- 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  - Alcohol-Induced Headache: A Narrative Review Based on Migraine Pathophysiology
Woo-Seok Ha
Headache and Pain Research.2026; 27(1): 21. CrossRef - Natural Diagnostic Classes of Headache Disorders: Latent Class Analysis of a Population-Based Study
Wonwoo Lee, Seok-Jae Heo, Jungyon Yum, Min Kyung Chu
Headache and Pain Research.2026; 27(1): 30. CrossRef - 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 - Validity of Migraine Diagnoses in Korean National Health Insurance Claims Data
Yoonkyung Chang, Soyoun Choi, Byung-Su Kim, Tae-Jin Song
Headache and Pain Research.2025; 26(2): 154. CrossRef - Tension-Type Headache and Primary Stabbing Headache: Primary Headaches Beyond Migraine
Mi-Kyoung Kang
Headache and Pain Research.2025; 26(2): 89. CrossRef - Injection-Based Therapies for Migraine in Older Adults: A Narrative Review of OnabotulinumtoxinA, Greater Occipital Nerve Block, and Anti Calcitonin Gene-Related Peptide Monoclonal Antibodies
Mi-Kyoung Kang, Soohyun Cho, Byung-Kun Kim, Heui-Soo Moon, Mi Ji Lee, Soo-Kyoung Kim, Hong-Kyun Park, Min-Kyung Chu, Woo-Seok Ha, Byung-Su Kim, Soo-Jin Cho
Journal of Korean Medical Science.2025;[Epub] CrossRef - Use of Antiseizure Medications in Neurological Disorders Beyond Epilepsy
Kyung Min Kim, Byung-Su Kim, Hee-Jin Kim, Seung Woo Kim, Kyoungwon Baik, Jin Myoung Seok, Jun-Sang Sunwoo, In-Uk Song, Ho Geol Woo, Eek-Sung Lee, Jin-Man Jung, Kyomin Choi, Yun Ho Choi, Kwang Ik Yang
Journal of the Korean Neurological Association.2025; 43(4): 245. CrossRef - A Practical Approach to Headache in Moyamoya Disease
Mi-Yeon Eun, Jin-Man Jung, Jay Chol Choi
Headache and Pain Research.2025; 26(3): 173. CrossRef - Evolution of Migraine Treatment: Recent Drugs and Clinical Trial Trends
Yoon-Kyung Chang, Tae-Jin Song
NeuroTrials.2025; 1(1): 7. CrossRef - Clinical Effectiveness and Cost-Effectiveness of Collaborative Treatment With Korean and Western Medicine for Primary Headache Disorders: Protocol for a Multicenter Prospective Observational Study
Jaeseung Kim, Jihwan Yun, Linae Kim, Shiva Raj Acharya, Changyon Han, NamKwen Kim
JMIR Research Protocols.2025; 14: e82819. CrossRef - Clinical Practice Guideline Recommendations for Post-Acute Sequelae of COVID-19
Jun-Won Seo, Yu Bin Seo, Seong Eun Kim, Yoonjung Kim, Eun Jung Kim, Tark Kim, Taehwa Kim, So Hee Lee, Eunjung Lee, Jacob Lee, Yeong-Hoon Jeong, Yeong Hee Jung, Yu Jung Choi, Joon Young Song
Infection & Chemotherapy.2025; 57(4): 478. CrossRef
- Lasmiditan: Another Therapeutic Option for Acute Migraine Treatment
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Hong-Kyun Park
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Published online December 31, 2021
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- 라스미디탄: 급성기 편두통 치료의 또 다른 방법
- Comorbid Medical Conditions in Patients with Medication Overuse Headache: Multicenter Prospective Medication Overuse Headache Registry Analysis
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Yooha Hong, Soo-Jin Cho, Min Kyung Chu, Sun-Young Oh, Heui-Soo Moon, Tae-Jin Song, Mi Ji Lee, Jin-Ju Kang, Hong-Kyun Park
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Published online December 31, 2021
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- 약물과용두통 환자에서 동반 이환되는 내과적 문제: 국내 다기관 전향적 약물과용두통 등록체계
- Clinical Practice Guideline of Pharmacologic Treatment for Migraine Prevention in Adults 2021: The Committee of Clinical Practice Guideline of the Korean Headache Society
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Kim Byung-Su, Jae Myun Chung, Pil-Wook Chung, Kwang-Yeol Park, Jin-Young Ahn, Heui-Soo Moon, Hong-Kyun Park, Dae Woong Bae, Jong-Geun Seo, Jong-Hee Sohn, Tae-Jin Song
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Published online December 31, 2021
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- 성인 편두통 예방치료 약제 진료지침 2021: 대한두통학회 진료지침위원회
- Migraine and Stroke
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Hong-Kyun Park, Keun-Sik Hong
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Published online December 31, 2018
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- 편두통과 뇌졸중
- Guideline for the Treatment of Cluster Headache: A Clinical Practice Guideline from the Korean Headache Society
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Byung-Su Kim, Pil-Wook Chung, Hong-Kyun Park, Mi Ji Lee, Jae Myun Chung, Kyung Min Kim, Jiyoung Kim, Heui-Soo Moon, Dae-Woong Bae, Jong-Hee Sohn, Tae-Jin Song, Wonwoo Lee, Soohyun Cho, Myoung-Jin Cha, Yun-Ju Choi, Miyoung Choi
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Received March 22, 2026 Accepted April 15, 2026 Published online May 19, 2026
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DOI: https://doi.org/10.62087/hpr.2026.0011
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Abstract
- Purpose: This clinical practice guideline (CPG) was developed by the Korean Headache Society (KHS) to provide evidence-based recommendations for the acute and preventive treatment of cluster headache (CH).
Methods
The CPG Committee of the KHS identified key clinical questions regarding the acute and preventive treatment of CH through a systematic literature review. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the quality of evidence and determine the strength of the evidence-based recommendations.
Results
For acute treatment, subcutaneous sumatriptan, intranasal zolmitriptan, intranasal sumatriptan, oral zolmitriptan, and oxygen are strongly recommended based on moderate-quality evidence. For preventive treatment, suboccipital steroid injection, oral corticosteroids, and galcanezumab (specifically for episodic CH) are strongly recommended based on moderate-quality evidence. Despite the low quality of evidence, verapamil is also strongly recommended, whereas lithium is recommended with a weaker strength of recommendation. Other oral triptans, NSAIDs, ergot derivatives, subcutaneous octreotide, intranasal lidocaine, and non-invasive vagus nerve stimulation (nVNS; specifically for episodic CH) are recommended for acute treatment based on expert consensus. For preventive treatment, topiramate, valproic acid, melatonin, and nVNS (as adjunctive therapy specifically for chronic CH) are recommended, whereas sphenopalatine ganglion stimulation, occipital nerve stimulation, and deep brain stimulation are recommended for patients with refractory chronic CH based on expert consensus.
Conclusion
This CPG provides evidence-based recommendations for the treatment of CH. In addition, the authors recommend the use of expert consensus-based treatments to bridge the gap between the available evidence and real-world clinical practice.
- Finding the Sweet Spot between Medication Overuse and Underuse in Headache Medicine
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Hong-Kyun Park
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Received March 27, 2026 Accepted April 26, 2026 Published online June 2, 2026
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DOI: https://doi.org/10.62087/hpr.2026.0012
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Abstract
- Medication-overuse headache (MOH) is a well-recognized secondary headache caused by the frequent use of acute symptomatic medications, particularly among patients with underlying primary headache disorders such as migraine. Medication-underuse headache (MUH) is a recently proposed conceptual framework describing the suboptimal use of indicated treatments, including underuse, delayed administration, poor adherence, or premature discontinuation, all of which may contribute to headache progression or chronification. Both conditions share pathophysiological substrates, including central sensitization, impaired descending pain modulation, and dysfunctional reward processing, which are rooted in dopaminergic mesocorticolimbic dysregulation and trigeminovascular sensitization. MUH may arise from fear of side effects, fear of withdrawal, poor adherence, or inadequate access to care and may lead to an escalating headache burden and increased reliance on acute treatments, potentially predisposing patients to MOH. Conversely, managing MOH without addressing underuse-related barriers may contribute to treatment resistance or relapse. Recent evidence suggests that calcitonin gene-related peptide (CGRP)-targeted monoclonal antibodies can achieve clinically meaningful improvement in MOH even without mandatory medication withdrawal, challenging the traditional assumption that detoxification is required for treatment response. MOH is also increasingly viewed as a multidimensional neurological and biobehavioral disorder, with preliminary neuroimaging data indicating that mindfulness-based interventions can modulate pain- and reward-related brain networks. This narrative review summarizes the clinical features and mechanisms of MOH and MUH and proposes a comprehensive management framework integrating patient education, structured lifestyle and mindfulness-based interventions, early initiation of preventive therapy, and CGRP-targeted treatments, with the aim of achieving therapeutic balance—not too much, not too little—and improving long-term outcomes.
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