• 구강회복응용과학지
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• 제32권2호
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• pp.102-108
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• 2016

두통은 전체 인구중 상당수가 일생에 한번 이상 겪게되는 질환으로, 계속하여 논의되고 개정되어 현재까지 국제적인 분류법이 마련되어 왔다. 원발두통은, 다른 원인질환에 의하지 않은 통증을 의미하며, 다음과 같이 분류할 수 있다: 1) 편두통 2) 긴장형두통 3) 군발두통과 기타 삼차자율신경두통 4) 기타 원발두통. 한편 턱관절장애에 기인한 두통 및 약물 과용 두통은 두통의 원인이 기질적인 경우로 이차성 두통에 분류된다. 본 종설에서는 국제두통질환분류 제3판의 베타판(ICHD-3 beta)에 근거한 두통의 진단에 대하여 고찰해보고자 한다.

• Journal of Acupuncture Research
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• 제36권4호
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• pp.187-196
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• 2019

This study was performed to review clinical research studies involving acupuncture treatment for primary headache disorders to provide a basic reference for future studies. Clinical studies of primary headache disorders treated with acupuncture were retrieved from 3 Korean electronic databases (NDSL, OASIS, and RISS). The studies were classified by year of publication, type of study, type of acupuncture, outlined acupoints, methods used for filiform needles, pharmacopuncture, auricular acupuncture, and thread-embedding acupuncture. Thirty-eight trials were reviewed, of which 33 used filiform needles, 6 pharmacopuncture, 1 auricular acupuncture, and 1used thread-embedding. Most of the studies reported that acupuncture treatment was effective in treating primary headache disorders. Some studies reported statistically significant effects, but the results overall were inconsistent. Therefore, there is insufficient evidence to support the treatment of acupuncture to resolve headaches. On the basis of these results, further studies should be performed to qualitatively and quantitatively determine the efficacy of acupuncture treatment for primary headache disorders.

• 동의생리병리학회지
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• 제31권4호
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• pp.201-212
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• 2017

This study draws pattern differentiations of headache disorders on the ground of modern clinical applications and Korean medical literature. Categorization and symptoms of headache disorders are based on International Classification of Headache Disorders 3rd edition(beta version). And clinical papers are searched in China Academic Journals(CAJ) of China National Knowledge Infrastructure(CNKI). In the aspect of eight principle pattern identification, primary headache occurs due to lots of yang qi and has more inner pattern rather than exterior pattern, heat pattern rather than cold pattern, excess pattern rather than deficiency pattern. And primary headache is related with liver in the aspect of visceral pattern identification and blood stasis, wind and phlegm are relevant mechanisms. Migraine without aura is associated with ascendant hyperactivity of liver yang, phlegm turbidity, sunken spleen qi, wind-heat, blood deficiency or yin deficiency. Migraine with aura is mainly related with wind and it's major mechanisms are ascendant hyperactivity of liver yang, liver fire, yin deficiency of liver and kidney, blood deficiency or liver depression and qi stagnation. High repetition rate of tension-type headache can be identified as heat pattern or excess pattern. And trigeminal autonomic cephalalgias can also be accepted as heat pattern or excess pattern when the occurrence frequency is high and is relevant to combined pattern with excess pattern of external contraction and deficiency pattern of internal damage based on facial symptoms by external contraction and nervous and anxious status by liver deficiency. This study can be expected to be Korean medical basis of clinical practice guidelines on headache by proposing pattern identifications corresponding to the western classifications of headache disorders.

• 대한한방내과학회지
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• 제39권6호
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• pp.1191-1205
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• 2018

Objectives: This study was performed to review clinical research trends in the treatment of primary headache disorders with pharmacopuncture. Methods: We searched clinical studies on primary headache disorders treated with pharmacopuncture in four electronic databases including OASIS, RISS, CNKI, and Pubmed. The selected studies were analyzed with regard to study design, subject, intervention, evaluation, and result. Results: Five randomized controlled trials, one non-randomized controlled trial, one before-and-after study, and six case series were selected. Most of the studies showed that pharmacopuncture treatment was significantly effective in treating primary headache disorders; however, the quality of the randomized controlled trials was low. Conclusions: According to this study, pharmacopuncture could be a useful treatment option for primary headache disorders. Based on these results, further studies on the effectiveness and safety of pharmacopuncture for primary headache disorders should be performed in the near future.

• The Korean Journal of Pain
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• 제35권1호
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• pp.4-13
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• 2022

Changes in diagnostic criteria, for example, the various International Classification of Headache Disorders criteria, would lead to changes in the outcomes of epidemiological studies. International Classification of Headache Disorders-1 was based mainly on expert opinion, yet most of the diagnostic criteria were reliable and valid, but it did not include chronic migraine. In its second version, the classification introduced chronic migraine, but this diagnosis resembled more a high-frequency migraine rather than the actual migraine transformation process. It also introduced medication overuse headache, but it necessitated analgesic withdrawal and subsequent headache improvement to be diagnosed as such. Hence patients having medication overuse headache could only be diagnosed in retrospect, which was an awkward situation. Such restrictive criteria for chronic migraine and medication overuse headache omitted a high proportion of patients. International Classification of Headache Disorders-3 allows a diagnosis of medication overuse headache due to combination analgesics if taken for at least 10 days per month for more than three months. Hence the prevalence rate of medication overuse headache and chronic migraine can increase compared to the previous version of the headache classification. Different criteria have been used across studies to identify chronic migraine and medication overuse headache, and therefore the information acquired from previous studies using earlier criteria becomes uncertain. Hence much epidemiological research would need to be interpreted cautiously or repeated with the most updated criteria, since the subjects in studies that apply the latest criteria may be phenotypically different from those in older studies.

• 대한신경과학회지
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• 제36권4호
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• pp.294-301
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• 2018

Background: Neuroimaging can play a crucial role in discovering potential abnormalities to cause secondary headache. There has been a progress in the fields of headache diagnosis and neuroimaging in the past two decades. We sought to investigate neuroimaging findings according to headache disorders, age, sex, and imaging modalities in first-visit headache patients. Methods: We used data of consecutive first-visit headache patients from 9 university and 2 general referral hospitals. The International Classification of Headache Disorders, third edition, beta version was used in headache diagnosis. We finally enrolled 1,080 patients undertook neuroimaging in this study. Results: Among 1,080 patients (mean age: $47.7{\pm}14.3$, female: 60.8%), proportions of headache diagnosis were as follows: primary headaches, n=926 (85.7%); secondary headaches, n=110 (10.2%); and cranial neuropathies and other headaches, n=43 (4.1%). Of them, 591 patients (54.7%) received magnetic resonance imaging (MRI). Neuroimaging abnormalities were found in 232 patients (21.5%), and their proportions were higher in older age groups and male sex. Chronic cerebral ischemia was the most common finding (n=88, 8.1%), whereas 76 patients (7.0%) were found to have clinically significant abnormalities such as primary brain tumor, cancer metastasis, and headache-relevant cerebrovascular disease. Patients underwent MRI were four times more likely to have neuroimaging abnormalities than those underwent computed tomography (33.3% vs. 7.2%, p<0.001). Conclusions: In this study, the findings of neuroimaging differed according to headache disorders, age, sex, and imaging modalities. MRI can be a preferable neuroimaging modality to identify potential causes of headache.

• Journal of Yeungnam Medical Science
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• 제39권4호
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• pp.278-284
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• 2022

Headache is one of the most common neurological disorders in children and adults and can cause significant distress and disability in children and their families. The spectrum of pediatric headaches is broad, and the underlying etiology is variable. The symptoms and phenotypes of headaches in children may differ slightly from those in adults. It is important to have a good understanding of headaches in children and to distinguish between primary and secondary headaches through appropriate history assessment and neurological examination. Accurate diagnosis and appropriate drug selection are helpful for effective treatment. This article reviews headaches in children and adolescents, focusing on approaches for diagnosis and management.

• 구강회복응용과학지
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• 제22권1호
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• pp.29-36
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• 2006

As migraine pain represents a substantial personal and social burden worldwide, there has been a great deal of effort in developing a screening instrument for migraine. Lipton et al(2003) developed and validated the ID Migraine questionnaire, which is a self-administered screener for migraine in primary care, and it is brief and easy to use for a primary care provider. The aim of this study was to determine if the ID Migraine questionnaire could be applied successfully to assess the headache patients with temporomandibular disorders(TMD) and orofacial pain. This study found that nausea, photophobia and headache-related disability had the highest individual sensitivities and specificities, and the performance of the three-item screener was equivalent to that reported in a previous study. Although the sensitivity of the three-item screener in this study (0.58) was lower than in a previous study (0.81), the specificity (0.98) was higher and the positive predictive value was 93.9%. This suggest that the ID Migraine questionnaire is very efficient in this setting. In conclusion, the ID Migraine questionnaire, which is a three-item screener consisting of nausea, photophobia and headache-related disability, is effective as a self-administered report for detecting migraine headaches in patients with temporomandibular disorders(TMD) and orofacial pain.

• Journal of Dental Anesthesia and Pain Medicine
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• 제21권5호
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• pp.413-429
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• 2021

Background: Migraine headaches are the second leading cause of disability worldwide and are responsible for significant morbidity, reduction in the quality of life, and loss of productivity on a global scale. The purpose of this systematic review and meta-analysis was to evaluate the efficacy of ketamine on migraines and other primary headache disorders compared to placebo and other active interventions, such as midazolam, metoclopramide/diphenhydramine, and prochlorperazine/diphenhydramine. Methods: An electronic search of databases published up to February 2021, including Medline via PubMed, EMBASE, Web of Science, and Cochrane Library, a hand search of the bibliographies of the included studies, as well as literature and systematic reviews found through the search was conducted to identify randomized controlled trials (RCTs) investigating ketamine in the treatment of migraine/headache disorders compared to the placebo. The authors assessed the risk of bias according to the Cochrane Handbook guidelines. Results: The initial search strategy yielded 398 unduplicated references, which were independently assessed by three review authors. After evaluation, this number was reduced to five RCTs (two unclear risk of bias and three high risk of bias). The total number of patients in all the studies was 193. Due to the high risk of bias, small sample size, heterogeneity of the outcomes reported, and heterogeneity of the comparison groups, the quality of the evidence was very low. One RCT reported that intranasal ketamine was superior to intranasal midazolam in improving the aura attack severity, but not duration, while another reported that intranasal ketamine was not superior to metoclopramide and diphenhydramine in reducing the headache severity. In one trial, subcutaneous ketamine was superior to saline in migraine severity reduction; however, intravenous (I.V.) ketamine was inferior to I.V. prochlorperazine and diphenhydramine in another study. Conclusion: Further double-blind controlled studies are needed to assess the efficacy of ketamine in treating acute and chronic refractory migraines and other primary headaches using intranasal and subcutaneous routes. These studies should include a long-term follow-up and different ketamine dosages in diagnosed patients following international standards for diagnosing headache/migraine.

• 정신신체의학
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• 제7권2호
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• pp.263-273
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• 1999

두통은 인류의 가장 흔한 호소 중의 하나로 임상에서 흔히 보는 장애이다. 두통은 뇌막염, 뇌출혈, 또는 뇌종양과 같은 다른 질환의 증상일수 있으나, 또한 편두통이나 군발두통 등과 같은 질병 자체로 표현된다. 일차적으로 두통 장애의 역학이나 국제 두통학회의 진단기준을 이해하고 흔치 않으나 심각한 이차적인 두통장애와 감별에 관심을 둬야 한다. 환자가 일차 두통장애의 기준에 맞으면 신경학적 진단검사의 보충이 없어도 치료를 시작한다. 두통 유형, 표현 양상, 동통기간과 강도 등에 따라 진통소염제나 혼합진통제, 혈관작용의 항편두통 약물 또는 신경이완제나 corticosteroid등을 선택한다. 편두통의 빈도와 강도에 따라 예방치료가 보통 4~6개월간 조절한다. 긴장형 두통은 발작성과 만성두통으로 구분되나 치료적으로는 급성완화와 예방치료로 시도된다. 많은 만성매일두통 환자들이 진통제나 ergotamine을 과용하고 있으며 그들의 의존성과 내재된 갈등조절, 수면장애, 우울등으로 과용된 약물의 제한이 쉽지 않다. 치료의 첫단계는 약물을 끊고 조심스럽게 대치요법을 시행한다.