- 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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- 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
- Understanding the Connection between the Glymphatic System and Migraine: A Systematic Review
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Myoung-Jin Cha, Kyung Wook Kang, Jung-won Shin, Hosung Kim, Jiyoung Kim
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Headache Pain Res. 2024;25(2):86-95. Published online July 31, 2024
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DOI: https://doi.org/10.62087/hpr.2024.0014
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10,010
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- The glymphatic system is a brain-wide perivascular pathway that functions similarly to the lymphatic system in the periphery of the body, playing a crucial role in removing waste from the brain. Although impaired glymphatic function has a well-known relationship with neurodegenerative diseases through abnormal protein accumulation, it is also associated with migraine. While still in its nascent phase, research on the glymphatic system in migraine patients is gradually increasing. This systematic literature review focuses on studies investigating the glymphatic system in migraineurs. Furthermore, it examines the methods used to evaluate the glymphatic system in these studies and their main findings.
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Citations
Citations to this article as recorded by - Chronic Migraine Is Associated With Region-Specific High-Grade Enlarged Perivascular Spaces: Retrospective Matched Case-Control Study
Jae Wook Cho, Gha-Hyun Lee, Jiyoung Kim
Journal of Clinical Neurology.2026; 22(1): 113. CrossRef - No Glymphatic Dysfunction in Trigeminal Neuralgia: A Preliminary Study
Barış Genç, Kerim Aslan
Brain and Behavior.2026;[Epub] CrossRef - Brain Glymphatic and Lymphatic Systems in Migraine: Mechanistic Insights and Neuromodulation Perspectives with an Emphasis on Ultrasound-Based Approaches
Jaeho Kim
Headache and Pain Research.2026; 27(1): 13. CrossRef - New Directions in Migraine Pathophysiology: The Glymphatic System and PACAP
Dan Iulian Cuciureanu, Cătălina Elena Bistriceanu, Georgiana-Anca Vulpoi, Victor Constantinescu, Diana Laura Blajuta, Ana-Maria Nădejde, Florina Antochi, Adina-Maria Roceanu
Life.2026; 16(5): 767. CrossRef - Diffusion Tensor Imaging-Based Glymphatic Dysfunction Assessments in Migraine Syndromes: Mechanisms and Diagnostic Implications
Emily Lai, Joshua Estin, Jiahao Zhou, Roger Sheffmaker, Manisha Koneru
Biomedicines.2025; 13(12): 2981. CrossRef
- Migraine and Stroke
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Myoung-Jin Cha, Ha Yeun Oh, Jiyoung Kim
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Korean J Headache. 2023;24(2):50-55. Published online December 31, 2023
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- The relationship between migraine and stroke is intricate and bidirectional. Migraine, a neurological disorder characterized by severe headaches and associated symptoms, exhibits some similarities in presentation with stroke. Conversely, stroke can at times mimic migraine symptoms. Migrainous infarction is directly associated with stroke. Specifically, migraine with aura has been linked to an increased risk of ischemic stroke. Migraine with aura and the frequency of headaches are considered risk factors for stroke. Moreover, migraine is associated with subclinical infarct-like brain lesions and white matter changes. Additionally, some genetic disorders predispose individuals to develop both migraine and stroke. In this review, we aim to investigate the relationship between migraine and stroke.
- Diagnostic Delay in Spontaneous Intracranial Hypotension
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Jiyoung Kim, Younjin Park, Jong-Hee Sohn, Sang-Hwa Lee, Eun Kyung Khil, Hee Jin Im, Min Jun Song, Myoung-Jin Cha, Soo-Jin Cho
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Published online June 30, 2022
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- 자발두개내저압의 진단 지연
- 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
- Diagnosis and Treatment of Tension-type Headache
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Myoung-Jin Cha, Jiyoung Kim, Ph.D.
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Published online June 30, 2020
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- 긴장형두통의 진단 및 치료
- 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
- The Impact of Limited Insurance Coverage on Long-Term Persistence with Anti-CGRP Monoclonal Antibody Therapy: A Multicenter Real-World Study in Korea
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Mi-Kyoung Kang, Jong-Hee Sohn, Myoung-Jin Cha, Yoo Hwan Kim, Yooha Hong, Hee-Jin Im, Soo-Jin Cho
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Received February 14, 2026 Accepted April 23, 2026 Published online June 4, 2026
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DOI: https://doi.org/10.62087/hpr.2026.0007
[Epub ahead of print]
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Abstract
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- Purpose: Anti-calcitonin gene-related peptide monoclonal antibodies (anti-CGRP mAbs) are effective preventive therapies for migraine. However, their high cost limits long-term use. In Korea, coverage of anti-CGRP mAbs by the National Health Insurance Service (NHIS) is highly restricted. This study aimed to evaluate the association between NHIS coverage and treatment persistence in a real-world setting.
Methods
This retrospective multicenter study included adult patients with migraine (≥18 years) who received anti-CGRP mAb therapy at four tertiary hospitals in Korea. Treatment compliance was assessed using persistence, defined as continuous treatment duration; persistence rates; and adherence, defined as the proportion of days covered. Reasons for treatment discontinuation were also analyzed. Treatment compliance was compared according to NHIS coverage, and treatment effectiveness was compared according to NHIS coverage and treatment continuation.
Results
Among 140 patients treated with anti-CGRP mAbs, only 12 (8.6%) received NHIS-covered therapy. Compared with the non-covered group, the NHIS-covered group had a lower discontinuation rate (50.0% [6/12] vs. 73.4% [94/128]; p=0.101) and higher persistence rates at 6 months (80.0% vs. 66.0%; p=0.493) and 12 months (66.7% vs. 47.2%; p=0.312). However, these differences were not statistically significant. Treatment effectiveness, assessed by changes in monthly headache days, did not differ significantly according to NHIS coverage or treatment continuation.
Conclusion
Treatment persistence appears to be influenced by multiple factors in real-world practice. NHIS coverage may support treatment continuation by improving access and reducing the financial burden. These findings highlight the importance of healthcare-system factors in optimizing long-term preventive treatment strategies for migraine.
- 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.
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KHS
