua are rare headache disorders characterized by severe unilateral headache accompanied by ipsilateral autonomic symptoms. Accurate diagnosis and specific treatment approaches for these conditions are crucial for appropriate management. This article covers the clinical features, diagnostic criteria, and treatment strategies of each disorder, aiming to differentiate them from other major headaches and provide targeted treatment strategies to improve patient outcomes.

자베게판트: 급성기 편두통 치료의 코투여 약물

서종근 대한두통학회 2023 두통 Vol.24 No.1

Calcitonin gene-related peptide (CGRP) is probably the most potent vasodilator in cerebral circulation. The new CGRP-targeted therapy for the treatment of acute treatment are now available for clinical practice. This review article summarized efficacy and safety of zavegepant, which is the first intranasal small molecule CGRP receptor antagonist for acute migraine treatment.

약물과용두통의 치료 전략

강미경,손종희 대한두통학회 2023 두통 Vol.24 No.2

Medication overuse headache (MOH) is a common secondary headache disorder in which chronic headaches develop or worsen due to frequent and excessive intake of medications used for acute headache treatment. While the concept of MOH is widely recognized among headache specialists, ongoing debates exist regarding its causes, diagnostic criteria, and treatment strategies. Treating MOH has traditionally been challenging, and there is currently no universal consensus on how to effectively manage patients with MOH. Furthermore, a specific treatment approach based on well-powered randomized trials is still lacking. The treatment strategy for MOH typically involves several steps: patient education and counseling, withdrawal of overused medications, preventive drug therapy, and non-pharmacological prevention. It is recommended that all patients discontinue the overused medication, which can be carried out on an outpatient or inpatient basis. Additionally, topiramate, Botox, and anti-calcitonin gene-related peptide monoclonal antibodies have shown potential in reducing headache and migraine frequency, as well as acute drug consumption, even without active drug withdrawal. However, many aspects of MOH management require further investigation through properly designed and adequately powered randomized controlled trials.

두통환자에서의 수면질환

이혜정,임희진,조수진,주민경 대한두통학회 2023 두통 Vol.24 No.1

Headache disorders and sleep problems are common conditions with a high prevalence in the general population, and impose a considerable socio-economic burden. They show a close association with headache disorders through various relationship. The prevalence of sleep problems is elevated in individuals with headache, especially for migraine. In most headache disorders, sleep problems are accompanied by the deterioration of clinical characteristics of headache disorders. The sharing brain structures and neurotransmitters involved in the pathogenesis of headache disorders and sleep disorders may be an explanation for the close relationship between two disorders. In this article, we briefly review the relationship of headache disorders with sleep disorders including insomnia, sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders, parasomnias, and sleep related movement disorders

편두통과 뇌졸중

차명진,김지영 대한두통학회 2023 두통 Vol.24 No.2

The relationship between migraine and stroke is intricate and bidirectional. Migraine, a neurological disorder characterized by severe headaches and associated symptoms, exhibits some similarities in presentation with stroke. Conversely, stroke can at times mimic migraine symptoms. Migrainous infarction is directly associated with stroke. Specifically, migraine with aura has been linked to an increased risk of ischemic stroke. Migraine with aura and the frequency of headaches are considered risk factors for stroke. Moreover, migraine is associated with subclinical infarct-like brain lesions and white matter changes. Additionally, some genetic disorders predispose individuals to develop both migraine and stroke. In this review, we aim to investigate the relationship between migraine and strok

편두통 급성기 치료를 위한 새로운 표적치료제

문희수,김병건 대한두통학회 2023 두통 Vol.24 No.2

Acute migraine treatments primarily aim to relieve headache pain and address accompanying symptoms such as photophobia, phonophobia, and nausea. Triptans have traditionally been the first-line treatment for moderate to severe migraine attacks. Nevertheless, they have several limitations, such as causing temporary vasoconstriction of blood vessels, contraindications in patients with cardiovascular issues, and distinctive side effects like chest tightness. Medication overuse is another concern with triptans, prompting research into new antimigraine drugs targeting calcitonin gene-related peptide (CGRP) or 5-HT1F receptors. Lasmiditan, an agonist at the 5-HT1F receptor, has emerged as a safe and effective option for abortive treatment in acute migraine attacks. It lacks the vasoconstrictive effects associated with triptans, making it a safer choice for individuals with contraindications to triptans. However, it may lead to central nervous system-related adverse effects, particularly dizziness and paresthesia. Gepants, which are CGRP antagonists, offer an innovative approach by targeting CGRP receptors which is believed to be central in migraine pathophysiology. These medications have demonstrated efficacy in alleviating migraine symptoms, providing alternatives to traditional treatments like triptans and ergots. Ubrogepant and rimegepant are the first approved oral gepants for acute migraine treatment, while Zavegepant is the first approved intranasal gepant. The most common treatment-related adverse events are gastrointestinal symptoms, including nausea. No vascular or hepatic concerns have emerged to date. In this review, we delve into the development of ditans and gepants for acute migraine treatment in adults and discuss their potential advantages and disadvantages in clinical use.

한국 치과대학에서 두통학 교육 현황 실태조사

강진규,김성택 대한두통학회 2023 두통 Vol.24 No.2

Background: Headache is a common pain condition encountered in clinical practice. Many patients visit a doctor or dentist complaining of headaches accompanied by toothaches or facial pain. However, it has been reported that education on headaches is insufficient in medical schools, which is believed to be a more serious problem in dental schools. Methods: We surveyed the current status of headache education curriculum in 11 dental schools in Korea. Results: In most dental schools, headache education was provided as part of orofacial pain course within the oral medicine program. Only two universities covered headache as an in-depth postgraduate course. Lectures were delivered by oral medicine faculty, and only one university included a neurologist as part of the team teaching. Dental textbooks still described headaches based on the 2nd edition of the International Classification of Headache Disorders. Conclusion: Currently, headache education in dental schools in Korea is inadequate and outdated. Considering the specificity of dentists who are in charge of pain in oral and facial region, continuous discussions and mutual cooperation with the neurology department are necessary to ensure sufficient education related to headaches during the undergraduate course.

비행 후 발생한 자발두개내저압

황호진,김영서 대한두통학회 2023 두통 Vol.24 No.2

Spontaneous intracranial hypotension usually manifests orthostatic headache caused by cerebrospinal fluid leakage without procedure or trauma to meninges. There was temporal relationship between intracranial hypotension and various precipitating factors such as positional changes, valsalva maneuver, minor trauma and only rarely airplane travel. Here, we report the first korean case of spontaneous intracranial hypotension after airplane travel. A 37-year-old woman presented with orthostatic headache after airplane travel. Her cerebrospinal fluid pressure is 55 mmCSF and cervical spinal level of cerebrospinal fluid leakage confirmed by cisternography. Her symptoms resolved after the epidural blood patch and she was later discharged without any complications.