• Title/Summary/Keyword: Headache Migraine

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Intravenous caffeine citrate vs. magnesium sulfate for reducing pain in patients with acute migraine headache; a prospective quasi-experimental study

  • Baratloo, Alireza;Mirbaha, Sahar;Kasmaei, Hossein Delavar;Payandemehr, Pooya;Elmaraezy, Ahmed;Negida, Ahmed
    • The Korean Journal of Pain
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    • v.30 no.3
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    • pp.176-182
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    • 2017
  • Background: Current evidence suggests that intravenous magnesium sulfate might be effective for reducing migraine pain. In a recent pilot study, we showed that intravenous caffeine citrate could reduce the severity of migraine headache. The objective of this study is to investigate the efficacy of intravenous caffeine citrate vs. magnesium sulfate for management of acute migraine headache. Methods: We conducted a prospective quasi-experimental study from January until May 2016 in two educational medical centers of Shahid Beheshti University of Medical Sciences (Shoahadaye Tajrish Hospital and Imam Hossein Hospital), Tehran, Iran. The study included patients who were referred to the emergency department and met the migraine diagnosis criteria of the International Headache Society. Patients were allocated into 2 groups receiving either 60 mg intravenous caffeine or 2 g intravenous magnesium sulfate. The pain scores, based on the visual analog scale, were recorded on admission, as well as one and two hours after receiving the drug. A Chi-Square test and student t-test were used for analysis of baseline characteristics. A Mann-Whitney U test and Wilcoxon singed rank test were used to analyze differences in the visual analogue scale (VAS) score between and within the groups respectively. Results: In total, 70 patients (35 patients in each group) with the mean age of $33.1{\pm}11.3years$ were included (64.3% female). For the Caffeine citrate group, the median pain score decreased from 9.0 (2.0) to 5.0 (4.0) after one hour and to 3.0 (4.0) after two hours. For the magnesium sulfate group, the pain score decreased from 8.0 (2.0) to 2.0 (2.0) after one hour and to 0.0 (1.0) after two hours. Both intravenous caffeine citrate and intravenous magnesium sulfate reduced pain scores significantly but the magnesium sulfate group showed more improvement than the Caffeine citrate group after one hour (P < 0.001) and after two hours (P < 0.001). Conclusions: It is likely that both intravenous caffeine and intravenous magnesium sulfate can reduce the severity of migraine headache. Moreover, intravenous magnesium sulfate at a dose of 2 g might be superior to intravenous caffeine citrate 60 mg for the short term management of migraine headache in emergency departments.

Botulinum Toxin Type A Therapy in Chronic Headache Patients (만성 두통 환자에서 Botulinum Toxin Type A 치료)

  • Moon, Dong Eon;Moon, Young Eun;Kim, Shi Hyeon;Kim, EunSung
    • The Korean Journal of Pain
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    • v.18 no.1
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    • pp.29-33
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    • 2005
  • Background: Chronic headache (CH) constitutes a significant public health problem, impacting on both the individual sufferer and society. Patients with CH, unresponsive to drug therapy or nerve block, suffer considerable disability due to the frequency and severity of attacks; therefore, they should be considered for novel therapy. Botulinum toxin type A (BoNT-A) has shown significant promise in the management of CH. In this paper, we review recent evidence on the efficacy of BoNT-A, and also report our experience with this treatment in CH patients. Methods: BoNT-A was used to treat 69 CH patients, including 47 in a chronic migraine group and 22 in a non-migraine CH group, who showed therapy-resistance to palliative drug or nerve block. We investigated the demography, dosage and site of BoNT-A injection, and used a visual analogue scale (VAS) for pain and the degree of satisfaction. The data were analyzed using t-tests and a Friedman repeated measures analysis of variance on ranks. Results: Significant decreases in the VAS for pain were found in both the chronic migraine and non-migraine CH groups, from 2, 4 and 12 weeks and from 4 and 12 weeks, respectively, after BoNT-A administration (P < 0.05). The chronic migraine group showed significantly lower VAS scores for pain than the non-migraine CH group from 2, 4 and 12 weeks after the BoNT-A administration (P < 0.05). Twenty eight patients (59.2%) in the chronic migraine group and eight (36.4%) in the non-migraine CH were satisfied with the BoNT-A treatment. Conclusions: This clinical study revealed that the use of BoNT-A demonstrated efficacy for CH patients resistant to drug therapy or nerve block. Moreover, BoNT-A proved itself more effective in the chronic migraine than non-migraine CH group.

Epidemiology and clinical characteristics of headache comorbidity with epilepsy in children and adolescents (소아청소년 간질 환자에서 동반된 두통의 역학과 임상적 특징)

  • Rho, Young Il
    • Clinical and Experimental Pediatrics
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    • v.50 no.7
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    • pp.672-677
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    • 2007
  • Purpose : To assess the prevalence and characteristics of headache comorbidity with epilepsy in children and adolescents in a specialty epilepsy clinic. Methods : Two hundred twenty nine consecutive patients attending the Chosun University Hospital Pediatric Epilepsy Clinic (mean age $10.0{\pm}4.1\;years$, range 4-17, M:F ratio 1.1:1.0) were interviewed with a standardized headache questionnaire. Headache was classified according to the International Classification of Headache Disorders, 2nd Edition and epilepsy was classified according to the International League Against Epilepsy. Disability was assessed using pediatric migraine disability assessment (PedMIDAS). Results : Of the 229 epilepsy patients, 86 (37.6%) had co-morbid headache. Of the headache patients, 64 (74.4%) had migraine (65.6%- migraine without aura, 20.3% - migraine with aura, 14.1% - probable migraine). The mean headache frequency was $7.2{\pm}8.4$ per month, mean duration was $2.2{\pm}4.0$ hours, mean severity was $5.2{\pm}2.2$ out of 10, and mean PedMIDAS score was $13.0{\pm}35.4$. The proportion of females was not higher in epilepsy with headache patients (48.8%) compared to epilepsy patients alone (48.0%). In the patients with migraine, 48.4% had complex partial seizures, 17.2% had simple partial seizures, and 34.4% had generalized seizures (P=0.368). A postictal association of migraine was reported in 18.8% with 17.2% reporting a preictal headache, and 7.8% reporting an ictal headache. Conclusion : The prevalence of headache in pediatric epilepsy is higher than that in general pediatric population, suggesting a co-morbidity of headache in epilepsy patients with migraine being the most frequent headache disorder. Altered cerebral excitability resulting in an increased occurrence of spreading depression may explain the headache comorbidity with epilepsy. Further studies are needed to assess the etiology of this co-morbidity as well as assess the frequency, duration, severity and disability response to antiepileptic drugs.

Review on the Causes of Headache in Hyungsang Medicine (두통(頭痛)의 원인에 따른 형상의학적(形象醫學的) 고찰 -동의보감(東醫寶鑑) 두문(頭門)을 중심으로)

  • Lee, Dong-Min;Park, Seong-Ha;Lee, Yong-Tae
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.21 no.4
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    • pp.835-841
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    • 2007
  • The followings are concluded from the treatment of headache in Hyungsang medicine, focussed on 11 kinds of headaches in Donguibogam. Headache is classified into overall headache and migraine according to the affected region. The causes are divided into exogenous affection and internal injury; The former brings on headache due to Wind-Cold and headache due to Damp-Heat. The latter, reversal headache, headache due to adverse rising of phlegm, headache due to regurgitation of Gi, headache due to excessive Heat, headache due to excessive Damp, true headache, and alcoholic headache. Headache due to internal injury generally tends to show deficiency syndrome with external affection. Headache due to exogenous affections is common to those who have big head or white skin and to Bangkwang type, and woman. The primary causes are Wind-Cold and Wind-Heat. When the body is observed in the perspective of eight phases, Damp-Heat is to be produced in the front, and Dry-Damp, in the back. Headache due to Damp-Heat is susceptible to Yangmyeong meridian type whose body develops more in the front and to woman. In the perspective of the upper and the lower, Yangdu(that is, head) is related to Eumdu(that is, glans of penis). Headache is also caused by the problems of Eumdu ,such as deficiency of Essence in man, pathologic change of uterus in women, and San syndrome in lower abdomen. In the case of man, headache is frequently severe and difficult to treat because head is a root for man. Disharmony of Gi and blood between the right and the left brings out migraine and headache due to regurgitation of Gi. Migraine is usually accompanied by symptoms of exogenous affection and often afflicts Gi-type, Shin-type, Soyang meridian type, deer type, and Dam-type. Headache due to regurgitation of Gi is brought by Gi deficiency or blood deficiency so that symptoms of exogenous affection do not show. It is mainly common with old people and those who have sunken eyes induced by deficiency of stomach Gi. In the perspective of the upper, the middle, and the lower, the pathologic change of head, chest and abdomen also bring about headache. The pathologic cause of head is Wind-Heat ,which triggers overall headache, migraine, headache due to Wind-Cold, headache due to excessive Heat, The pathogen of chest is phlegm-Fire and brings out headache due to Damp-Heat and headache due to adverse rising of phlegm. The pathologic factor in abdomen is Cold-Damp and produces headache due to adverse rising of phlegm and headache due to excessive Damp. In case of women, headache is generally caused by phlegm-Fire and retention of undigested food.

Giant Arachnoid Granulations in Headache Mimicking Migraine with Aura

  • Park, Jung E;Lee, Eun-ja
    • Investigative Magnetic Resonance Imaging
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    • v.21 no.3
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    • pp.192-194
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    • 2017
  • Giant arachnoid granulations have been reported to be associated with headaches, which can be acute or chronic in presentation. In some cases, idiopathic intracranial hypertension, previously called pseudotumor cerebri, may occur. The pathophysiology of these enlarged structures seen as filling defects on imaging is not clearly defined, although they are presumed to cause symptoms such as headache via pressure resulting from secondary venous sinus obstruction. We present a unique presentation of secondary headache in a 39-year-old man with no prior history of headaches found to have giant arachnoid granulations, presenting as migraine with aura.

A proposal for management of migraine in dental clinic (치과임상에서 편두통 치료에 대한 제안)

  • Park, YounJung;Lee, Hye-Jin;Kim, Seong Taek
    • Journal of Dental Rehabilitation and Applied Science
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    • v.35 no.4
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    • pp.199-205
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    • 2019
  • Management of migraine, one of common primary headache disorders, involves the diverse strategies non-pharmacological treatment, such as headache diary, lifestyle modification, regular exercise and relaxation, cognitive behavioral therapy and neurostimulation, and pharmacological treatment. Among the treatments, this review described a pharmacologic treatment of migraine, classified into acute and preventive treatment based on the severity and the frequency of headache. It introduced the way to optimize pharmacological treatment and updated the latest treatment for migraine.

A Clinical Study of Patients with Headache visited Neuropsychiatry (신경정신과(神經精神科)를 내원(來源)한 두통환자(頭痛患者)에 대한 임상적(臨床的) 고찰(考察))

  • Shim, Sang-Min;Heo, Seong
    • Journal of Oriental Neuropsychiatry
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    • v.11 no.1
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    • pp.83-96
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    • 2000
  • Objectives: In order to study the effect of the oriental medical therapy on the patients who visited Neuropsychiatry and oriental medical differentiation of symptoms and signs with ABR (Autonomic Bioelectric Response recorder)-2000, these clinical studies were performed. Methods: Sixty six patients with headache were classified into three groups; the first is tension headache, the second is migraine headache, the last is the others, each group was investigated of a various characteristic, the effect of the oriental medical therapy and stress was measured by ABR-2000. Result: 1. According to the statics, the tention headache's rate was higher than migraine; on the whole woman's rate was higher than man's. however in the migraine the rate of sex was equal. 2. According to the cause facter, oversensitiveness, overexertion, dyspepsia, etc. were numorous in the order. 3. According to the oriental medical differentiation of symptoms and signs, the rate of stagnation of the liver-qi' s fire-transmission(肝鬱化火) and deficiency of qi(氣虛), these two types were highest. result of analyzing ABR-2000 is that stagnation of the liver-qi's fire-transmission(肝鬱化火) is the highest stress. 4. According to treatment rate, 80.3 percent of patients satisfied of treatment.

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A Clinical Study of Headache in 58 Cases (두통(頭痛)의 임상양상(臨床樣狀) 및 생체전기자율반응에 대(對)한 임상적(臨床的) 고찰(考察))

  • Lee Sang-Ryong;Kim Myung-Jin
    • Journal of Oriental Neuropsychiatry
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    • v.12 no.2
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    • pp.103-122
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    • 2001
  • The clinical study was carried out the 58 patients with Headache who were treated in Department of Neuropsychiatry, College of Oriental Medicine, Dae Jeon University from 14 October 1999 to 15 October 2001. The results were summarized as follows. 1. The ratio of male and female was 15:43, 40s(36.2%) was frequent, the ratio of Tension headache and Migraine was 43:12, hypernoia and overwork oneself were the most inducing factor. 2. In distribution of the period of the clinical history, Tension headache was comparatively short term within 1 month(62.8%) and Migraine was comparatively long term over 1 year(91.7%), Tension headache was frequent at whole portion(41.3%) and occipital portion(26.1%), Migraine was frequent at temporal portion(76.9%). 3. In pain type, Tension headache has many vandlike discomport type, Migraine has many pulsatile type, neck-stiffness-pain and dizziness were mainly coexited. 4. Toung aspect has many SULDAMHONGTAEBAEKHOO(舌淡紅苔白厚), GINMAEK(緊脈) and HEUNMAEK(弦脈) were frequent in Pulse type, the GAEDAMSUNKIJEETONG(祛淡順氣止痛) prescription drugs were frequent such as GEYNTONGA(肩痛A), GEYNTONGDODAMTANG(?通導淡湯), Tension headache patients were well treated(90.7%). 5. In Tension headache and Migraine, the Curve has many SL except Tension headache‘s 2th SANGHAN(상한), in Regulation RR was frequent at 1th, 2th, 3th, 4th, 7th SANGHAN and RL was frequent at 5th, 6th SANGHAN, the result of Graph, Activity and Reactivity have many low response at the whole. 6. The Curve was within normal limit at whole portion and frequent SL at temporal portion, the whole and temporal portion s Regulation also have many RR at 1th, 2th, 3th, 4th, 7th SANGHAN and RL at 5th, 6th SANGHAN, Activity and Reactivity have many low response at the whole. 7. The occipital and frontal portion‘s Curve have many SL at 1th SANGHAN, the occipital portion’s Regulation has many RR at 1th, 2th, 4th, 7th SANGHAN and RL at 5th, 6th SANGHAN, Activity has many low response at the whole, Reactivity has many low response at 1th, 4th, 5th, 6th SANGHAN and high response 2th, 3th SANGHAN, the frontal portion s Regulation has many RL at 1th, 3th, 5th, 6th, 7th SANGHAN and RR at 4th SANGHAN, Activity and Reactivity also have many low response at the whole except 6th, 7th SANGHAN respectively.

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Assessment of Autonomic Function in Functional Headache by Heart Rate Variability (심인성(心因性) 두통(頭痛)의 심박변이도(HRV) 분석에 의한 자율신경기능 평가)

  • Kim, Kyung-Ok;Song, Ji-Hyung;Kim, Geun-Woo;Koo, Byung-Soo;Shim, Sang-Min
    • Journal of Oriental Neuropsychiatry
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    • v.13 no.1
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    • pp.19-37
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    • 2002
  • Objectives : This study sought to define autonomic functional difference on heart rate variability between headache patients and normal subjects Methods : We determined, heart rate variability of 52 headache patients and 30 normal subjects by means of three time domain measures: Mean PR(mean pulse rate), SDNN(standard deviation of all normal R-R intervals), RMSSD(the square root of the mean of sum of the squares of differences between adjacent normal R-R intervals), and five frequency domain measures: TP(total power), VLF(very low frequency), LF(low frequency), HF(high frequency). Results : 1) RMSSD, TP, HF, HF Norm of HRV decreased with aging and LF Norm, LF/HF increased with aging in headache patients. 2) There was no significant differences between migraine and tention headache in any standard index of HRV, whereas, HRV of total headache patients were smaller than those of normal subjects. 3) In the gender comparison, SDNN, RMSSD, HF of tention headache patients were the smallest and then migraine patients, normal subjects in order with man, whereas, LF Norm, LF/HF of normal subjects were the smallest with man. RMSSD of migraine patients were the smallest and then tention headache patients, normal subjects in order with women. 4) In the term of history of headache patients, SDNN, RMSSD were getting lower as long term. 5) There was no significant differences of HRV in physical symptom of headache patients. Conclusions : All of these results show that standard index of HRV of headache patients were significantly different with normal subjects.

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The Effect of Trigger Point Injection and $C_2$-ganglion Block for the Patients with Chronic Headache (만성두통환자 치료에 통증유발점 치료 및 제 2 경추신경절 차단술의 효과)

  • Song, Chan-Woo;Kim, Jung-Won
    • The Korean Journal of Pain
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    • v.8 no.2
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    • pp.272-278
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    • 1995
  • Headache is a common disease of the general population. But the main problem in any study of headache has been that of defining the disease entities. In 1988, the Headache Classification committee of the International Headache Society introduced operational diagnostic criteria for all headache disorders into 13 major group; migraine, tension-type headache, cluster headache and chronic paroxysmal hemicrania etc. Sjaastad was the first to describe "cervicogenic headache", one of various head pain syndromes that probably originate in the cervical spine. Between March 1995 and June 1995, we studied 78 out-patients of the Department of Neuro pain clinic, Sanggye Paik Hospital, Inje university. We divided the patients into three study group: Fifty-three patients with tension-type headache, 13 with cervicogenic headache, and 12 with migraine headache. The reponse of trigger point injection and $C_2$-ganglion block in patients was investigated. We paid particular attention to the response of trigger point injection in patients of the three group. The effect of trigger point injection was more marked in tension-type headache group than in the other categories. The pain reduction after $C_2$-ganglion block was more marked in cervicogenic headache group than in the others.

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