• 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.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.18 no.4
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• pp.224-229
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• 2015

Cyclic vomiting syndrome (CVS) is a functional disorder characterized by stereotypical episodes of intense vomiting separated by weeks to months. Although it can occur at any age, the most common age at presentation is 3-7 years. There is no gender predominance. The precise pathophysiology of CVS is not known but a strong association with migraine headaches, in the patient as well as the mother indicates that it may represent a mitochondriopathy. Studies have also suggested the role of an underlying autonomic neuropathy involving the sympathetic nervous system in its pathogenesis. CVS has known triggers in many individuals and avoiding these triggers can help prevent the onset of the episodes. It typically presents in four phases: a prodrome, vomiting phase, recovery phase and an asymptomatic phase until the next episode. Complications such as dehydration and hematemesis from Mallory Wise tear of the esophageal mucosa may occur in more severe cases. Blood and urine tests and abdominal imaging may be indicated depending upon the severity of symptoms. Brain magnetic resonance imaging and upper gastrointestinal endoscopy may also be indicated in certain circumstances. Management of an episode after it has started ('abortive treatment') includes keeping the patient in a dark and quiet room, intravenous hydration, ondansetron, sumatriptan, clonidine, and benzodiazepines. Prophylactic treatment includes cyproheptadine, propranolol and amitriptyline. No mortality has been reported as a direct result of CVS and many children outgrow it over time. A subset may develop other functional disorders like irritable bowel syndrome and migraine headaches.

• 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.

• Korean Journal of Psychosomatic Medicine
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• v.7 no.2
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• pp.263-273
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• 1999

Headache is a symptom with varied etiologies and extraordinarily frequent. Headaches can be a symptom of another diseases, such as meningitis, subarachnoid hemorrhage or brain tumor, may represent the disease entity itself as the case in migraine. The international Headache Society criteria were the first to distinguish between primary and secondary headache disorders. When evaluating a patient who presents with headache, the physician abviously needs to identify or exclude the myriad conditions that can cause secondary headache and initial diagnostic workup should be considered. If patient meets the criteria for a primary headache disorder, treatment commonly initiated without additional neurodiagnostic tests. The headache type, its associated feature, and the duration and the intensity of the pain attack all can influence the choice of acute therapy in migraine. Pharmacologically, such as NSAIDs, combination analgesics, vasoactive antimigraineous drugs, neuroleptics, antidepressants, or corticosteroids. Other approches to managing headache include a headache diary to identify triggers, biofeedback, relaxation technique and behavioral modification. Daily preventive medication should be considered by his attack frequency and intensity, and maintained for 4 to 6 months. Tension-type headaches are distinguished between episodic and chronic tension-type headache, but physician must make sure that patient is not drug-overuse or independent during symptomatic abortive therapy or preventive medication. The most difficult headache patients to treat are those with chronic daily headache. They often have physical dependency, low frustration tolerance, sleep problems, and depression. So discontinuation of overused medication is crucial. New developments in migraine therapy are broadening the scope of abortive and prophylactic treatment choices available to the physician. The enhanced ease of the use of sumatriptan and DHE will likely increase patient compliance and satisfaction.

• Clinical and Experimental Pediatrics
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• v.52 no.5
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• pp.557-566
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• 2009

Purpose : To evaluate the clinical features and characteristics of childhood periodic syndromes (CPS) in Korea using the new criteria of the International Classification of Headache Disorders (ICHD)-II. Methods : The study was conducted at pediatric neurology clinics of five urban tertiary-care medical centers in Korea from January 2006 to December 2007. Patients (44 consecutive children and adolescents) were divided into three groups (cyclic vomiting syndrome [CVS], abdominal migraine [AM], and benign paroxysmal vertigo of childhood [BPVC]) by recurrent paroxysmal episodes of vomiting, abdominal pain, dizziness, and/or vertigo using the ICHD-II criteria and their characteristics were compared. Results : Totally, 16 boys (36.4%) and 28 girls (63.6%) were examined (aged 4-18 yr), with 20 CVS (45.5%), 8 AM (18.2%), and 16 BPVC (36.4%) patients. The mean age at symptom onset was $6.3{\pm}3.6$ yr, $8.5{\pm}2.7$ yr, and $8.5{\pm}2.9$ yr in the CVS, AM, and BPVC groups, respectively, showing that symptoms appeared earliest in the CVS group. The mean age at diagnosis was $8.0{\pm}3.4$ yr, $10.5{\pm}2.6$ yr, and $10.1{\pm}3.2$ yr the CVS, AM, and BPVC groups, respectively. Of the 44 patients, 17 (38.6%) had a history of recurrent headaches and 11 (25.0%) showed typical symptoms of migraine headache, with 5 CVS (25.0%), 2 AM (25.0%), and 4 BPVC (25.0%) patients. Family history of migraine was found in 9 patients (20.4%): 4 in the CVS group (20.0%), 2 in the AM group (25.0%), and 3 in the BPVC group (18.8%). Conclusion : The significant time lag between the age at symptom onset and final diagnosis possibly indicates poor knowledge of CPS among pediatric practitioners, especially in Korea. A high index of suspicion may be the first step toward caring for these patients. Furthermore, a population-based longitudinal study is necessary to determine the incidence and natural course of these syndromes.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.21 no.4
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• pp.264-270
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• 2018

Purpose: The aim of this study was to describe functional gastrointestinal disorders (FGID) presented in a tertiary medical center, characteristics of patients and results of the diagnostic work-up together with an outcome during the follow up. Methods: This was a retrospective, single center, observational study including all patients who were diagnosed with FGID based on Rome III criteria from January to December 2015 in tertiary medical center. Results: Overall 294 children were included (mean age, 8.9 years [range, 1-18 years]; 165 females). Majority had functional constipation (35.4%), followed by functional abdominal pain (30.6%), irritable bowel syndrome (17.0%), functional dyspepsia (12.6%), functional nausea (3.4%) and abdominal migraine (1.0%). Regression model found that only significant factor associated with improvement of symptoms is the establishment of the functional diagnosis at the first visit (hazard ratio, 2.163; 95% confidence inverval, 1.029-4.544). There was no association between improvement of symptoms and presence of alarm signs/symptoms (weight loss, nocturnal symptoms and severe vomiting) at diagnosis. Furthermore, in pain symptoms (functional abdominal pain, irritable bowel syndrome, dyspepsia) no treatment positively correlated with pain improvement. Conclusion: Regardless of the initial diagnosis of FGID, positive diagnosis at the first visit increases a chance for resolution of symptoms.

• BMB Reports
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• v.56 no.10
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• pp.527-536
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• 2023

Serotonin receptors, also known as 5-HT receptors, belong to the G protein-coupled receptors (GPCRs) superfamily. They mediate the effects of serotonin, a neurotransmitter that plays a key role in a wide range of functions including mood regulation, cognition and appetite. The functions of serotonin are mediated by a family of 5-HT receptors including 12 GPCRs belonging to six major families: 5-HT₁, 5-HT₂, 5-HT₄, 5-HT₅, 5-HT₆ and 5-HT₇. Despite their distinct characteristics and functions, these receptors' subtypes share common structural features and signaling mechanisms. Understanding the structure, functions and pharmacology of the serotonin receptor family is essential for unraveling the complexities of serotonin signaling and developing targeted therapeutics for neuropsychiatric disorders. However, developing drugs that selectively target specific receptor subtypes is challenging due to the structural similarities in their orthosteric binding sites. This review focuses on the recent advancements in the structural studies of 5-HT receptors, highlighting the key structural features of each subtype and shedding light on their potential as targets for mental health and neurological disorders (such as depression, anxiety, schizophrenia, and migraine) drugs.

• The Korean Journal of Pain
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• v.37 no.2
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• pp.107-118
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• 2024

Nociplastic pain by the "International Association for the Study of Pain" is defined as pain that arises from altered nociception despite no clear evidence of nociceptive or neuropathic pain. Augmented central nervous system pain and sensory processing with altered pain modulation are suggested to be the mechanism of nociplastic pain. Clinical criteria for possible nociplastic pain affecting somatic structures include chronic regional pain and evoked pain hypersensitivity including allodynia with after-sensation. In addition to possible nociplastic pain, clinical criteria for probable nociplastic pain are pain hypersensitivity in the region of pain to non-noxious stimuli and presence of comorbidity such as generalized symptoms with sleep disturbance, fatigue, or cognitive problems with hypersensitivity of special senses. Criteria for definitive nociplastic pain is not determined yet. Eight specific disorders related to central sensitization are suggested to be restless leg syndrome, chronic fatigue syndrome, fibromyalgia, temporomandibular disorder, migraine or tension headache, irritable bowel syndrome, multiple chemical sensitivities, and whiplash injury; non-specific emotional disorders related to central sensitization include anxiety or panic attack and depression. These central sensitization pain syndromes are overlapped to previous functional pain syndromes which are unlike organic pain syndromes and have emotional components. Therefore, nociplastic pain can be understood as chronic altered nociception related to central sensitization including both sensory components with nociceptive and/or neuropathic pain and emotional components. Nociplastic pain may be developed to explain unexplained chronic pain beyond tissue damage or pathology regardless of its origin from nociceptive, neuropathic, emotional, or mixed pain components.

• Journal of Oral Medicine and Pain
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• v.31 no.4
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• pp.355-364
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• 2006

Headache is a common disease which influences not only individually but also socially. Temporomandibular disorders(TMD) refers to pain and dysfunction within the temporomandibular joint(TMJ) and associated muscles. TMD is presented commonly, and 70% of population are found to have one or more related symptom. A number of studies have been conducted to verify the association between headache and TMD, and some authors have proposed that headache and TMD may be related. In this study, we studied the patterns of headache presented by the patients who visited the TMJ and Orofacial pain clinic. Among the patients participated in this study, tension type headache showed the highest prevalence(48.5%), followed by migraine without aura(15.0%), probable migraine(10.6%), migraine with aura(7.1%), probable tension type headache(4.8%), and other primary headaches(1.8%). The high prevalence of tension type headache may be due to the accompaniment of orofacial pain by pericranial muscle tenderness. Comparison of sex showed that the rate of migraine was higher in female than male(female to male ratio 35.8:25.3). In age analysis, the rate of migraine was high in the twenties(42.2%) and the thirties(40.0%). As the age increased, the rate of migraine decreased, and this trend was in accordance with the previous studies. The percentage of the patients who had previously received treatment was only 26.2%, and that of those who were aware of the diagnosis was merely 8.7%. Therefore, it is not common for headache patients to get treatment, however, since orofacial pain is often accompanied by headache, more systematic diagnosis as well as precise treatment would be necessary. Moreover, since TMD could induce and aggravate headache, proper evaluation and management of TMD would be essential for diagnosis and treatment of headache. In the future, more systematic and broad investigation on the influence of causative factors of TMD on headache as well as the change in headache pattern with the treatment of TMD would be required.

• Proceedings of the Plant Resources Society of Korea Conference
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• 2003.10b
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• pp.17-17
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• 2003

Enzymes involved in catecholamine synthesis are present in the highest concentration in the adrenal medulla, however they were found also in other, mainly nervous tissues. Increased transcription of genes for catecholamine biosynthetic enzymes is an important mechanism to increase the capacity for epineprine/norepinephrine biosynthesis with stress. Gastrodia elata(Chinese name: Tienma), are very important Chinese herbal medicines used for the medical treatment of headaches, migraine, dizziness, epilepsy, rheumatism, neuralgia, paralysis and other neuralgic and nervous disorders. Immobilize stressed rat markedly increased tyrosine hydroxylase (TH) mRNA and dopamine-${\beta}$-hydroxylase (DBH) mRNA transcriptior level more than control group. But treated Gastrodia elata extracts in immobilized stressed rat slightly increased TH mRNA and DBH mRNA transcription level more than normal group. In addition, we are obtained identical results in PC12 cell line. Decrease of transcription level of TH mRNA and DBH mRNA is indicating that Gastrodia elata have a anti-stress effects which decrease the transcription level of TH and DBH mRNA on catecholamine biosynthesis pathway.