PURPOSE: Recurrent headaches are common among Korean students, causing absences from school or learning impediments. However, most school nurses are unable to provide appropriate diagnosis and treatment as they lack accurate information about the clinical aspects or treatment of headaches. The aim of this study was to investigate school nurses's clinical knowledge, assessment, and management of headache and educational needs in headache management. METHODS: This was a cross-sectional study targeting 250 school nurses who participated in the training lecture hosted by and were working at elementary, middle, and high schools. Surveys with insufficient data were excluded. RESULTS: Participants were 237 school nurses; 122 elementary school nurses, 62 middle school nurses, and 53 high school nurses, with an average age of 42.4±8.8 years. In all, 58.2% of the school nurses responded that they had received headache education, 68.8% responded that they knew the classifications of a headache, and 38.4% responded that they knew a headache assessment method. Only, 29% had a protocol for headache treatment. The educational needs (0-7 points) of school nurses to manage students with headaches were 5.8 for headache knowledge education, 5.5 for acute pharmacotherapy, 5.0 for preventive pharmacotherapy, 6.0 for lifestyle modification, and 6.0 for complementary remedy. CONCLUSION: School nurses had high educational needs for headache management but, they had insufficient knowledge of headaches and had not a protocol for the headache management in most cases. It suggests that headache knowledge education should be performed and the standardized headache management guideline should be developed to improve the performance of school nurses.
Classification ; Cross-Sectional Studies ; Diagnosis ; Disease Management ; Drug Therapy ; Education ; Headache* ; Humans ; Learning ; Life Style ; Methods ; School Nursing

PURPOSE: Recurrent headaches are common among Korean students, causing absences from school or learning impediments. However, most school nurses are unable to provide appropriate diagnosis and treatment as they lack accurate information about the clinical aspects or treatment of headaches. The aim of this study was to investigate school nurses's clinical knowledge, assessment, and management of headache and educational needs in headache management. METHODS: This was a cross-sectional study targeting 250 school nurses who participated in the training lecture hosted by and were working at elementary, middle, and high schools. Surveys with insufficient data were excluded. RESULTS: Participants were 237 school nurses; 122 elementary school nurses, 62 middle school nurses, and 53 high school nurses, with an average age of 42.4±8.8 years. In all, 58.2% of the school nurses responded that they had received headache education, 68.8% responded that they knew the classifications of a headache, and 38.4% responded that they knew a headache assessment method. Only, 29% had a protocol for headache treatment. The educational needs (0-7 points) of school nurses to manage students with headaches were 5.8 for headache knowledge education, 5.5 for acute pharmacotherapy, 5.0 for preventive pharmacotherapy, 6.0 for lifestyle modification, and 6.0 for complementary remedy. CONCLUSION: School nurses had high educational needs for headache management but, they had insufficient knowledge of headaches and had not a protocol for the headache management in most cases. It suggests that headache knowledge education should be performed and the standardized headache management guideline should be developed to improve the performance of school nurses.
Classification ; Cross-Sectional Studies ; Diagnosis ; Disease Management ; Drug Therapy ; Education ; Headache* ; Humans ; Learning ; Life Style ; Methods ; School Nursing

Craniofrontonasal dysplasia(CFND), a rare congenital syndrome, is characterized by varying degrees of frontonasal dysplasia, craniosynostosis, and variable extracranial abnormalities. It was first reported by Cohen in 1979. The inheritance pattern is not straightforward. Although all modes of Mendelian inheritance have been suggested, the most plausible explanation is that this is an X-linked condition with the unusual situation of complete expression in females, and minimal to no expression in males. In our case, CFND was diagnosed in a female neonate who had unilateral coronal craniosynostosis, frontal bossing, orbital hypertelorism, broad nasal root, clefting nasal tip, corpus callosum agenesis and mild extremity abnormalities.
Agenesis of Corpus Callosum ; Craniosynostoses ; Extremities ; Female ; Humans ; Hypertelorism ; Infant, Newborn ; Inheritance Patterns ; Male ; Orbit ; Parturition* ; Wills

PURPOSE: The aim of this study was to estimate the efficacy and safety of flunarizine in the treatment of pediatric headaches. METHODS: We conducted a retrospective analysis of clinical records of children aged between 4 and 19 years who were treated with flunarizine for headache at the Chosun university hospital between April 2006 and December 2012. Flunarizine was initially prescribed to patients 5 mg daily and was then escalated once in 7 patients because of the unresponsiveness to the initial dose. We evaluated the frequency, duration, severity, and disability of headache before and after the treatment of flunarizine. Effective treatment was defined as a reduction in the frequency of individual attacks by at the least 50%. RESULTS: Eighty five patients were identified, but 23 were excluded due to missing records. Sixty two children were included in the study: 18 boys and 44 girls with a mean age of 11 years. The diagnostic categories included migraine (27), tension type headache (7), others (28). The mean frequency of attack was 15.1+/-8.9 per month. Good outcome was observed 54.8% (34/62) in 1 month, 70.4% (38/54) in 3 month, and 80.8% (42/52) in 6 month. Adverse effects were seen in 15 (24.2%): worsening of headache (4), sedation (3), weight gain/increased appetite (2), dizziness (1), drowsiness (1) and others (4). Flunarizine was discontinued due to adverse effects in 6 patients, which includes worsening of headache (4), muscle ache (1), and tremor (1). In addition, it was discontinued due to lack of efficacy in seven patients. CONCLUSION: Flunarizine appears to be effective and safe in pediatric headache in our study. However, further studies are needed.
Appetite ; Child ; Dizziness ; Female ; Flunarizine* ; Headache* ; Humans ; Migraine Disorders ; Muscles ; Retrospective Studies ; Sleep Stages ; Tension-Type Headache ; Tremor

The primary headaches include migraine, tension-type headache(TTH), cluster headache, and other primary headaches. An understanding of the basic pathophysiology facilitates the assessment and management of patients with headache. There have been remarkable advances in the last decade in unraveling the mystery of primary headaches. The vascular theory has been superseded by the neurovascular phenomenon, which seems to be the permissive triggering factor in migraine and cluster headache. Calcitonin gene-related peptide(CGRP) is one of the main neuropetides involved in the neurogenic inflammation, which is important in the generation of migraine. The serotonin also appears to have a pivotal role in some aspects of migraine pathogenesis. Cortical spreading depression(CSD) seems to be an important phenomenon explaining migraine with aura. The brain stem nuclei(raphe and locus coeruleus) and cortical hyperexcitability may well have a important role in generating CSD. These have been achieved through new imaging modalities such as positron emission tomography(PET) and functional magnetic resonance imaging(fMRI). In migraine, the throbbing pain is mediated by the sensitization of the meningeal nociceptor of trigeminovascular neurons. The sustained sensitization of peripheral trigeminal neurons eventually leads to subsequent sensitization of central trigeminovascular neurons, which can be manifested as cutaneous allodynia. TTH and migraine belong to the same physiological spectrum. However, they are genetically most likely multifactorial.
Brain Stem ; Calcitonin ; Cluster Headache ; Electrons ; Headache* ; Humans ; Hyperalgesia ; Migraine Disorders ; Migraine with Aura ; Neurogenic Inflammation ; Neurons ; Nociceptors ; Serotonin

A flaccid tetraparesis in Bickerstaff's brainstem encephalitis (BBE) is presumed to be a sign of overlapping Guillain-Barre syndrome (GBS). In addition, BBE and Fisher syndrome, which are clinically similar and are both associated with the presence of the immunoglobulin G anti-GQ1b antibody, represent a specific autoimmune disease with a wide spectrum of symptoms that include ophthalmoplegia and ataxia. A 2-year-old boy presented with rapidly progressive ophthalmoplegia, ataxia, hyporeflexia, weakness of the lower extremities, and, subsequently, disturbance of consciousness. He experienced bronchitis with watery diarrhea and had laboratory evidence of recent infection with Epstein-Barr virus (EBV). He was diagnosed as having overlapping GBS and BBE associated with EBV and received treatment with a combination of immunoglobulin and methylprednisolone, as well as acyclovir, and had recovered completely after 3 months. In addition, he has not experienced any relapse over the past year. We suggest that combinations of symptoms and signs of central lesions (disturbance of consciousness) and peripheral lesions (ophthalmoplegia, facial weakness, limb weakness, and areflexia) are supportive of a diagnosis of overlapping GBS and BBE and can be helpful in achieving an early diagnosis, as well as for the administration of appropriate treatments.
Acyclovir ; Ataxia ; Autoimmune Diseases ; Brain Stem* ; Bronchitis ; Child, Preschool ; Consciousness ; Diagnosis ; Diarrhea ; Early Diagnosis ; Encephalitis* ; Extremities ; Guillain-Barre Syndrome* ; Herpesvirus 4, Human* ; Humans ; Immunoglobulin G ; Immunoglobulins ; Lower Extremity ; Male ; Methylprednisolone ; Miller Fisher Syndrome ; Ophthalmoplegia ; Recurrence ; Reflex, Abnormal

Paroxysmal hemicrania (PH) is rare in children and not widely recognized. It is characterized by pain attacks and associated symptoms and signs similar to those experiencing cluster headaches, but the features have a shorter effect, are more frequent, and respond completely to indomethacin. Some patients with PH may experience slight pain across the midline. There are only four cases of bilateral PH in the literature and it is very rare in children. Here, I report the case of a 10-year-old female with bilateral PH diagnosed by the typical symptoms along with the favorable response to indomethacin therapy.
Child ; Cluster Headache ; Female ; Humans ; Hydrogen-Ion Concentration ; Indomethacin ; Paroxysmal Hemicrania

The relation between headache and diabetes mellitus (DM) is interesting. The pathogenesis of headache in diabetic patients has been suggested to stem from the fact that DM reduces vascular reactivity and causes numerous changes of neurotransmitters that may be relevant in the pathogenesis of migraines; however, this mechanism remains unclear. We report a 17-year-old female patient with newly diagnosed type 2 diabetes mellitus, without any past history and symptoms of diabetes mellitus, who presented with persistent severe headache for 10 days. She did not complain of any headache following DM treatment. The author recommends that pediatricians consider and investigate diabetes mellitus in cases of progressive or persistent headache or refractory headache with headache treatment.
Adolescent ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Female ; Headache ; Humans ; Neurotransmitter Agents

Headache is a frequent neurological symptom in children and adolescents. Recurrent headaches have a significant disabling effect, with consequences including school absenteeism, decreased participation in extracurricular activities, and poor academic performance, and are a risk factor for further chronic headaches and other pain syndromes that merit increased attention. The most common types of primary headache in children and adolescents are migraine and tension-type headache (TTH). In a recent survey of South Korean school students, 29.1% of schoolchildren reported having recurrent headaches. TTH was more frequent than recurrent migraine headaches (13.7% vs. 8.7%), and the frequency of migraine and TTH increased with age. The prevalence rate of TTH in urban areas was higher than in suburban and rural areas. A trend was found for more severe disabilities to occur in older children with headache. Children and adolescents with migraine had the most severe headache-related disabilities. The predictors of headache-related disability were found to be migraine, severe intensity of the headache, frequent headache, and a longer duration of symptoms before presentation. Children and adolescents with recurrent or significant headaches should be diagnosed and treated promptly to reduce headache-related disability and to improve their quality of life.
Absenteeism ; Adolescent* ; Child* ; Headache Disorders ; Headache* ; Humans ; Migraine Disorders ; Prevalence* ; Quality of Life ; Risk Factors ; Tension-Type Headache

The principle of surgery of the parotid gland is adequate removal of the tumor with functional and anatomical preservation of all blanches of the facial nerve. There are two main surgical approaches to superficial or total conservative parotidectomy. Anterior approach and posterior approach. Preliminary identification of the main trunk of the facial nerve is probably the most favoured techniques, but identification of the peripheral blanches of the facial nerve, with subsequent Proximal dissection to the main trunk, is long established but less popular technique. We have prospectively experienced the low incidence of facial nerve damage in series of 55 conservative parotidectomies performed using the anterior approach. The techniques employed is described with a deport of results obtained in the belief that this approach warrants greater popularity and saute technique.
Facial Nerve ; Incidence ; Parotid Gland ; Prospective Studies