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*

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: Headache is one of the most common symptoms having experienced by many people. High school girls are expected to experience headache very often. Their proper treatment and adequate medical service is doubtful, and stressful environment of the Korean high school will augment the chronicity of headache. Knowing the forms of headache and categorizing the headache according to headache classification system is important for proper treatment of headache. Types of headache in high school girls have been categorized using International Headache Society (IHS) system. The relationships of headache with Beck Depression Inventory (BDI) and Family APGAR score of the headache groups and control group are investigated. Thus, the purpose of this study was to attribute to the treatment of the headache in female youths. METHODS: The questionnaires .on headache, under direct interviews, was given to each high school girls in Seoul, from March 1 to 31, 1999. The headache group was subclassified into migraine group, tension headache group and other headache group, using IHS system. Furthermore, the migraine group was subclassified into migraine with aura (classic migraine), migraine without aura (common migraine) and other migronous disorder. The students who had not experienced any headaches during the recent one year have been selected as the normal group. The normal group was compared with the headache group, i.e., tension headache and migraine. Depressed tendency was assessed using the BDI; and family function was evaluated by Family APGAR. The data are analyzed using SPSS 8.0. RESULTS: Among the subjects, 304 (60.4%) high school girls had experienced a headache during the previous one year. The girls with migraine, tension headache, and other types of headache were 110 (38%), 81 (27%) and 113 (35%), respectively. The migraine group showed higher BDI scores (p<0.01). Also, the migraine group showed more depressiveness than the normal group (p<0.01), according to the scores on the BDI which were greater than the cutting score of 21. In the Family APGAR, there was no significant difference between the headache groups and the normal group.(P>0.05) CONCLUSIONS: When the headache in high school girls was classified by using IHS system, headache in the migraine group was more prevalent than in the tension headache group and normal group. And the migraine group had more depressive tendency. When physicians deal with the headache in high school girls, they need to be aware of migraine headache and associated depressive tendency.
Adolescent ; Apgar Score ; Classification ; Depression ; Female* ; Headache* ; Humans ; Migraine Disorders ; Migraine with Aura ; Migraine without Aura ; Seoul ; Tension-Type Headache ; Surveys and Questionnaires

BACKGROUND AND PURPOSE: Cluster headache (CH) can present with migrainous symptoms such as nausea, photophobia, and phonophobia. In addition, an overlap between CH and migraine has been reported. This study aimed to determine the differences in the characteristics of CH according to the presence of comorbid migraine. METHODS: This study was performed using data from a prospective multicenter registry study of CH involving 16 headache clinics. CH and migraine were diagnosed by headache specialists at each hospital based on third edition of the International Classification of Headache Disorders (ICHD-3). We interviewed patients with comorbid migraine to obtain detailed information about migraine. The characteristics and psychological comorbidities of CH were compared between patients with and without comorbid migraine. RESULTS: Thirty (15.6%) of 192 patients with CH had comorbid migraine, comprising 18 with migraine without aura, 1 with migraine with aura, 3 with chronic migraine, and 8 with probable migraine. Compared to patients with CH without migraine, patients with CH with comorbid migraine had a shorter duration of CH after the first episode [5.4±7.4 vs. 9.0±8.2 years (mean±standard deviation), p=0.008], a lower frequency of episodic CH (50.0% vs. 73.5%, p=0.010), and a higher frequency of chronic CH (13.3% vs. 3.7%, p=0.033). Psychiatric comorbidities did not differ between patients with and without comorbid migraine. The headaches experienced by patients could be distinguished based on their trigeminal autonomic symptoms, pulsating character, severity, and pain location. CONCLUSIONS: Distinct characteristics of CH remained unchanged in patients with comorbid migraine with the exception of an increased frequency of chronic CH. The most appropriate management of CH requires clinicians to check the history of preceding migraine, particularly in cases of chronic CH.
Classification ; Cluster Headache ; Comorbidity ; Headache ; Headache Disorders ; Humans ; Hyperacusis ; Migraine Disorders ; Migraine with Aura ; Migraine without Aura ; Nausea ; Photophobia ; Prospective Studies ; Specialization

BACKGROUND AND PURPOSE: Complete information on migraine-related disabilities facilitate the making of appropriate treatment decisions. Although the accessibility and ease of use of the Headache Impact Test-6 (HIT-6) make it a very promising instrument, there are few data available for comparing HIT-6 scores with the actual amount of disability. METHODS: To determine whether the disability measured using the HIT-6 questionnaire realistically reflects the amount of disability as extracted from a headache diary, which would help when deciding a management plan, 130 patients with migraine without aura were instructed to complete a headache diary on the days on which headache occurred. Each diary booklet also contained questions on the resulting disability, and comprised five items originating from the Migraine Disability Assessment Scale. After submitting their diaries, the participants completed the HIT-6 for the same time period. RESULTS: Disability as recorded in diaries was present for a mean of 2.7 days per month, and its duration differed significantly with HIT-6 score: 0.9, 2.6, and 4.6 days per month for littleto-no impact, moderate impact, and severe impact, respectively. The summed disability score from diaries was also related to the HIT-6 score. Headache frequency was the only headache characteristic that contributed significantly to the HIT-6 score. CONCLUSIONS:This study demonstrates that the HIT-6 could be useful for assessing headache-related disability in migraine patients, especially given that the questionnaire is both simple and ease of use.
Headache ; Humans ; Migraine Disorders ; Migraine without Aura ; Pamphlets ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to evaluate the clinical course and prognosis of migraines in childhood and adolescence, and the influence of preventive therapy on them. METHODS: We recruited 110 children and adolescents with migraines who had been newly diagnosed and treated. Treatment was composed of observation after consultation, acute symptomatic treatment, and preventive therapy. We prescribed topiramate for preventive therapy. The recipients of preventive therapy were those patients who complained of disturbance in daily life due to severe headache. The clinical course was evaluated on the basis of changes in the frequency of migraine attack and was divided into three groups: complete recovery, partial recovery, and non-recovery. The prognosis of migraine was classified into those free from migraine attack, decreased, and persistant. RESULTS: Forty-six (41.8%) of 110 patients completely recovered, and 70 (63.6%) were free from migraine attack. In those suffering from migraines without aura, 38.3% of the patients completely recovered and 59.6% were free from migraine attack. Regarding migraines with aura, 58.5% of the patients completely recovered and 70.7% were free from migraine attack. With respect to cases of probable migraine, 18.2% completely recovered and 59.6% were free from migraine attack. In those receiving preventive treatment, 80.0% of all patients completely recovered and 85.0% were free from migraine. According to migraine type, 66.7% of patients with migraine without aura completely recovered and 80% were free from migraine. In those with migraine and aura, 88.8% of patients completely recovered and 88.8% were free from migraine attack. CONCLUSION: It was estimated that the clinical course and prognosis of migraine patients who were treated by pediatric neurologists were generally good. The clinical course was better in the preventive therapy group. In particular, the effect of preventive treatment and prognosis were optimal in patients with migraine with aura.
Adolescent ; Child ; Epilepsy ; Fructose ; Headache ; Humans ; Migraine Disorders ; Migraine with Aura ; Migraine without Aura ; Prognosis ; Stress, Psychological

PURPOSE: Headache is a frequent symptom in pediatric practice, but the prevalence of chronic recurrent headache was estimated in several studies with wide variations, because of inadequate expression and differences in case definition in children. Headache classification of International Headache Society is usually used in adults, but the application of it to children is uncommon, so we tried to diagnosis children with headache by using International Headache Society Classification. METHODS: We analyzed the clinical pictures, physical examinations including neurologic examination, PNS series, EEG and CT or MRI in 53 children with nonprogressing recurrent headache over than one month, who visited to pediatric department of Dong-A University hospital from January, 1995 to Feburary, 1996 and diagnosed them by using International Headache Society Classification. RESULTS: 1) The sex ratio between male and female was 1:1.2. 2) Diagnosed groups consisted of children with migraines in 22 cases(41.5%), tension-type headache in 19 cases(35.9%), coexisting migraine and tension-type headaches in 5 cases(9.4%), miscellaneous headaches not associated with structual lesion in 1 case(1.9%), headache associated with vascular disorders in 2 cases(3.8%), headache associated with nonvascular intracranial disorder in 1 case(1.9%), headache due to facial pain in 3 cases(5.6%). 3) Of 22 migraine cases, 13 cases(59.1%) had migraine with aura, 8 cases(40.9%) have migraine without aura and of 19 tension-type headache cases, 8 cases(42.1%) have episodic type, 11(57.9%) cases have chronic type. 4) Of 53 cases with recurrent headache, 3 cases(6%) had abnormal findings in CT or MRI. 5) Of 53 cases with recurrent headache, 9 cases(17%) had abnormal findings in EEG. CONCLUSIONS: International Headache Society Classifications are useful, but the diagnostic criteria are too strict for children, especially in migraine and tension type headache.
Adult ; Child* ; Classification* ; Diagnosis ; Electroencephalography ; Facial Pain ; Female ; Headache* ; Humans ; Magnetic Resonance Imaging ; Male ; Migraine Disorders ; Migraine with Aura ; Migraine without Aura ; Neurologic Examination ; Physical Examination ; Prevalence ; Sex Ratio ; Tension-Type Headache

BACKGROUND: The pathophysiology of migraine is not yet fully understood. Homocysteine acts as an excitatory amino acid in vivo and may influence the threshold of migraine. The previous studies have revealed strong association between the homozygous C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene and hyperhomocysteinemia. In this study, we examined the association between both homocysteine and MTHFR C677T polymorphism and headache, such as migraine and tension headache. METHODS: We enrolled 148 headache patients (75 tension headache, 34 migraine with aura [MWA], and 39 migraine without aura [MOA]) and 121 normal controls; checked their fasting homocysteine levels and analyzed for the MTHFR C677T polymorphism. For the multivariate analysis, we used logistic regression to adjust for age and sex. RESULTS: Plasma homocysteine levels were significantly higher in patients with MWA than those in controls (adjusted odds ratio (AOR), 1.12; 95% confidence intervals (CI), 1.02~1.23). The AOR and 95% CI of the MTHFR 677TT genotype was significantly higher in patients with total migraine (AOR, 3.32; 95% CI, 1.30~9.55; p< 0.05) and with MWA (AOR, 4.70; 95% CI, 1.44~15.29; p<0.01) than the controls. However, the AOR was not significant in patients with tension headache (AOR, 0.93; 95% CI, 0.37~2.32) and with MOA (AOR, 2.77; 95% CI, 0.78~9.74). CONCLUSIONS: Our findings suggest that both elevated homocysteine level and the homozygous C677T mutation in the MTHFR gene are associated with migraine with aura.
Excitatory Amino Acids ; Fasting ; Genotype ; Headache ; Homocysteine* ; Humans ; Hyperhomocysteinemia ; Logistic Models ; Methylenetetrahydrofolate Reductase (NADPH2) ; Migraine Disorders* ; Migraine with Aura* ; Migraine without Aura ; Multivariate Analysis ; Odds Ratio ; Plasma ; Risk Factors ; Tension-Type Headache

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