- Evidence-Based Recommendations on Pharmacologic Treatment for Migraine Prevention: A Clinical Practice Guideline from the Korean Headache Society
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Byung-Su Kim, Pil-Wook Chung, Jae Myun Chung, Kwang-Yeol Park, Heui-Soo Moon, Hong-Kyun Park, Dae-Woong Bae, Jong-Geun Seo, Jong-Hee Sohn, Tae-Jin Song, Seung-Han Lee, Kyungmi Oh, Mi Ji Lee, Myoung-Jin Cha, Yun-Ju Choi, Miyoung Choi
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Headache Pain Res. 2025;26(1):5-20. Published online January 16, 2025
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DOI: https://doi.org/10.62087/hpr.2024.0019
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 Abstract
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- Purpose: The aim of this clinical practice guideline (CPG) from the Korean Headache Society is to provide evidence-based recommendations on the pharmacologic treatment for migraine prevention in adult migraine patients.
Methods
The present CPG was developed based on the guideline adaptation methodology through a comprehensive systematic search for literature published between January 2012 and July 2020. The overall quality of the CPGs was assessed using the Korean version of the Appraisal of Guidelines for Research and Evaluation II tool. High-quality CPGs were adapted to make key recommendations in terms of strength (strong or weak) and direction (for or against).
Results
The authors selected nine available high-quality guidelines throughout the process of assessment of quality. Regarding oral migraine preventive medications, propranolol, metoprolol, flunarizine, sodium divalproex, and valproic acid are recommended to adult patients with episodic migraines based on high-quality evidence (“strong for”). Topiramate can be recommended for either episodic or chronic migraine (“strong for”). For migraine prevention using calcitonin gene-related peptide monoclonal antibodies, galcanezumab, fremanezumab, erenumab, and eptinezumab are recommended for adult patients with either episodic or chronic migraine on the basis of high-quality evidence (“strong for”). OnabotulinumtoxinA is recommended for adult patients with chronic migraine based on high-quality evidence (“strong for”). Last, frovatriptan, naratriptan, and zolmitriptan are recommended for short-term prevention in women with menstrual migraine (“strong for”).
Conclusion
In the present CPG, the authors provide specific, straightforward, and easy-to-implement evidence-based recommendations for pharmacologic migraine prevention. Nevertheless, these recommendations should be applied in real-world clinical practice based on optimal individualization.
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Citations
Citations to this article as recorded by  - One-Year Compliance After Calcitonin Gene-Related Peptide Monoclonal Antibody Therapy for Migraine Patients in a Real-World Setting: A Multicenter Cross-Sectional Study
Mi-kyoung Kang, Jong-Hee Sohn, Myoung-Jin Cha, Yoo Hwan Kim, Yooha Hong, Hee-Jin Im, Soo-Jin Cho
Journal of Clinical Medicine.2025; 14(3): 734. CrossRef - Beyond the Pain: Rethinking Migraine Care with the RELIEF PLAN Approach
Sanghyo Ryu
Headache and Pain Research.2025; 26(1): 1. CrossRef - Concurrent Extracerebral Vasoconstriction in Patients with Reversible Cerebral Vasoconstriction Syndrome: A Cross-Sectional Study
Byung-Su Kim, Sumin Kim, Eunhee Kim, Ick-Mo Chung, Sodam Jung, Yoonkyung Chang, Dong Woo Shin, Tae-Jin Song
Journal of Clinical Medicine.2025; 14(13): 4402. CrossRef
- Persistent Headache after Pulling Physical Activity as a First Manifestation of Vertebral Artery Dissection
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Byung-Su Kim, Hyun-Jeung Yu, Eun Hye Jeong, MunKyung Sunwoo, Min-Jae Sung, Dae Yoon Kim, Hyun Jin Kim, Jeongyeon Kim
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Published online December 31, 2022
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- 잡아당김 신체 활동 후 발생한 지속두통을 초기 증상으로 보인 척추동맥박리
- Two Case Report of Melatonin Add-on Therapy for Cluster Headache
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Byung-Su Kim, Myoung-Jin Cha, Soo-Jin Cho
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Published online December 31, 2021
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- 군발두통에서 멜라토닌 추가 치료에 효과를 보인 2례
- Diagnostic Delay of Cluster Headache in Korea
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Byung-Su Kim, Soo-Kyoung Kim, Pil-Wook Chung, Byung-Kun Kim, Mi Ji Lee, Min Kyung Chu, Jin-Young Ahn, Dae Woong Bae, Tae-Jin Song
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Published online June 30, 2020
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- 국내 군발두통의 진단지연
- Relapsed Stabbing Headache as the Presenting Manifestation of Aggravated Intracranial Hemangiopericytoma
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Young Ik Jung, Byung-Su Kim, Junghee Seo, Hee Jin Lee, Hyun-Jeung Yu, Eun Hye Jeong, MunKyung Sunwoo, Yun Kyung Park
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Published online December 31, 2018
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- 재발된 찌름두통으로 발현된 혈관주위세포종의 악화
- Retropharyngeal Lymphadenitis Presenting with an Uncommon Headache Manifestation
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Byung-Su Kim, Mun Kyung Sunwoo, Eun Hye Jeong, Hyun-Jeung Yu, Dae Yoon Kim, Jeongyeon Kim
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Published online December 31, 2017
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- 드물게 두통으로 발현한 인두뒤림프절염
- A Case of Superior Orbital Fissure Syndrome Attributed to Sinusitis Presenting Unilateral Throbbing Headache
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Byung-Su Kim, Byung-Kun Kim, Soo-Kyoung Kim, Jae-Moon Kim, Heui-Soo Moon, Kwang-Yeol Park, Jong-Hee Sohn, Tae-Jin Song, Min Kyung Chu, Myoung-Jin Cha, Soo-Jin Cho, J
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Published online December 31, 2017
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- 두통 초진 환자에서 이차두통의 임상적 예측인자: 다기관 연구
- The Frequency and Characteristics of Other Primary Headache Disorders in First-Visit Headache Patients in Korea: A Multicenter Study
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Myoung-Jin Cha, Byung-Kun Kim, Byung-Su Kim, Jong-Hee Sohn, Soo-Kyoung Kim, Heui-Soo Moon, Tae-Jin Song, Jae-Moon Kim, Jeong Wook Park, Min Kyung Chu, Kwang-Yeol Park
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Published online December 31, 2017
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- 신경과 외래를 방문한 두통 초진 환자에서 기타 원발두통의 빈도와 특징 - 다기관 연구
- Natural Products in Migraine Prophylaxis
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Byung-Su Kim, M.S.
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Published online June 30, 2016
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- 편두통 예방치료에서의 천연물
- Upper Cervical Myelitis Presenting as Isolated Occipital Neuralgia
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Eun Hye Jeong, Hyun-soon Jang, Mun Kyung Sunwoo, Byung-Su Kim, Hyun-Jeung Yu, Sook Young Roh, Jeong Yeon Kim
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Published online December 31, 2015
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- 후두신경통으로만 발현된 상부경추척수염
- Exercise: Trigger Factor of Migraine or Not ?
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Byung-Su Kim
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Published online December 31, 2015
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- 운동과 편두통: 운동은 편두통의 유발요인인가?
- Aggravation by Routine Physical Activity and Associated Factors in the Korean Migraine Population
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Byung-Su Kim, Min Kyung Chu, Byung-Kun Kim, Jae-Moon Kim
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Published online June 30, 2015
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- 한국인 편두통 인구에서 일상신체활동에 의한 두통의 악화와 관련 인자
- Immunotherapy-responsive Recurrent Painful Ophthalmoplegic Neuropathy
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Byung-Su Kim, Sook Young Roh, Hyun-Jeung Yu, Eun Hye Jeong, Mun Kyung Sunwoo, Hyun-soon Jang
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Published online December 31, 2014
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- 편두통과 원발두통 환자에서 대사증후군: 일개 두통클리닉 기반 연구
- Clinical Characteristics of Migraine Subjects with Nausea and Vomiting:An Analysis of Data from the Korean Headache Survey
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Byung-Su Kim, Chin-Sang Chung, Chung-Bin Lee, Min Kyung Chu
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Published online December 31, 2013
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- 구역, 구토를 가진 편두통 환자의 임상적 특성: Korean Headache Survey 자료 분석
- Validity of Migraine Diagnoses in Korean National Health Insurance Claims Data
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Yoonkyung Chang, Soyoun Choi, Byung-Su Kim, Tae-Jin Song
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Received March 3, 2025 Accepted May 19, 2025 Published online June 19, 2025
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DOI: https://doi.org/10.62087/hpr.2025.0004
[Epub ahead of print]
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 Supplementary Material
- Purpose: Accurate case identification using administrative datasets relies on diagnostic coding, yet these codes’ accuracy for migraine remains uncertain. This study aimed to validate the diagnostic accuracy of International Statistical Classification of Diseases and Related Health Problems 10th Revision (International Classification of Diseases, ICD-10) codes for migraine, migraine without aura (MOA), and migraine with aura (MA) in the Korean National Health Insurance Service database.
Methods
We retrospectively reviewed the electronic medical records of 500 patients (migraine [G43.X], 200; MOA [G43.0], 200; MA [G43.1], 100) from secondary and tertiary hospitals between January 2019 and December 2024. Diagnoses confirmed by headache specialists using the International Classification of Headache Disorders, third edition served as the gold standard. Validation metrics included the positive predictive value (PPV), negative predictive value, sensitivity, specificity, and the kappa statistic. Diagnostic accuracy was assessed based on ICD-10 claim frequency and improved by combining diagnostic codes with prescriptions for migraine medications.
Results
A single ICD-10 claim had a PPV of 74.00%. Accuracy improved significantly with increased claim frequency (≥3 claims: PPV, 81.14%; sensitivity, 98.61%; specificity, 28.26%), particularly when combined with medication prescriptions (≥3 claims with medication: PPV, 94.96%; sensitivity, 91.87%; specificity, 85.37%). MOA (≥3 claims with medication: PPV, 95.20%) and MA (≥3 claims with medication: PPV, 93.65%) showed similar trends. Excellent inter-rater reliability was observed (kappa, 0.806–0.951), with no significant accuracy differences between hospitals.
Conclusion
Employing multiple claims and prescriptions improved the accuracy of migraine diagnoses using ICD-10 codes, supporting the use of this method in epidemiological studies and health policy decisions.
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