BACKGROUND: The International Classification of Headache Disorders, an essential tool in the diagnosis of headache disorders, has been revised as its 3rd edition, beta (ICHD-IIIbeta). The clinical application in practice is needed to test the feasibility and usefulness of the Korean version of ICHD-IIIbeta. METHODS: Neurologists enrolled consecutive first-visit headache patients from February to March 2014. The classification of headache disorder was done by each investigator according to ICHD-IIIbeta based on the initial structured questionnaire, clinical evaluation, and neuroimaging studies, if needed. A consensus meeting dealt with the cases that were difficult to diagnose. The feasibility and usefulness of this version was assessed by the proportion of unclassified headache disorders using ICHD-IIIbeta compared to the previous version. RESULTS: A total of 207 patients were enrolled: the mean age was 41 years (16-87 years) and women constituted 63.3%. Primary headache disorders were diagnosed in 167 patients (80.7%): 82 migraines, 37 tension-type headaches, 3 cluster headaches, and 45 other primary headache disorders. Thirty-five patients (16.9%) had secondary headache disorders or painful cranial neuropathies/other facial pain and 5 patients (2.4%) could not be classified by ICHD-IIIbeta. The diagnoses differed as compared to the previous version in 32 patients (15.5%): 14.5% differed due to the mitigation of the previous strict criteria and 1% differed due to the introduction of a new diagnostic category. CONCLUSIONS: Classifications by ICHD-IIIbeta are possible in more than 97% of the first-visit headache patients and ICHD-IIIbeta has proved to be more useful than its previous version.
Classification* ; Cluster Headache ; Consensus ; Diagnosis ; Facial Pain ; Female ; Headache ; Headache Disorders* ; Headache Disorders, Primary ; Headache Disorders, Secondary ; Humans ; Migraine Disorders ; Neuroimaging ; Surveys and Questionnaires ; Research Personnel ; Tension-Type Headache

BACKGROUND AND PURPOSE: Cluster headache (CH) is frequently either not diagnosed or the diagnosis is delayed. We addressed this issue by developing the self-administered Cluster Headache Screening Questionnaire (CHSQ). METHODS: Experts selected items from the diagnostic criteria of CH and the characteristics of migraine. The questionnaire was administered to first-visit headache patients at nine headache clinics. The finally developed CHSQ included items based on the differences in responses between CH and non-CH patients, and the accuracy and reliability of the scoring model were assessed. RESULTS: Forty-two patients with CH, 207 migraineurs, 73 with tension-type headache, and 18 with primary stabbing headache were enrolled. The CHSQ item were scored as follows: 3 points for ipsilateral eye symptoms, agitation, and duration; 2 points for clustering patterns; and 1 point for the male sex, unilateral pain, disability, ipsilateral nasal symptoms, and frequency. The total score of the CHSQ ranged from 0 to 16. The mean score was higher in patients with CH than in non-CH patients (12.9 vs. 3.4, p < 0.001). At a cutoff score of >8 points, the CHSQ had a sensitivity, specificity, positive predictive value, and negative predictive value of 95.2%, 96%, 76.9%, and 99.3%, respectively. CONCLUSIONS: The CHSQ is a reliable screening tool for the rapid identification of CH.
Cluster Headache* ; Diagnosis ; Dihydroergotamine ; Headache ; Headache Disorders, Primary ; Humans ; Male ; Mass Screening* ; Migraine Disorders ; Prevalence ; Sensitivity and Specificity ; Tension-Type Headache

Headache disorders, one of most common disease in general population, have been developed according to many versions of international classifications. The primary headaches are those in which no consistently identified organic cause can be determined. It is divided into the following categories: (1) migraine, (2) tension-type headache, (3) cluster headache and other trigeminal autonomic cephalalgias, (4) other primary headaches. This review described a diagnosis of primary headache disorders based on International Classification of Headache Disorders (ICHD)-3 beta criteria.
Classification ; Cluster Headache ; Dental Clinics* ; Diagnosis* ; Headache Disorders ; Headache Disorders, Primary ; Headache* ; Migraine Disorders ; Temporomandibular Joint Disorders ; Tension-Type Headache ; Trigeminal Autonomic Cephalalgias

It has been known that the prevalence and the etiology of headache in the elderly are different from these in the general population. Nevertheless studies of headache in the elderly have been rare. Under these backgrounds, prospective study was performed to find the clinical characteristics of headache in the Korean elderly. The subjects consisted of 237 patients (male:femal = l.0:1.7). A detailed and relevant history was gathered by headache history force, and specific headache diagnosis was based on diagnostic criteria of the International Headache Society (1988). This study revealed that episodic/chronic tension-type headache (43%) was the meet common diagnosis, followed by headache not classifiable (8%), headache from substance withdrawal (6%), occipital neuralgia (5%), idiopathic stabbing headache (4%), and migraine(40%). Relatively because many patients with tension type headache had oromandibular dysfunctions, somewhat high proportion of the patients reported unilateral predominance in the location of pain. The proportion of symptomatic headache that start in the elderly were higher than that of idiopathic headache. When comparing with the general population, the importance of migraine and cluster headache declined, while the important of symptomatic headaches increased. Idiopathic headache was more common in woman than in men, but symptomatic headache had no definite sex difference. In conclusion, the etiologies and types of headache in the elderly are more complex and diverse, so that thorough diagnostic workups are needed.
Aged* ; Cluster Headache ; Diagnosis ; Female ; Headache Disorders, Primary ; Headache* ; Humans ; Male ; Migraine Disorders ; Neuralgia ; Prevalence ; Prospective Studies ; Sex Characteristics ; Tension-Type Headache

BACKGROUND: We investigated the demographic features and characteristics of headache (HA) in patients visiting a primary care clinic (PCC). METHODS: We prospectively collected the demographic and clinical data of 261 consecutive HA patients in a PCC located in Taejon from Oct. 1996 to Jul. 1998. All patients were interviewed and examined by a single neurologist. The types of HA were classified as migraine, tension-type, mixed, and others. RESULTS: The mean age at the initial visit was 37.2 +/-13.4 years. Women were 3 times more common than men (193 patients vs. 68 patients). More than half of the female patients were housewives (47.5%). Migraine was the most common type of headache (114 patients, 43.7%), followed by mixed type (72 patients, 27.6%) and tension-type headaches (57 patients, 21.8%). 85.7% of patients with HA for more than 1 month had taken medication before their initial visit. Among the 168 patients who reported their attitude toward HA, 55 patients continuously worried about their HA even in the HA-free period. CONCLUSIONS: In a PCC, migraine was the prevailing type of HA. The majority of HA sufferers were housewives.
Daejeon ; Female ; Headache* ; Humans ; Male ; Migraine Disorders ; Neurology* ; Primary Health Care* ; Prospective Studies ; Tension-Type Headache

BACKGROUND AND PURPOSE: The epidemiology and impact of headache disorders are only partially documented for Asian countries. We investigated the prevalence and impact of migraine and tension-type headache - which are the two most common primary headache disorders - in a Korean population. METHODS: A stratified random population sample of Koreans older than 19 years was selected and evaluated using a 29-item, semistructured interview. The questionnaire was designed to classify headache types according to the criteria of the International Classification of Headache Disorders, second edition, including migraine and tension-type headache. The questionnaire also included items on basic demographics such as age, gender, geographical region, education level, and income, and the impact of headache on the participant. RESULTS: Among the 1507 participants, the 1-year prevalence of all types of headaches was 61.4% (69.9% in women and 52.8% in men). The overall prevalence rates of migraine and tension-type headaches were 6.1% (9.2% in women and 2.9% in men) and 30.8% (29.3% in women and 32.2% in men), respectively. The prevalence of migraine peaked at the age of 40-49 years in women and 19-29 years in men. In contrast to migraine, the prevalence of tension-type headache was not influenced by either age or gender. Among individuals with migraine and tension-type headache, 31.5% and 7% reported being substantially or severely impacted by headache, respectively (Headache Impact Test score > or =56). Overall, 13.4% of all headache sufferers reported being either substantially or severely impacted by headache. CONCLUSIONS: The 1-year prevalence rates of migraine and tension-type headache in the studied Korean population were 6.1% and 30.8%, respectively. One-third of migraineurs and some individuals with tension-type headache reported being either substantially or severely impacted by headache.
Asian Continental Ancestry Group ; Demography ; Female ; Headache ; Headache Disorders ; Headache Disorders, Primary ; Humans ; Korea ; Male ; Migraine Disorders ; Prevalence ; Tension-Type Headache ; Surveys and Questionnaires

BACKGROUND: Headache is one of the most common disorders, and shows ethnic or geographic diversities. Moreover, the prevalence and epidemiologic characteristics of headache, especially in people living in an island area, is lacking. Therefore, we investigated the prevalence and subtypes of headache in an island area of Korea. METHODS: We collected the demographic and clinical data of all residents living in the survey island area. A neurologist interviewed 352 respondents in a face-to-face method. The specific headache diagnosis was based on the diagnostic criteria of the International Headache Society. RESULTS: The survey island area represented a typical aging society like that of a rural area in Korea. Tension-type headache was the most common type. The prevalence of migraine, tension-type headache, and other headache were 4.0%, 7.1%, and 1.7%, respectively. Migraine with aura occupied 1.7% and migraine without aura occupied 2.3%. Episodic tension-type headache occupied 6.5% and chronic tension-type headache occupied 0.6%. Migraine showed a peak prevalence below the third decade of age and tension-type headache showed a peak prevalence above the sixth decade. CONCLUSIONS: This study showed a characteristic pattern of the prevalence of headache in an island area of Korea. We thought this low prevalence of headache might be due to not only subject age but also social-environmental factors. This study may be helpful in understanding headaches and can provide some basic information for future studies.
Aging ; Surveys and Questionnaires ; Diagnosis ; Epidemiology ; Headache* ; Korea* ; Migraine Disorders ; Migraine with Aura ; Migraine without Aura ; Prevalence ; Tension-Type Headache

BACKGROUND: White-matter abnormalities (WMAs) are frequently encountered on MRI conducted for the diagnosis of headache. Although many studies have suggested an association between migraine and stroke or WMAs, no definite conclusions can be drawn from these data because of confounding factors. The purpose of our study was thus to determine whether the incidence and location of WMAs in migraine differ from those in tension-type headache. METHODS: The MRI findings of 180 patients (130 with migraine and 50 with tension-type headache) under 45 years of age without vascular risk factors were reviewed. MRI findings were reviewed with respect to focal white-matter hyperintensities on fluid-attenuated inversion recovery. The frequency, location, and volume of the abnormalities were measured. RESULTS: WMAs were observed in 24% of patients with migraine and 28% of those with tension-type headache (p=0.71). The number and volume of abnormalities in both groups were not different. WMAs were most frequently located in the subcortical area in both groups. The age of patients with WMAs was older than patients without abnormalities (36.4+/-7.2 vs 29.6+/-9.2, mean+/-SD; p<0.01). There was a positive correlation between patient age and the volume of WMAs (p=0.04). In the migraine group, WMAs were seen in 21% of patients with migraine without aura and in 60% of those with migraine with aura (p=0.01). CONCLUSIONS: Although the characteristics of WMAs were not different between patients with migraine and those with tension-type headache, the incidence of WMAs was significantly higher in migraine with aura. This may be extrapolated to an increased risk for stroke in patients with migraine with aura, but not in those with migraine without aura.
Headache ; Humans ; Incidence ; Magnetic Resonance Imaging ; Migraine Disorders ; Migraine with Aura ; Migraine without Aura ; Risk Factors ; Stroke ; Tension-Type Headache

BACKGROUND AND PURPOSE: New-onset headache in elderly patients is generally suggestive of a high probability of secondary headache, and the subtypes of primary headache diagnoses are still unclear in the elderly. This study investigated the characteristics of headache with an older age at onset (≥65 years) and compared the characteristics between younger and older age groups. METHODS: We prospectively collected demographic and clinical data of 1,627 patients who first visited 11 tertiary hospitals in Korea due to headache between August 2014 and February 2015. Headache subtype was categorized according to the International Classification of Headache Disorders, Third Edition Beta Version. RESULTS: In total, 152 patients (9.3%, 106 women and 46 men) experienced headache that began from 65 years of age [elderly-onset group (EOG)], while the remaining 1,475 patients who first experienced headache before the age of 65 years were classified as the younger-age-at-onset group (YOG). Among the primary headache types, tension-type headache (55.6% vs. 28.8%) and other primary headache disorders (OPH, 31.0% vs. 17.3%) were more common in the EOG than in the YOG, while migraine was less frequent (13.5% vs. 52.2%) (p=0.001) in the EOG. Among OPH, primary stabbing headache (87.2%) was more frequent in the EOG than in the YOG (p=0.032). The pain was significantly less severe (p=0.026) and the frequency of medication overuse headache was higher in EOG than in YOG (23.5% vs. 7.6%, p=0.040). CONCLUSIONS: Tension-type headache and OPH headaches, primarily stabbing headache, were more common in EOG patients than in YOG patients. The pain intensity, distribution of headache diagnoses, and frequency of medication overuse differed according to the age at headache onset.
Age of Onset ; Aged ; Classification* ; Diagnosis ; Electrooculography ; Female ; Headache Disorders* ; Headache Disorders, Primary ; Headache Disorders, Secondary ; Headache* ; Humans ; Korea ; Migraine Disorders ; Prescription Drug Overuse ; Prospective Studies ; Tension-Type Headache ; Tertiary Care Centers

BACKGROUND: A paracervical C2 ganglion blockade was carried out for therapeutic and diagnostic reasons of cervicogenic headache only. METHODS: This study was designed to investigate the therapeutic effect of C2 ganglion blockade in patients with cervicogenic headache(CEH), migraine without aura, and tension-type headache(TTH). From March 1995 to June 1995, we treated 24 cases of chronic headache(CEH:12, TTH:9, migraine:3) using C2 ganglion blockade with methylprednisolone and mepivacaine. The diagnoses of CEH in this study was established according to the recent diagnostic criteria(Sjaastad et al. 1990). The diagnoses of migraine and TTH were based on the IHS criteria. RESULTS: In the cases of cervicogenic headache, 11 patients out of 12(91.67%) improved after C2 ganglion blockade. In the cases of tension-type headache, 7 patients out of 9 improved(77.78%). In the cases of migraine, 1 patient out of 3(33.33%) improved. CONCLUSION: No significant differences of the therapeutic value were found in patients with three groups of headache(Fishers exact test).
Diagnosis ; Ganglion Cysts* ; Headache ; Humans ; Mepivacaine ; Methylprednisolone ; Migraine Disorders* ; Migraine without Aura* ; Post-Traumatic Headache* ; Tension-Type Headache*