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Review Article
The Hidden Risks of Medication Underuse in Migraine Progression
Heui-Soo Moon, Pil-Wook Chung
Headache Pain Res. 2025;26(3):209-217.   Published online October 23, 2025
DOI: https://doi.org/10.62087/hpr.2025.0019
  • 214 View
  • 12 Download
AbstractAbstract PDF
Migraine is a progressive neurological disorder in which inadequate treatment can lead to chronification. For decades, clinical attention has centered on medication overuse headache (MOH) as the primary iatrogenic risk factor for this progression. However, medication underuse (MU) has emerged as a critical yet less established framework for understanding gaps in migraine care. This review reframes MU, which includes ineffective therapies, delayed administration, and non-adherence due to intolerability, as an active contributor to disease progression. Untreated or undertreated migraine attacks promote the development of central sensitization, a state of neuronal hyperexcitability that increases attack frequency, severity, and treatment resistance. This paper posits that MU and MOH are not opposing concepts but interconnected manifestations of suboptimal disease management. Specifically, disease progression driven by MU can directly precipitate the escalating medication use that characterizes MOH, resulting in a more refractory clinical state. Therefore, preventing chronification requires a paradigm shift from merely avoiding overuse to achieving optimal use. This entails adherence to evidence-based guidelines for both acute and preventive therapy—implementing stratified acute care within the neurobiological window to prevent central sensitization and initiating timely preventive treatment in eligible patients to reduce the overall attack burden. The integration of novel targeted therapies provides new opportunities to overcome the limitations of traditional agents. Ultimately, reducing the risks associated with MU through proactive, evidence-based management and strong patient–clinician communication is essential to alter the natural history of migraine and prevent the long-term disability associated with its progression.
Case Report
Isolated Dental and Lower-Facial Pain Mimicking Trigeminal Neuropathy: An Indirect Carotid-Cavernous Fistula
Byoungchul Choi, Chulho Kim, Sung-Hwan Kim, Jong-Hee Sohn
Headache Pain Res. 2025;26(3):226-231.   Published online October 22, 2025
DOI: https://doi.org/10.62087/hpr.2025.0020
  • 243 View
  • 9 Download
AbstractAbstract PDF
Carotid-cavernous fistula (CCF) is a pathological arteriovenous communication in which carotid arterial flow is diverted into the cavernous sinus. Clinical manifestations typically include ocular signs, cranial neuropathies, and headache. Neurologic deficits most commonly reflect involvement of cranial nerves III, IV, V1/V2, and VI within or along the cavernous sinus; in contrast, isolated trigeminal presentations are rare, and V3 involvement is particularly uncommon. A 69-year-old woman presented with isolated V2/V3-territory pain, perceived as molar, gingival, and lower facial discomfort. Her symptoms were initially misattributed to trigeminal neuropathy or dental pathology. Subsequently, she developed horizontal diplopia, and bedside testing localized a right abducens palsy. Brain magnetic resonance imaging revealed findings suspicious for a CCF, which was angiographically confirmed as an indirect CCF. Following embolization, the patient’s pain markedly improved, implicating the CCF as the source of the V2/V3 symptoms. This case highlights that an atypical, trigeminal-predominant onset—even with pain limited to the V2/V3 distribution—may indicate an indirect CCF. When atypical trigeminal neuropathy is suspected and dental or other peripheral causes are excluded, clinicians should consider the possibility of a CCF.
Original Article
Trigeminal Autonomic Cephalalgias Following Unilateral Dorsolateral Medullary Infarction: A Case Series and Literature Review
Jae-Myung Kim, Hak-Loh Lee, You-Ri Kang, Joon-Tae Kim, Seung-Han Lee
Headache Pain Res. 2025;26(3):218-225.   Published online October 22, 2025
DOI: https://doi.org/10.62087/hpr.2025.0013
  • 491 View
  • 7 Download
AbstractAbstract PDF
Purpose: Secondary trigeminal autonomic cephalalgias (TACs) are typically associated with posterior fossa abnormalities, such as tumors and vascular malformations. However, TACs following brainstem infarctions are rarely reported. This study aimed to characterize the clinical and anatomical features of TACs after unilateral dorsolateral medullary infarction.
Methods
We analyzed four patients with dorsolateral medullary infarction who developed secondary TACs, diagnosed using the International Classification of Headache Disorders, third edition criteria. All patients underwent detailed neurological examinations and neuroimaging, including diffusion-weighted magnetic resonance imaging and magnetic resonance angiography. Additionally, five published cases were identified through a literature review and analyzed in conjunction with our cohort.
Results
All patients exhibited stabbing or electric shock-like pain in the ipsilateral periorbital, hemifacial, and temporal regions. Headaches developed weeks to months post-stroke with brief attacks (1–2 minutes) occurring 1–5 times daily. Lacrimation and conjunctival injection were common. Three patients were diagnosed with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), while a fourth had short-lasting unilateral neuralgiform with cranial autonomic symptoms (SUNA). Each patient, as well as four of the five from the literature, exhibited ipsilateral facial sensory loss, suggesting involvement of the trigeminal spinal tract and nucleus. Delayed headache onset was more frequent in persistent cases.
Conclusion
Headache characteristics were more consistent with SUNCT/SUNA than with typical cluster headaches. Careful neurological examination is essential to detect focal signs and guide neuroimaging for identifying secondary causes. Clinicians should consider secondary TACs in patients with new-onset SUNCT/SUNA and focal brainstem signs.
Review Articles
Interictal Burden of Migraine: A Narrative Review
Soo-Kyoung Kim, Todd J. Schwedt
Headache Pain Res. 2025;26(3):200-208.   Published online October 21, 2025
DOI: https://doi.org/10.62087/hpr.2025.0018
  • 210 View
  • 7 Download
AbstractAbstract PDF
Migraine is a chronic neurological disorder associated with substantial disability and societal costs. Traditionally, research and clinical care have focused on the ictal phase, characterized by headache and accompanying symptoms. However, growing evidence suggests that a considerable portion of migraine-related disability occurs between attacks, known as the interictal burden (IIB). IIB encompasses a wide spectrum of cognitive, emotional, sensory, and functional impairments that persist during headache-free periods, including fatigue, allodynia, photophobia, cognitive dysfunction, anticipatory anxiety, and social withdrawal. These symptoms can markedly reduce quality of life, work productivity, and family functioning, even in individuals with infrequent attacks. In a descriptive survey of 506 migraine respondents, 67% experienced severe IIB. The effects of IIB extend beyond patients themselves, contributing to presenteeism in the workplace and imposing emotional and logistical strain within families. Several instruments, including the Migraine Interictal Burden Scale (MIBS-4), Migraine-Specific Quality of Life Questionnaire (MSQ v2.1), Headache Impact Test (HIT-6), and Migraine Disability Assessment (MIDAS), have been employed to assess different dimensions of IIB. Nonetheless, no single comprehensive and standardized tool fully captures the multidimensional nature of IIB. Recognizing and addressing IIB is essential for delivering holistic, patient-centered migraine care. Future research should focus on developing validated assessment instruments and incorporating IIB measures into clinical trials and routine practice to better understand and alleviate the hidden burden of migraine.
Gepants for Migraine: An Update on Long-Term Outcomes and Safety Profiles
Soohyun Cho, Kimoon Chang
Headache Pain Res. 2025;26(3):184-192.   Published online October 21, 2025
DOI: https://doi.org/10.62087/hpr.2025.0012
  • 3,798 View
  • 32 Download
AbstractAbstract PDF
Calcitonin gene-related peptide receptor antagonists, also referred to as gepants, represent a transformative advancement in migraine pharmacotherapy, providing both acute and preventive treatment options without the vasoconstrictive limitations of triptans. Since their initial approval in 2019, gepants have gained widespread clinical adoption, necessitating comprehensive evaluation of their long-term safety and efficacy. This review synthesizes current evidence on four calcitonin gene-related peptide receptor antagonists (rimegepant, atogepant, ubrogepant, and zavegepant) derived from pivotal trials, open-label extension studies, and real-world observational data. Rimegepant demonstrates sustained efficacy and minimal adverse events over 52 weeks, with no evidence of medication-overuse headaches or hepatotoxicity. Atogepant maintains progressive clinical benefits and favorable tolerability for up to 1 year, exhibiting low rates of treatment-emergent adverse events and discontinuation. Ubrogepant remains effective and well-tolerated during long-term intermittent use, with no clinically significant safety signals over extended exposure. Zavegepant, the first intranasal gepant, shows promising long-term tolerability, with the most frequently reported localized adverse event being transient dysgeusia. No consistent hepatic, cardiovascular, or serious systemic toxicity has emerged for any of the agents, and discontinuation rates due to adverse events remain consistently low. Current evidence supports gepants as safe and effective therapies for long-term migraine management, although ongoing surveillance and extended-duration studies remain essential to fully characterize their safety profile, particularly in high-risk populations and combination therapy scenarios. In conclusion, gepants offer a well-tolerated, non-vasoconstrictive alternative for migraine patients who require sustained treatment, representing a significant therapeutic advancement in migraine.
Headache as a Somatic Symptom in Pediatrics: Diagnosis and Integrated Management
Hye Eun Kwon
Headache Pain Res. 2025;26(3):193-199.   Published online October 20, 2025
DOI: https://doi.org/10.62087/hpr.2025.0016
  • 209 View
  • 6 Download
AbstractAbstract PDF
Somatization—the expression of psychological distress through physical symptoms—presents a frequent and complex challenge in pediatric practice. Headache and dizziness are among its most common manifestations. This review addresses the diagnostic challenge of determining whether these symptoms indicate a primary headache disorder or reflect somatic symptom presentations. The difficulty becomes particularly evident when conditions manifest in severe or persistent forms, such as chronic primary headache (CPH) and somatic symptom and related disorders (SSRD), where clinical overlap is considerable and coexistence may occur. We first explore the shared pathophysiological mechanisms, emphasizing central sensitization as a unifying process. We then propose a clinical framework for differential diagnosis that includes careful evaluation of predisposing risk factors and contrasts the defined diagnostic criteria of CPH with the maladaptive psychological responses frequently observed in SSRD. Management strategies diverge pharmacologically but converge on key non-pharmacological approaches. For primary headaches, pharmacotherapy is primarily used for prophylaxis, although its efficacy remains limited in pediatric trials. In contrast, for somatic presentations, medication typically serves as an adjunctive treatment targeting comorbidities, while psychotherapy (particularly cognitive behavioral therapy [CBT]) functions as the cornerstone of care. Non-pharmacological interventions such as CBT and biofeedback are essential for improving functioning across both conditions. Therefore, effective management relies on a framework of comprehensive psychoeducation, holistic assessment, and integrated interdisciplinary care.
Editorial
Toward Precision Migraine Care: Genetics, Symptoms, and Big-Data-Driven Approaches
Soo-Jin Cho
Headache Pain Res. 2025;26(3):171-172.   Published online October 17, 2025
DOI: https://doi.org/10.62087/hpr.2025.0017
  • 250 View
  • 8 Download
PDF
Review Article
A Practical Approach to Headache in Moyamoya Disease
Mi-Yeon  Eun, Jin-Man Jung, Jay Chol Choi
Headache Pain Res. 2025;26(3):173-183.   Published online October 17, 2025
DOI: https://doi.org/10.62087/hpr.2025.0011
  • 289 View
  • 8 Download
AbstractAbstract PDF
Moyamoya disease (MMD) is a progressive steno-occlusive cerebrovascular disorder of the intracranial internal carotid arteries characterized by fragile collateral vessel formation. Although ischemic and hemorrhagic strokes are the most widely recognized manifestations of MMD, headaches are common, often disabling, and remain underacknowledged. Epidemiological studies report headache in 17%–85% of MMD patients, with particularly high rates among pediatric patients. Clinically, headache phenotypes are diverse and include migraine-like headaches with or without aura, tension-type, cluster, and hemiplegic variants. These presentations often overlap with primary headache disorders, complicating the diagnosis and sometimes delaying the recognition of underlying MMD. The pathophysiology of MMD-related headaches is multifactorial, involving vascular stenosis, abnormal collateral circulation, altered hemodynamics, and neurogenic inflammation. Chronic hypoperfusion may lower the threshold for cortical spreading depression, contributing to migraine-like or aura-associated symptoms. Surgical revascularization has been reported to alleviate headaches in both pediatric and adult patients, but persistent or new headaches may occur postoperatively, and long-term outcomes remain inconsistent. Management often involves general analgesics such as acetaminophen and non-steroidal anti-inflammatory drugs, but vasoconstrictive agents (e.g., triptans and ergotamines) should be avoided. Lasmiditan, a non-vasoconstrictive 5-HT1F agonist, may represent a safer option for acute treatment, while the efficacy of other pharmacological agents remains unclear due to limited evidence. In conclusion, headaches in MMD are not only a frequent source of disability but also a potential clinical marker of disease activity. Wider recognition of their epidemiology, phenotypes, and mechanisms may improve the diagnosis, guide individualized treatment, and ultimately enhance quality of life for patients.
Correction
Erratum to “Premonitory Symptoms in Migraine: Implications for Disease Burden and Cognitive Impairment, with Some Promising Answers”
Utku Topbaş, Bahar Taşdelen, Nevra Öksüz Gürlen, Aynur Özge
Headache Pain Res. 2025;26(3):232-232.   Published online August 20, 2025
DOI: https://doi.org/10.62087/hpr.2024.0031.e1
Corrects: Headache Pain Res 2025;26(2):130
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Original Articles
Clinical Characteristics of Migraine and Serum Beta-Endorphin Levels in Undergraduate Students in Osun State, Nigeria
Adebimpe Ogunmodede, Ahmed Idowu, Ahmad Sanusi, Uchenna Eke, Akintunde Adebowale, Michael Fawale, Morenikeji Komolafe
Headache Pain Res. 2025;26(2):162-170.   Published online June 30, 2025
DOI: https://doi.org/10.62087/hpr.2025.0006
  • 2,237 View
  • 13 Download
AbstractAbstract PDF
Purpose: Migraine is a common neurological disorder diagnosed using the International Classification of Headache Disorders (ICHD). Beta-endorphin has pain-reducing properties and may serve as a future prognostic marker for migraine. This study aimed to assess the clinical characteristics of migraine and compare serum beta-endorphin levels in migraine patients and healthy controls among young undergraduate students.
Methods
This comparative cross-sectional study was conducted among undergraduate students at Obafemi Awolowo University, Nigeria. Fifty participants with migraine headaches were recruited using purposive sampling according to the ICHD-3 criteria. Healthy controls were recruited using convenience sampling and matched for age and sex. A study questionnaire was administered to all participants. Serum beta-endorphin concentrations in both migraineurs and healthy controls were measured using enzyme-linked immunosorbent assays. The beta-endorphin levels between migraine patients and healthy controls were compared using the Mann-Whitney U-test. The data were analyzed using SPSS version 26.0. A p-value of <0.05 was considered statistically significant.
Results
A total of 12 males and 38 females were recruited in both groups.The most commonly used medication for acute migraine treatment was paracetamol, while amitriptyline was the most frequently used prophylactic. Median serum beta-endorphin levels were significantly lower in the migraine group, at 385.4 pg/mL (328.5–423.4 pg/mL), compared to the control group, at 442.9 pg/mL (357.5–477.6 pg/mL) (p=0.01).
Conclusion
Serum beta-endorphin levels were significantly lower in young adults with migraine, suggesting a potential role for reduced endogenous analgesia in migraine pathophysiology. This supports the potential utility of beta-endorphin as a prognostic biomarker for migraine.
Validity of Migraine Diagnoses in Korean National Health Insurance Claims Data
Yoonkyung Chang, Soyoun Choi, Byung-Su Kim, Tae-Jin Song
Headache Pain Res. 2025;26(2):154-161.   Published online June 19, 2025
DOI: https://doi.org/10.62087/hpr.2025.0004
  • 2,465 View
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  • 1 Citations
AbstractAbstract PDFSupplementary 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.

Citations

Citations to this article as recorded by  
  • Toward Precision Migraine Care: Genetics, Symptoms, and Big-Data-Driven Approaches
    Soo-Jin Cho
    Headache and Pain Research.2025; 26(3): 171.     CrossRef
Availability, Accessibility, and Utilization of Diagnostics and Therapeutics for Spontaneous Intracranial Hypotension in Asia
Soyoun Choi, Woo-Seok Ha, Soo-Jin Cho, Aynur Özge, Betül Baykan, Esme Ekizoglu, Kiratikorn Vongvaivanich, Koichi Hirata, Linh Tuyen Nguyen, Mamoru Shibata, Min Kyung Chu, Otgonbayar Luvsannorov, Ryotaro Ishii, Shengyuan Yu, Shih-Pin Chen, Shuu-Jiun Wang, Takao Takeshima, Tsubasa Takizawa, Vinh Khang Nguyen, Wei-Ta Chen, Yen-Feng Wang, Soo-Kyoung Kim, Mi Ji Lee
Headache Pain Res. 2025;26(2):142-153.   Published online June 16, 2025
DOI: https://doi.org/10.62087/hpr.2025.0005
  • 2,390 View
  • 28 Download
AbstractAbstract PDFSupplementary Material
Purpose: Recent advances in imaging techniques have significantly enhanced the diagnosis of spontaneous intracranial hypotension (SIH). However, these developments have been reported mostly in Europe and the United States. This study aimed to evaluate the availability and utilization of diagnostic and treatment modalities for SIH in Asia, through a survey of regional headache specialists.
Methods
A literature search was conducted using PubMed, and members of the Asian Regional Consortium for Headache were contacted. Participants completed a two-step survey evaluating the availability, accessibility, and frequency of SIH diagnostic and treatment methods in their countries and institutions. Descriptive statistics were used to analyze the data.
Results
Twenty physicians from eight countries completed both rounds of the survey. Lumbar puncture, brain magnetic resonance imaging (MRI), and spinal MRI are widely available across Asia, but real-time imaging techniques—such as dynamic computed tomography myelography and digital subtraction myelography—that precisely localize cerebrospinal fluid leaks are less accessible. Blind or semi-targeted epidural blood patches (EBPs) are available at most centers, but are easily accessible in only about half of cases. Surgical interventions are rarely available.
Conclusion
Most diagnostic methods for SIH are available in Asia, despite some regional disparities. The utilization of EBP and surgical interventions remains somewhat limited. This highlights the need for greater awareness and standardization of diagnostic methods in Asia.
Review Article
Vestibular Migraine: Challenges in Diagnosis and Management
Byung-Kun Kim
Headache Pain Res. 2025;26(2):106-115.   Published online June 11, 2025
DOI: https://doi.org/10.62087/hpr.2025.0001
  • 16,549 View
  • 236 Download
  • 1 Citations
AbstractAbstract PDF
Vestibular migraine (VM) remains a clinical challenge due to its heterogeneous presentation and the frequent absence of typical migraine features during vestibular episodes. Although many studies have adopted the diagnostic criteria defined by the International Classification of Headache Disorders (ICHD), interpretation of findings is often complicated by variability in how these criteria are applied across studies. VM is frequently underdiagnosed or misdiagnosed, owing to its clinical overlap with other vestibular disorders. This review provides a comprehensive overview of the epidemiology, diagnostic criteria, differential diagnosis, and treatment strategies for VM. Particular emphasis is placed on distinguishing VM from other causes of vertigo to support accurate diagnosis and tailored management. By synthesizing current evidence, this review aims to improve clinical recognition, diagnostic precision, and therapeutic outcomes for patients with this under-recognized and often debilitating condition.

Citations

Citations to this article as recorded by  
  • Toward Precision Migraine Care: Genetics, Symptoms, and Big-Data-Driven Approaches
    Soo-Jin Cho
    Headache and Pain Research.2025; 26(3): 171.     CrossRef
Editorial
Tension-Type Headache and Primary Stabbing Headache: Primary Headaches Beyond Migraine
Mi-Kyoung Kang
Headache Pain Res. 2025;26(2):89-90.   Published online June 5, 2025
DOI: https://doi.org/10.62087/hpr.2025.0007
  • 1,696 View
  • 39 Download
  • 1 Citations
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Citations

Citations to this article as recorded by  
  • Results of the observational program CITOTREK (use of the drug CITOflavin in Tablets) in patients with tension headaches against the backgRound of asthenic syndromE taKing into account comorbidity
    M.V. Putilina, N.I. Shabalina, I.A. Blinova
    S.S. Korsakov Journal of Neurology and Psychiatry.2025; 125(10): 104.     CrossRef
Review Article
Genetic Architecture of Migraine: From Broad Insights to East Asian Perspectives
Joonho Kim, Min Kyung Chu
Headache Pain Res. 2025;26(2):116-129.   Published online May 27, 2025
DOI: https://doi.org/10.62087/hpr.2025.0003
  • 3,823 View
  • 32 Download
  • 1 Citations
AbstractAbstract PDF
Migraine is a complex neurological disorder with a strong genetic component, ranging from rare monogenic forms, such as familial hemiplegic migraine (FHM), to common polygenic migraine. FHM is primarily caused by mutations in CACNA1A, ATP1A2, and SCN1A, which affect ion channel function and cortical excitability. Additional genes, including PRRT2, have also been implicated, broadening the genetic landscape of monogenic migraine. Genome-wide association studies (GWAS) have identified multiple susceptibility loci for common migraine, highlighting key pathways related to neuronal excitability and vascular function. These findings have reinforced the neurovascular hypothesis of migraine pathogenesis. GWAS on other headache disorders, such as broadly defined headache or cluster headache, have also revealed both overlapping and distinct genetic risk factors. Genetic studies in East Asians have identified both ancestry-specific risk variants and overlapping loci with European populations, suggesting similarities in biological pathways while also highlighting population-specific differences in migraine susceptibility. Expanding research on the genetics of migraine in East Asian populations is essential for uncovering novel risk factors and improving the generalizability of genetic findings.

Citations

Citations to this article as recorded by  
  • Toward Precision Migraine Care: Genetics, Symptoms, and Big-Data-Driven Approaches
    Soo-Jin Cho
    Headache and Pain Research.2025; 26(3): 171.     CrossRef
Original Article
Premonitory Symptoms in Migraine: Implications for Disease Burden and Cognitive Impairment, with Some Promising Answers
Utku Topbaş, Bahar Taşdelen, Nevra Öksüz Gürlen, Aynur Özge
Headache Pain Res. 2025;26(2):130-141.   Published online May 26, 2025
DOI: https://doi.org/10.62087/hpr.2024.0031
Correction in: Headache Pain Res 2025;26(3):232
  • 4,508 View
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  • 2 Citations
AbstractAbstract PDF
Purpose: This study evaluated the prevalence and impact of premonitory symptoms (PS) in people with migraine, assessing their influence on disability, cognitive function, and quality of life.
Methods
In a cross-sectional analysis at Mersin University Hospital, 186 migraine patients were interviewed to identify the presence of PS, using a structured questionnaire that included measures of disability (Migraine Disability Assessment Scale or MIDAS), quality of life (European Health Impact Scale or EUROHIS-8), and cognition (Migraine Attack Related Subjective Cognitive Scale or Mig-SCOG). Statistical analyses included descriptive statistics, the t-test, and the Mann-Whitney U-test, with a significance threshold set at p<0.05.
Results
Among participants, 74.7% reported one or more PS, with the most common being neck stiffness (64.7%), photophobia (56.8%), fatigue (52.8%), and phonophobia (50.3%). Patients with PS demonstrated significantly lower quality of life scores (EUROHIS-8, p<0.001) and higher cognitive impairment scores (Mig-SCOG, p<0.001) than those without PS, despite similar levels of migraine disability (MIDAS, p=0.050).
Conclusion
The high prevalence of PS in people with migraine and their association with greater cognitive impairment and reduced quality of life indicate that more targeted interventions are necessary in this subgroup. PS may be either a driver of cognitive and quality of life burden or just a marker of it, and disambiguating these possibilities will be a critical area for future research and clinical focus. More optimized and standardized prospective studies are needed to clarify the prevalence of PS.

Citations

Citations to this article as recorded by  
  • Toward Precision Migraine Care: Genetics, Symptoms, and Big-Data-Driven Approaches
    Soo-Jin Cho
    Headache and Pain Research.2025; 26(3): 171.     CrossRef
  • Interictal Burden of Migraine: A Narrative Review
    Soo-Kyoung Kim, Todd J. Schwedt
    Headache and Pain Research.2025; 26(3): 200.     CrossRef
Review Article
Efficacy and Safety of Repetitive Transcranial Magnetic Stimulation in Postherpetic Neuralgia: A Systematic Review and Meta-Analysis
Abdallah Abbas, Basant Lashin, Mohamed Abouzid, Hadir Mustafa Mohamed, Mohamed El-Moslemani, Mohamed A. Zanaty, Haneen Sabet, Dina Essam Abo-elnour, Ahmed Ibrahim Ghonimy Shedid, Mohamed Salah Mohamed Syed, Amna Hussein, Hoda Awad, Ahmed M. Raslan
Headache Pain Res. 2025;26(2):91-105.   Published online April 16, 2025
DOI: https://doi.org/10.62087/hpr.2024.0032
  • 9,473 View
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AbstractAbstract PDFSupplementary Material
This study evaluated the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) for pain management in postherpetic neuralgia (PHN). A comprehensive literature search was conducted through May 2024 in Scopus, PubMed, Web of Science, and Cochrane Library. Eligible studies included clinical trials, observational, and case-control studies. Two reviewers independently screened studies and extracted data. Risk of bias was assessed using RoB 2 for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. Meta-analysis was performed using Review Manager v.5.3, with heterogeneity evaluated by chi-square and I² tests. Five studies (245 patients) were included, with rTMS sessions ranging from 10 to 28. Meta-analysis showed significant pain reduction with rTMS compared to sham treatment. At 2 weeks post-treatment, the mean pain score difference (visual analogue scale) was –1.44 (95% CI: –2.12 to –0.77; p<0.0001), with sustained relief at 1 and 3 months. However, no significant differences were found in the patient’s global impression of change scale, sleep quality, quality of life (QoL), medication regulation, or adverse events. rTMS exerted a consistent pain relief effect of rTMS, but its impact on broader aspects of patient well-being was less clear. rTMS provides sustained pain relief in PHN for up to 3 months, but its impact on QoL and secondary outcomes remains unclear, warranting further investigation.
Letter to the Editor
The honored list of reviewer in 2024
Headache Pain Res. 2025;26(1):88-88.   Published online February 28, 2025
DOI: https://doi.org/10.62087/hpr.2025.0002
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  • 3 Download
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Editorials
Exploring Secondary Headaches: Insights from Glaucoma and COVID-19 Infection
Soo-Kyoung Kim
Headache Pain Res. 2025;26(1):3-4.   Published online February 24, 2025
DOI: https://doi.org/10.62087/hpr.2024.0033
  • 1,387 View
  • 14 Download
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Beyond the Pain: Rethinking Migraine Care with the RELIEF PLAN Approach
Sanghyo Ryu
Headache Pain Res. 2025;26(1):1-2.   Published online February 17, 2025
DOI: https://doi.org/10.62087/hpr.2024.0035
  • 1,241 View
  • 21 Download
  • 1 Citations
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Citations

Citations to this article as recorded by  
  • The Hidden Risks of Medication Underuse in Migraine Progression
    Heui-Soo Moon, Pil-Wook Chung
    Headache and Pain Research.2025; 26(3): 209.     CrossRef
Review Articles
Does Atogepant Offer a Safe and Efficacious Option for Episodic Migraine Prophylaxis? A Systematic Review and Meta-analysis
Ahmed Mostafa Amin, Abdallah Abbas, Samar Ahmed Amer, Hoda Awad, Mahmoud Tarek Hefnawy, Anas Mansour, Mohamed El-Moslemani, Haneen Sabet, Aynur Ozge
Headache Pain Res. 2025;26(1):21-37.   Published online February 17, 2025
DOI: https://doi.org/10.62087/hpr.2024.0030
  • 4,704 View
  • 45 Download
  • 3 Citations
AbstractAbstract PDFSupplementary Material
Migraine, a chronic neurological disorder, imposes a significant burden on individuals and healthcare systems globally. This systematic review and meta-analysis evaluated the efficacy and safety of atogepant in preventing episodic migraine (EM) in adults. A systematic search was conducted in four major databases (PubMed, Scopus, Web of Science, and Cochrane CENTRAL) up to June 2024. The inclusion criteria targeted randomized controlled trials (RCTs) comparing atogepant to placebo or standard care in patients with EM. Statistical analyses were performed using Review Manager (RevMan) software. Four RCTs with 2,018 patients receiving atogepant and 761 patients receiving placebo or standard care were included. Atogepant significantly reduced monthly migraine days compared to placebo at 10 mg daily (mean difference [MD], –1.16 days; 95% confidence interval [95% CI], –1.60 to –0.73), 30 mg daily (MD, –1.15 days; 95% CI, –1.64 to –0.66), 60 mg daily (MD, –1.48 days; 95% CI: –2.36 to –0.61 days), 30 mg twice daily (MD, –1.30 days; 95% CI, –2.17 to –0.43), and 60 mg twice daily (MD, –1.20 days; 95% CI, –1.90 to –0.50). A ≥50% reduction in migraine days was frequently significantly achieved with atogepant across all dosages. Atogepant was generally well tolerated, though it was associated with higher incidence rates of constipation and nausea compared to placebo. Atogepant is an effective and well-tolerated option for preventing EM, offering patients a noninvasive oral alternative to injectable therapies. Further research is warranted to explore its long-term safety and efficacy in diverse patient populations and refine its role in this field.

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  • Tension-Type Headache and Primary Stabbing Headache: Primary Headaches Beyond Migraine
    Mi-Kyoung Kang
    Headache and Pain Research.2025; 26(2): 89.     CrossRef
  • The role of Atogepant in migraine prevention: a systematic review and meta-analysis
    Naresh Kumar Ladhwani, Priya Bai, Rohan Lal, Aresha Masood Shah, Sheela Bai, Ghazi Uddin Ahmed, Rimsha Zameer, Varisha Fatima Shaikh, Arsalan Hyder, Sikander Ali, Muhammad Hamza Beg, Maheen Adeeb, Mahir Tesfaye
    BMC Neurology.2025;[Epub]     CrossRef
  • Gepants for Migraine: An Update on Long-Term Outcomes and Safety Profiles
    Soohyun Cho, Kimoon Chang
    Headache and Pain Research.2025; 26(3): 184.     CrossRef
The Current Role of Artificial Intelligence in the Field of Headache Disorders, with a Focus on Migraine: A Systemic Review
Wonwoo Lee, Min Kyung Chu
Headache Pain Res. 2025;26(1):48-65.   Published online February 17, 2025
DOI: https://doi.org/10.62087/hpr.2024.0024
  • 7,646 View
  • 155 Download
  • 2 Citations
AbstractAbstract PDF
The application of artificial intelligence (AI) in the field of headache disorders, particularly migraine, is rapidly expanding, and AI has demonstrated significant potential for diagnosis, treatment, and research. This review examines the current role of AI in migraine management, categorizing AI applications into diagnosis and classification, assessment of treatment response, prediction of migraine attacks, and research. A systematic search of literature published between 2000 and 2024 was conducted, following PRISMA guidelines and utilizing the snowball technique. Of the 398 articles identified, along with five additional articles, 61 were finally reviewed. The results highlight promising AI applications, including the use of patient questionnaires, natural language processing, and imaging for migraine diagnosis, as well as predicting treatment responses and forecasting migraine attacks. Nonetheless, challenges remain in improving the accuracy, generalizability, validation, and clinical relevance of AI applications. Despite the substantial promise of AI for improving migraine management, it does not always guarantee better results than traditional methods. Careful consideration of the study design and method selection is crucial. Additionally, the interpretation of AI-generated results, particularly those from generative models, requires caution to avoid potential pitfalls.

Citations

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  • Primary Headache Disorders: The Virtual Neurologic Examination in Telehealth Practice
    Lindsey Plato-Johnson, Caroline Stowe
    The Journal for Nurse Practitioners.2026; 22(1): 105593.     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
Morning Headaches: An In-depth Review of Causes, Associated Disorders, and Management Strategies
Yooha Hong, Mi-Kyoung Kang, Min Seung Kim, Heejung Mo, Rebecca C. Cox, Hee-Jin Im
Headache Pain Res. 2025;26(1):66-79.   Published online January 17, 2025
DOI: https://doi.org/10.62087/hpr.2024.0023
  • 33,306 View
  • 129 Download
AbstractAbstract PDF
Morning headaches, which are defined by occurrence upon or shortly after waking up in the morning, range from mild discomfort to severe pain and significantly impact an individual’s quality of life. Although morning headaches are a prevalent and potentially debilitating condition, the criteria for defining these headaches vary. The lack of universally accepted diagnostic criteria complicates understanding their etiology, associated factors, and potential interventions. The causes of morning headaches are multifaceted, including primary headache disorders like migraines and cluster headaches, and secondary causes such as sleep disorders, hypertension, abnormal intracranial pressure, and brain parenchymal diseases. Psychological factors, including anxiety and depression, as well as substance use, further complicate the clinical presentation, often requiring a multidisciplinary approach for effective diagnosis and treatment. This review provides a comprehensive overview of morning headaches, examining their various aspects and possible treatment options, with the goal of enhancing clinicians’ understanding and management of this common yet often overlooked condition.
Original Article
Evidence-Based Recommendations on Pharmacologic Treatment for Migraine Prevention: A Clinical Practice Guideline from the Korean Headache Society
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
Headache Pain Res. 2025;26(1):5-20.   Published online January 16, 2025
DOI: https://doi.org/10.62087/hpr.2024.0019
  • 7,918 View
  • 191 Download
  • 8 Citations
AbstractAbstract PDF
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.

Citations

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  • 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
Review Article
Update on Tension-type Headache
Hye Jeong Lee, Soo-Jin Cho, Jong-Geun Seo, Henrik Winther Schytz
Headache Pain Res. 2025;26(1):38-47.   Published online December 30, 2024
DOI: https://doi.org/10.62087/hpr.2024.0025
  • 21,856 View
  • 582 Download
  • 5 Citations
AbstractAbstract PDF
Tension-type headache (TTH) is the most common type of headache, characterized by mild to moderate intensity, bilateral, with a pressing or tightening (non-pulsating) quality. Migraine and TTH can occur in the same person, and their risk factors and treatments can overlap. However, TTH receives less attention than migraine. Furthermore, despite the expanding market for migraine treatments targeting calcitonin gene-related peptide (CGRP) mechanisms, the lack of evidence regarding mechanisms related to CGRP-related mechanisms in TTH continues to be neglected. There remains a need to develop effective preventive treatments for chronic TTH, which imposes a very high burden of disease. From this perspective, this review aims to provide the latest evidence on TTH.

Citations

Citations to this article as recorded by  
  • Tension-Type Headache and Primary Stabbing Headache: Primary Headaches Beyond Migraine
    Mi-Kyoung Kang
    Headache and Pain Research.2025; 26(2): 89.     CrossRef
  • Hallmarks of primary headache: part 2– Tension-type headache
    Li-Ling Hope Pan, Yu-Hsiang Ling, Shuu-Jiun Wang, Linda Al-Hassany, Wei-Ta Chen, Chia-Chun Chiang, Soo-Jin Cho, Min Kyung Chu, Gianluca Coppola, Adriana Della Pietra, Zhao Dong, Esme Ekizoglu, Charl Els, Fatemeh Farham, David Garcia-Azorin, Woo-Seok Ha, F
    The Journal of Headache and Pain.2025;[Epub]     CrossRef
  • Trends in the Burden of Headache Disorders in Europe, 1990–2021: A Systematic Analysis from the Global Burden of Disease Study 2021
    Terry Jung, Yoonkyung Chang, Moon-Kyung Shin, Sohee Wang, Seyedehmahla Hosseini, Joonho Kim, Min Kyung Chu, Tae-Jin Song
    Journal of Clinical Medicine.2025; 14(19): 6966.     CrossRef
  • Interoception Accuracy Differences in Patients with Chronic Tension-type Headache
    İnan Özdemir, Güllüşah Üstün, Serkan Aksu, Semai Bek, Gülnihal Kutlu
    Neurological Sciences and Neurophysiology.2025; 42(3): 116.     CrossRef
  • Results of the observational program CITOTREK (use of the drug CITOflavin in Tablets) in patients with tension headaches against the backgRound of asthenic syndromE taKing into account comorbidity
    M.V. Putilina, N.I. Shabalina, I.A. Blinova
    S.S. Korsakov Journal of Neurology and Psychiatry.2025; 125(10): 104.     CrossRef
Editorial
Nutritional Approaches to Managing Pediatric Migraine
Hye Eun Kwon
Headache Pain Res. 2024;25(2):75-76.   Published online October 24, 2024
DOI: https://doi.org/10.62087/hpr.2024.0027
  • 1,452 View
  • 16 Download
PDF
Original Articles
Subjective Cognitive Decline Patterns in Patients with Migraine, with or without Depression, versus Non-depressed Older Adults
Sun Hwa Lee, Soo-Jin Cho
Headache Pain Res. 2024;25(2):103-110.   Published online October 24, 2024
DOI: https://doi.org/10.62087/hpr.2024.0022
  • 3,605 View
  • 41 Download
AbstractAbstract PDF
Purpose: Cognitive decline is a common complaint in young patients with migraine, especially those with depression. Independent of psychiatric factors such as depression, subjective cognitive decline (SCD) is associated with an elevated risk of progression to dementia. This study aimed to investigate patterns of subjective cognitive complaints between migraineurs with or without depression and non-depressed older adults.
Methods
This retrospective study included 331 outpatients with SCD (293 from a headache clinic and 38 from a memory clinic). SCD was diagnosed as “yes” based on two questions about SCD. The Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to assess cognitive function. The SCD Questionnaire (SCD-Q) with three subdomains was analyzed to compare SCD between groups.
Results
Among patients with SCD, significant differences in duration of education were found among the groups—specifically, migraineurs with depression (12.39 years) had longer education than non-depressed older adults (10.50 years) and shorter education than migraineurs without depression (14.28 years). The total MMSE and MoCA scores did not differ between migraineurs with and without depression. Regarding SCD-Q scores, migraineurs with depression showed higher scores overall and in all cognitive domains than migraineurs without depression, with no significant difference compared to non-depressed older adults.
Conclusion
Although the depressed migraineurs with SCD were younger and more educated than the non-depressed older adults with SCD, both groups reported similarly high levels of SCD. Higher levels of surveillance for cognitive decline are warranted for migraineurs with depression who have SCD.
Bilateral Greater Occipital Nerve Block for Preventing the OnabotulinumtoxinA Wear-off Phenomenon in the Treatment of Chronic Migraine: A Case Series of 12 Patients
Sanghyun Kim, Jae Young An, Dae Woong Bae
Headache Pain Res. 2024;25(2):111-116.   Published online October 23, 2024
DOI: https://doi.org/10.62087/hpr.2024.0021
  • 3,468 View
  • 30 Download
  • 1 Citations
AbstractAbstract PDF
Purpose: OnabotulinumtoxinA is widely used to treat chronic migraines; however, the wear-off phenomenon before the next scheduled dose has emerged as a challenge. This study suggests a new strategy for preventing the wear-off phenomenon using bilateral greater occipital nerve block.
Methods
We conducted a retrospective review of patients diagnosed with chronic migraine who were treated with onabotulinumtoxinA and bilateral greater occipital nerve block at St. Vincent Hospital from January 2023 to December 2023. Twelve chronic migraine patients with a history of the wear-off phenomenon received a greater occipital nerve block 8 weeks after the initial onabotulinumtoxinA injection for two sessions. Responses to treatment were evaluated with regular follow-ups and daily headache diaries.
Results
All patients who had previously experienced the wear-off phenomenon with conventional onabotulinumtoxinA treatment did not experience the wear-off phenomenon during two sessions with an additional greater occipital nerve block administered 8 weeks after each onabolulinumtoxinA injection.
Conclusion
Bilateral greater occipital nerve block administered 8 weeks after the initial onabotulinumtoxinA injection effectively prevents the wear-off phenomenon, enabling sustained therapeutic benefits in chronic migraine patients. Further research is needed to confirm these findings in larger cohorts.

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  • When Should Headache Specialists Hold a Needle? The Role of Botulinum Toxin Injections and Occipital Nerve Blocks
    Soo-Jin Cho
    Headache and Pain Research.2024; 25(2): 73.     CrossRef
Editorial
When Should Headache Specialists Hold a Needle? The Role of Botulinum Toxin Injections and Occipital Nerve Blocks
Soo-Jin Cho
Headache Pain Res. 2024;25(2):73-74.   Published online October 17, 2024
DOI: https://doi.org/10.62087/hpr.2024.0020
  • 1,733 View
  • 32 Download
  • 1 Citations
PDF

Citations

Citations to this article as recorded by  
  • Update on Tension-type Headache
    Hye Jeong Lee, Soo-Jin Cho, Jong-Geun Seo, Henrik Winther Schytz
    Headache and Pain Research.2025; 26(1): 38.     CrossRef
Case Report
Mechanical Thrombectomy in Cerebral Venous Thrombosis Caused by Spontaneous Intracranial Hypotension: A Case Report with Novel Pathological Findings of Fibrin/Platelet-predominant Thrombus
Min Kyoung Kang, Eun Young Kim, Hye-Rim Shin
Headache Pain Res. 2024;25(2):122-127.   Published online October 2, 2024
DOI: https://doi.org/10.62087/hpr.2024.0016
  • 1,537 View
  • 13 Download
AbstractAbstract PDF
This case report presents pathological findings in a rare case of cerebral venous thrombosis (CVT) caused by spontaneous intracranial hypotension (SIH) that was treated successfully with mechanical thrombectomy. The etiologies and prognosis of CVT vary, and CVT resulting from SIH is particularly uncommon and challenging to diagnose and manage. In this case, magnetic resonance imaging revealed signs consistent with both SIH and CVT, which contributed to the patient’s worsening weakness. The patient was treated with a combination of endovascular thrombectomy and epidural blood patch, followed by anticoagulation therapy, and recovered without any complications. A pathological analysis of the retrieved thrombus using hematoxylin and eosin staining showed a high proportion of fibrin and platelets, which could shed light on the mechanism of CVT induced by SIH under conditions of low blood flow due to venous engorgement.
Review Article
Advances in Primary Stabbing Headache: Diagnostic Criteria, Epidemiological Insights, and Tailored Treatment Approaches
Ayush Chandra, Avinash Chandra, Soohyun Cho
Headache Pain Res. 2025;26(1):80-87.   Published online September 2, 2024
DOI: https://doi.org/10.62087/hpr.2024.0018
  • 8,906 View
  • 52 Download
  • 2 Citations
AbstractAbstract PDF
Primary stabbing headache (PSH), characterized by sudden, localized stabbing headache pain, is a recognized primary headache disorder with evolving diagnostic criteria. Epidemiological studies show a wide range of prevalence, influenced by various factors. PSH is more common in females, frequently occurring in conjunction with migraine, and can manifest in children. Recent diagnostic criteria have changed the definition of sharp stabbing pain, which is no longer restricted to the first division of the trigeminal nerve. In addition, the criterion of “no accompanying symptoms” has been refined to “no cranial autonomic symptoms” specifically. These changes have increased the sensitivity for capturing PSH. Although it is generally considered benign, stabbing headache can be associated with secondary causes. Clinical red flag signs can be helpful in distinguishing secondary headaches from PSH. A recent prospective study has proposed the monophasic, intermittent, and chronic patterns as subtypes, and this division may be helpful for predicting the prognosis. Pharmacological treatment is typically not required for PSH, although indomethacin and other alternating agents can be used. The treatment should be selected based on individual clinical features and comorbidities. This review aims to highlight the necessity of recognizing the distinctive clinical profile of PSH and of tailoring treatment approaches to patients’ individual needs.

Citations

Citations to this article as recorded by  
  • Tension-Type Headache and Primary Stabbing Headache: Primary Headaches Beyond Migraine
    Mi-Kyoung Kang
    Headache and Pain Research.2025; 26(2): 89.     CrossRef
  • Two-year prognosis of primary stabbing headache and its associated factors: a clinic-based study
    Soohyun Cho, Byung-Kun Kim
    The Korean Journal of Pain.2025; 38(3): 332.     CrossRef
Case Report
Primary Headache Associated with Sexual Activity Presenting with Persistent Genital Arousal Disorder: A Case Report
Woo-Seok Ha, Hye-Kyung Baek
Headache Pain Res. 2024;25(2):117-121.   Published online September 2, 2024
DOI: https://doi.org/10.62087/hpr.2024.0012
  • 4,893 View
  • 28 Download
  • 1 Citations
AbstractAbstract PDF
Persistent genital arousal disorder (PGAD) is characterized by unwanted and distressing genital sensations that are not associated with concomitant sexual interest or thoughts. Several etiologies have been proposed, but the underlying mechanism of the condition remains unclear. In this report, we describe a case of PGAD presenting with primary headache associated with sexual activity (PHASA). A 57-year-old female with no history of headache experienced recurrent, unwanted episodes of genital arousal lasting 3 to 5 days for 4 years. One day, she began to experience intense genital arousal that she had never experienced before. On the fourth day of arousal, while attempting intercourse with her partner, she experienced an abrupt explosive headache, which was repeated during another session of intercourse a week later. The patient underwent laboratory tests, as well as brain magnetic resonance imaging (MRI) and magnetic resonance angiography, all of which showed normal findings. She was referred to a sexual medicine specialist and prescribed amitriptyline, escitalopram, and propranolol with a diagnosis of PGAD. Her sexual arousal gradually diminished, and when she stopped all medications 3 months later, all symptoms had disappeared. On further investigation, spinal MRI revealed a Tarlov cyst. She has been in remission for three years. This case illustrates the co-occurrence of PHASA and PGAD and suggests a possible common pathophysiology shared between these two rare disorders.

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  • Early nimodipine treatment in reversible cerebral vasoconstriction syndrome: A serial transcranial Doppler study
    Soohyun Cho, Minjung Seong, Mi Ji Lee
    Headache: The Journal of Head and Face Pain.2025; 65(9): 1617.     CrossRef
Original Article
Side Shift of Attacks in Cluster Headache: A Prospective Single-center Study
Michelle Sojung Youn, Jun Pyo Kim, Mi Ji Lee
Headache Pain Res. 2024;25(2):96-102.   Published online August 28, 2024
DOI: https://doi.org/10.62087/hpr.2024.0013
  • 3,415 View
  • 26 Download
  • 1 Citations
AbstractAbstract PDF
Purpose: Although strict unilaterality is a characteristic of cluster headache (CH), side shift of attacks has been reported. We aimed to assess the prevalence and patterns of side shifts, as well as their correlations with clinical characteristics and treatment response in CH patients.
Methods
We prospectively recruited and followed up CH patients at a university hospital. Patients with two or more lifetime CH bouts were interviewed about their side shift history using a structured questionnaire. The demographics and disease characteristics were collected at baseline, and the treatment response at 2- to 4-week follow-up examinations was compared between patients with versus without side shifts.
Results
Out of 124 CH patients, 26 (21.0%) experienced side shifts. Sixteen (61.5%) experienced shifts between bouts, 13 (50.0%) within a bout, and four (15.4%) within an attack, with none (0%) reporting bilateral pain during an attack. Among patients who experienced shifts between bouts, six (37.5%) reported a single shift during the entire disease course, while 10 (62.5%) reported multiple shifts between bouts. The demographics, characteristics, and treatment response did not significantly differ according to the history of side shift.
Conclusion
In our study, the prevalence and pattern of side shifts were comparable to the results from earlier studies. The presence of side shifts did not show significant association with a specific clinical profile and their incidence did not impact the treatment response. These findings suggest that side-shifting CH is not a distinct entity or migraine variant, but rather within the spectrum of CH.

Citations

Citations to this article as recorded by  
  • Pain Lateralization in Cluster Headache and Associated Clinical Factors
    Soohyun Cho, Mi Ji Lee, Min Kyung Chu, Jeong Wook Park, Heui-Soo Moon, Pil-Wook Chung, Jong-Hee Sohn, Byung-Su Kim, Daeyoung Kim, Kyungmi Oh, Byung-Kun Kim, Soo-Jin Cho
    Journal of Clinical Neurology.2025; 21(3): 220.     CrossRef
Review Articles
Understanding the Connection between the Glymphatic System and Migraine: A Systematic Review
Myoung-Jin Cha, Kyung Wook Kang, Jung-won Shin, Hosung Kim, Jiyoung Kim
Headache Pain Res. 2024;25(2):86-95.   Published online July 31, 2024
DOI: https://doi.org/10.62087/hpr.2024.0014
  • 6,448 View
  • 131 Download
AbstractAbstract PDF
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.
What a Neurologist Should Know about Functional Anatomy for Botulinum Toxin Injections in the Head, Face, and Neck: A Practical Perspective
So Ra Kim, Vittorio Favero, Alec Hyung Kim, SeongTaek Kim
Headache Pain Res. 2024;25(2):77-85.   Published online July 22, 2024
DOI: https://doi.org/10.62087/hpr.2024.0005
  • 6,781 View
  • 135 Download
  • 1 Citations
AbstractAbstract PDF
Since botulinum toxin (BoNT) was approved by the US Food and Drug Administration as a prophylactic treatment for chronic migraines in 2010, subsequent studies have shown that BoNT is effective in the management of chronic migraines due to its pain-relieving effects. Therefore, neurologists are increasingly utilizing BoNT as a therapeutic tool for chronic migraine. It is crucial to thoroughly understand the functional anatomy in the head, face, and neck regions to successfully administer BoNT injections in these areas. This review describes the complexity of muscles and their associated target nerves in the frontal, temporal, and occipital areas and serves as a resource for essential functional anatomy, with the goal of providing clinicians with a practical perspective on utilizing BoNT injections.

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  • When Should Headache Specialists Hold a Needle? The Role of Botulinum Toxin Injections and Occipital Nerve Blocks
    Soo-Jin Cho
    Headache and Pain Research.2024; 25(2): 73.     CrossRef
Editorial
Migraine in Women: Inescapable Femaleness?
Soo-Kyoung Kim
Headache Pain Res. 2024;25(1):1-2.   Published online April 24, 2024
DOI: https://doi.org/10.62087/hpr.2024.0010
  • 4,591 View
  • 34 Download
  • 2 Citations
PDF

Citations

Citations to this article as recorded by  
  • Calcitonin Gene-Related Peptide Monoclonal Antibody Treatment in Nine Cases of Persistent Headache Following COVID-19-Infection
    Soyoun Choi, Yooha Hong, Mi-Kyoung Kang, Tae-Jin Song, Soo-Jin Cho
    Journal of Korean Medical Science.2025;[Epub]     CrossRef
  • Morning Headaches: An In-depth Review of Causes, Associated Disorders, and Management Strategies
    Yooha Hong, Mi-Kyoung Kang, Min Seung Kim, Heejung Mo, Rebecca C. Cox, Hee-Jin Im
    Headache and Pain Research.2025; 26(1): 66.     CrossRef
Review Articles
Update on Cluster Headaches: From Genetic to Novel Therapeutic Approaches
Myun Kim, Je Kook Yu, Yoo Hwan Kim
Headache Pain Res. 2024;25(1):42-53.   Published online April 22, 2024
DOI: https://doi.org/10.62087/hpr.2024.0009
  • 13,512 View
  • 137 Download
  • 10 Citations
AbstractAbstract PDF
Cluster headaches affect 0.1% of the population and are four times more common in males than in females. Patients with this condition present with severe unilateral head pain localized in the frontotemporal lobe, accompanied by ipsilateral lacrimation, conjunctival injection, nasal congestion, diaphoresis, miosis, and eyelid edema. Recently, the first genome-wide association study of cluster headaches was conducted with the goal of aggregating data for meta-analyses, identifying genetic risk variants, and gaining biological insights. Although little is known about the pathophysiology of cluster headaches, the trigeminovascular and trigeminal autonomic reflexes and hypothalamic pathways are involved. Among anti-calcitonin gene-related peptide monoclonal antibodies, galcanezumab has been reported to be effective in preventing episodic cluster headaches.

Citations

Citations to this article as recorded by  
  • Exercise as an abortive treatment for cluster headaches: Insights from a large patient registry
    Mi‐Kyoung Kang, Yooha Hong, Soo‐Jin Cho
    Annals of Clinical and Translational Neurology.2025; 12(1): 149.     CrossRef
  • Morning Headaches: An In-depth Review of Causes, Associated Disorders, and Management Strategies
    Yooha Hong, Mi-Kyoung Kang, Min Seung Kim, Heejung Mo, Rebecca C. Cox, Hee-Jin Im
    Headache and Pain Research.2025; 26(1): 66.     CrossRef
  • Does Laterality Matter? Insights Into Unilateral Pain in Cluster Headache
    Tae-Jin Song
    Journal of Clinical Neurology.2025; 21(3): 157.     CrossRef
  • Pain Lateralization in Cluster Headache and Associated Clinical Factors
    Soohyun Cho, Mi Ji Lee, Min Kyung Chu, Jeong Wook Park, Heui-Soo Moon, Pil-Wook Chung, Jong-Hee Sohn, Byung-Su Kim, Daeyoung Kim, Kyungmi Oh, Byung-Kun Kim, Soo-Jin Cho
    Journal of Clinical Neurology.2025; 21(3): 220.     CrossRef
  • Subtype shift, relapse rate and risk factors of frequent relapse in cluster headache: A multicenter, prospective, longitudinal observation
    Mi Ji Lee, Soo-Kyoung Kim, Min Kyung Chu, Jae Myun Chung, Heui-Soo Moon, Pil-Wook Chung, Jeong Wook Park, Byung-Kun Kim, Kyungmi Oh, Yun-Ju Choi, Jong-Hee Sohn, Byung-Su Kim, Dae Woong Bae, Daeyoung Kim, Tae-Jin Song, Kwang-Yeol Park, Soo-Jin Cho
    Cephalalgia.2025;[Epub]     CrossRef
  • Inverse association of obesity with bout periodicity in episodic cluster headache: a multicenter cross-sectional study
    Byung-Su Kim, Mi Ji Lee, Byung-Kun Kim, Jong-Hee Sohn, Tae-Jin Song, Min Kyung Chu, Soo-Kyoung Kim, Jeong Wook Park, Heui-Soo Moon, Pil-Wook Chung, Soo-Jin Cho
    The Journal of Headache and Pain.2025;[Epub]     CrossRef
  • Trigeminal Autonomic Cephalalgias Following Unilateral Dorsolateral Medullary Infarction: A Case Series and Literature Review
    Jae-Myung Kim, Hak-Loh Lee, You-Ri Kang, Joon-Tae Kim, Seung-Han Lee
    Headache and Pain Research.2025; 26(3): 218.     CrossRef
  • Isolated Dental and Lower-Facial Pain Mimicking Trigeminal Neuropathy: An Indirect Carotid-Cavernous Fistula
    Byoungchul Choi, Chulho Kim, Sung-Hwan Kim, Jong-Hee Sohn
    Headache and Pain Research.2025; 26(3): 226.     CrossRef
  • Side Shift of Attacks in Cluster Headache: A Prospective Single-center Study
    Michelle Sojung Youn, Jun Pyo Kim, Mi Ji Lee
    Headache and Pain Research.2024; 25(2): 96.     CrossRef
  • Reduction of neck pain severity in patients with medication-overuse headache
    Yooha Hong, Hong-Kyun Park, Mi-Kyoung Kang, Sun-Young Oh, Jin-Ju Kang, Heui-Soo Moon, Tae-Jin Song, Mi Ji Lee, Min Kyung Chu, Soo-Jin Cho
    The Journal of Headache and Pain.2024;[Epub]     CrossRef
Menstrual Migraine: A Review of Current Research and Clinical Challenges
Jong-Geun Seo
Headache Pain Res. 2024;25(1):16-23.   Published online April 22, 2024
DOI: https://doi.org/10.62087/hpr.2024.0004
  • 22,047 View
  • 283 Download
  • 6 Citations
AbstractAbstract PDF
The term “menstrual migraine” is commonly used to describe migraines that occur in association with menstruation, as distinct from other migraine types. A significant proportion of women of reproductive age experience migraine attacks related to their menstrual cycle. Menstrual migraine is characterized by migraine attacks occurring on day 1±2 (i.e., days −2 to +3) of menstruation in at least two out of three menstrual cycles. Although the reported prevalence of menstrual migraine varies considerably, population-based studies have found that menstrual migraine affects up to 60% of women with migraines. Several hypotheses have been proposed to explain the etiology of menstrual migraine, among which the estrogen withdrawal hypothesis is the most widely accepted. Women who experience menstrual migraines often face considerable disability due to perimenstrual attacks. Studies have reported that perimenstrual attacks are more severe and more difficult to manage. The principles of acute managing perimenstrual attacks are the same as those for managing nonmenstrual attacks. Short-term preventive therapy is needed to prevent menstrual migraines before they occur during the perimenstrual period. This review summarizes the prevalence, distinct clinical features, pathophysiological mechanisms, and management of menstrual migraine.

Citations

Citations to this article as recorded by  
  • Sex hormones and diseases of the nervous system
    Hyman M. Schipper
    Brain Medicine.2025; : 1.     CrossRef
  • Evidence-Based Recommendations on Pharmacologic Treatment for Migraine Prevention: A Clinical Practice Guideline from the Korean Headache Society
    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
    Headache and Pain Research.2025; 26(1): 5.     CrossRef
  • Morning Headaches: An In-depth Review of Causes, Associated Disorders, and Management Strategies
    Yooha Hong, Mi-Kyoung Kang, Min Seung Kim, Heejung Mo, Rebecca C. Cox, Hee-Jin Im
    Headache and Pain Research.2025; 26(1): 66.     CrossRef
  • Migraine in Women: Inescapable Femaleness?
    Soo-Kyoung Kim
    Headache and Pain Research.2024; 25(1): 1.     CrossRef
  • Three-month treatment outcome of medication-overuse headache according to classes of overused medications, use of acute medications, and preventive treatments
    Sun-Young Oh, Jin-Ju Kang, Hong-Kyun Park, Soo-Jin Cho, Yooha Hong, Mi-Kyoung Kang, Heui-Soo Moon, Mi Ji Lee, Tae-Jin Song, Young Ju Suh, Min Kyung Chu
    Scientific Reports.2024;[Epub]     CrossRef
  • Understanding the Connection between the Glymphatic System and Migraine: A Systematic Review
    Myoung-Jin Cha, Kyung Wook Kang, Jung-won Shin, Hosung Kim, Jiyoung Kim
    Headache and Pain Research.2024; 25(2): 86.     CrossRef
Application and Effectiveness of Dietary Therapies for Pediatric Migraine
Ji-Hoon Na
Headache Pain Res. 2024;25(1):34-41.   Published online April 17, 2024
DOI: https://doi.org/10.62087/hpr.2024.0007
  • 6,784 View
  • 82 Download
  • 6 Citations
AbstractAbstract PDF
Migraine is a representative type of primary headache and a common chronic neurological disease that accounts for a large proportion of headaches in children, adolescents, and adults. Unlike migraine in adulthood, pediatric migraine occurs when brain development is not yet complete. This characteristic may require a new perspective for the treatment and management of pediatric migraine. Dietary therapies, mainly the ketogenic diet and its variants, can have positive effects on pediatric migraine. Several recent studies have revealed that dietary therapies, such as the classic ketogenic diet, modified Atkins diet, and low glycemic index diet, improve various neurological diseases by improving dysbiosis of microbiota, reducing proinflammatory cytokines, and increasing mitochondrial function. Nonetheless, the mechanism through which active dietary therapy affects pediatric migraine requires further research. To achieve this, an important role is played by the neuro-nutritional team, which can develop and manage tolerable diets for pediatric migraine patients through mutual collaboration among pediatric neurologists, nurses, and nutritionists.

Citations

Citations to this article as recorded by  
  • Episodic Migraine in the Pediatric Population: Behavioral Therapies and other Non-Pharmacological Treatment Options
    Parisa Gazerani
    Current Pain and Headache Reports.2025;[Epub]     CrossRef
  • Current Trends in Pediatric Migraine: Clinical Insights and Therapeutic Strategies
    Adnan Khan, Sufang Liu, Feng Tao
    Brain Sciences.2025; 15(3): 280.     CrossRef
  • Clinical Efficacy and Safety of the Ketogenic Diet in Patients with Genetic Confirmation of Drug-Resistant Epilepsy
    Ji-Hoon Na, Hyunjoo Lee, Young-Mock Lee
    Nutrients.2025; 17(6): 979.     CrossRef
  • Clinical profile and treatment outcomes of idiopathic intracranial hypertension: a multicenter study from Korea
    Kyung-Hee Cho, Seol-Hee Baek, Sung-Hee Kim, Byung-Su Kim, Jong-Hee Sohn, Min Kyung Chu, Mi-Kyoung Kang, Hee Jung Mo, Sang-Hwa Lee, Hong-Kyun Park, Soohyun Cho, Sun-Young Oh, Jong-Geun Seo, Wonwoo Lee, Ju-Young Lee, Mi Ji Lee, Soo-Jin Cho
    The Journal of Headache and Pain.2024;[Epub]     CrossRef
  • Nutritional Approaches to Managing Pediatric Migraine
    Hye Eun Kwon
    Headache and Pain Research.2024; 25(2): 75.     CrossRef
  • Reduction of neck pain severity in patients with medication-overuse headache
    Yooha Hong, Hong-Kyun Park, Mi-Kyoung Kang, Sun-Young Oh, Jin-Ju Kang, Heui-Soo Moon, Tae-Jin Song, Mi Ji Lee, Min Kyung Chu, Soo-Jin Cho
    The Journal of Headache and Pain.2024;[Epub]     CrossRef
Original Article
Cluster Headache Characteristics and the Severity of Obstructive Sleep Apnea: Insights from Polysomnography Analysis
Yooha Hong, Mi-Kyoung Kang, Min Kyung Chu, Soo-Jin Cho, Hee-Jin Im
Headache Pain Res. 2024;25(1):63-71.   Published online April 16, 2024
DOI: https://doi.org/10.62087/hpr.2024.0001
  • 4,155 View
  • 34 Download
  • 3 Citations
AbstractAbstract PDF
Purpose: Cluster headache (CH) is characterized by circadian rhythmicity of the attacks, and it is known to respond exceptionally well to oxygen therapy. Furthermore, obstructive sleep apnea (OSA) frequently co-occurs with CH, and both conditions may be parallel outcomes of hypothalamic dysfunction rather than being causally related. The aim of this study was to analyze the association between CH characteristics and polysomnographic factors stratified by the severity of OSA in patients diagnosed with CH and OSA.
Methods
We retrospectively analyzed the data of OSA patients with CH who were enrolled in the Korean Cluster Headache Registry and underwent polysomnography due to clinical suspicion of OSA. Basic demographic data, headache-related parameters, and polysomnographic parameters were analyzed according to the severity of OSA (apnea-hypopnea index: <15 or ≥15 per hour).
Results
Twelve CH patients with OSA were evaluated. The onset age of CH was higher (38.5 years vs. 19.0 years, p=0.010), and the maximal duration of cluster bouts was longer (156.5 days vs. 47.0 days, p=0.037) in the moderate-to-severe OSA group than in the mild OSA group. Unlike other polysomnographic parameters, the apnea-hypopnea index and respiratory arousal index during rapid eye movement (REM) sleep were comparable across different OSA severity levels.
Conclusion
The onset age and duration of cluster bouts were associated with the severity of OSA in CH patients. Additionally, the relatively high susceptibility to hypoxia during REM sleep in patients with mild OSA implies that interventions may be potentially advantageous, even in CH patients with mild OSA.

Citations

Citations to this article as recorded by  
  • Morning Headaches: An In-depth Review of Causes, Associated Disorders, and Management Strategies
    Yooha Hong, Mi-Kyoung Kang, Min Seung Kim, Heejung Mo, Rebecca C. Cox, Hee-Jin Im
    Headache and Pain Research.2025; 26(1): 66.     CrossRef
  • Inverse association of obesity with bout periodicity in episodic cluster headache: a multicenter cross-sectional study
    Byung-Su Kim, Mi Ji Lee, Byung-Kun Kim, Jong-Hee Sohn, Tae-Jin Song, Min Kyung Chu, Soo-Kyoung Kim, Jeong Wook Park, Heui-Soo Moon, Pil-Wook Chung, Soo-Jin Cho
    The Journal of Headache and Pain.2025;[Epub]     CrossRef
  • Subtype shift, relapse rate and risk factors of frequent relapse in cluster headache: A multicenter, prospective, longitudinal observation
    Mi Ji Lee, Soo-Kyoung Kim, Min Kyung Chu, Jae Myun Chung, Heui-Soo Moon, Pil-Wook Chung, Jeong Wook Park, Byung-Kun Kim, Kyungmi Oh, Yun-Ju Choi, Jong-Hee Sohn, Byung-Su Kim, Dae Woong Bae, Daeyoung Kim, Tae-Jin Song, Kwang-Yeol Park, Soo-Jin Cho
    Cephalalgia.2025;[Epub]     CrossRef
Review Articles
Migraines in Women: A Focus on Reproductive Events and Hormonal Milestones
Seonghoon Kim, Jeong Wook Park
Headache Pain Res. 2024;25(1):3-15.   Published online April 5, 2024
DOI: https://doi.org/10.62087/hpr.2024.0003
  • 14,683 View
  • 231 Download
  • 10 Citations
AbstractAbstract PDF
Migraine, a prevalent neurological disorder, is more common in women than in men. This sex difference is more pronounced after menarche and diminishes after menopause. Migraines in women are influenced by the menstrual cycle, pregnancy, and lactation, suggesting a connection to sex hormones, known as the estrogen withdrawal theory. Beyond endogenous hormonal changes accompanying reproductive events, exogenous hormonal factors such as contraceptives or hormone replacement therapy may also affect migraines. The hormonal influence cannot be explained simply by serum estrogen levels; instead, it involves a complex interplay of various factors. Here, we delineate aspects of migraines associated with endogenous and exogenous hormonal changes over the course of a woman’s life, exploring the mechanisms and contributing factors through which sex hormones influence migraines.

Citations

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  • Framing and Management of Migraines in Women: An Expert Opinion on Challenges, Current Approaches, and Future Multidisciplinary Perspectives
    Piero Barbanti, Rossella E. Nappi
    Healthcare.2025; 13(2): 164.     CrossRef
  • Morning Headaches: An In-depth Review of Causes, Associated Disorders, and Management Strategies
    Yooha Hong, Mi-Kyoung Kang, Min Seung Kim, Heejung Mo, Rebecca C. Cox, Hee-Jin Im
    Headache and Pain Research.2025; 26(1): 66.     CrossRef
  • Calcitonin Gene-Related Peptide Monoclonal Antibody Treatment in Nine Cases of Persistent Headache Following COVID-19-Infection
    Soyoun Choi, Yooha Hong, Mi-Kyoung Kang, Tae-Jin Song, Soo-Jin Cho
    Journal of Korean Medical Science.2025;[Epub]     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
  • Trends in the Burden of Headache Disorders in Europe, 1990–2021: A Systematic Analysis from the Global Burden of Disease Study 2021
    Terry Jung, Yoonkyung Chang, Moon-Kyung Shin, Sohee Wang, Seyedehmahla Hosseini, Joonho Kim, Min Kyung Chu, Tae-Jin Song
    Journal of Clinical Medicine.2025; 14(19): 6966.     CrossRef
  • Sex differences in migraine: bridging pathophysiology and clinical care in women
    U. K. Egodage, M.S. Mohideen, S.P. Mohotti
    Advances in Physiology Education.2025; 49(4): 1109.     CrossRef
  • Migraine in Women: Inescapable Femaleness?
    Soo-Kyoung Kim
    Headache and Pain Research.2024; 25(1): 1.     CrossRef
  • Three-month treatment outcome of medication-overuse headache according to classes of overused medications, use of acute medications, and preventive treatments
    Sun-Young Oh, Jin-Ju Kang, Hong-Kyun Park, Soo-Jin Cho, Yooha Hong, Mi-Kyoung Kang, Heui-Soo Moon, Mi Ji Lee, Tae-Jin Song, Young Ju Suh, Min Kyung Chu
    Scientific Reports.2024;[Epub]     CrossRef
  • Subjective Cognitive Decline Patterns in Patients with Migraine, with or without Depression, versus Non-depressed Older Adults
    Sun Hwa Lee, Soo-Jin Cho
    Headache and Pain Research.2024; 25(2): 103.     CrossRef
  • Understanding the Connection between the Glymphatic System and Migraine: A Systematic Review
    Myoung-Jin Cha, Kyung Wook Kang, Jung-won Shin, Hosung Kim, Jiyoung Kim
    Headache and Pain Research.2024; 25(2): 86.     CrossRef
COVID-19 Infection-related Headache: A Narrative Review
Yoonkyung Chang, Tae-Jin Song
Headache Pain Res. 2024;25(1):24-33.   Published online April 2, 2024
DOI: https://doi.org/10.62087/hpr.2024.0008
  • 6,593 View
  • 42 Download
  • 5 Citations
AbstractAbstract PDF
Severe acute respiratory syndrome coronavirus 2 is the virus responsible for coronavirus disease 2019 (COVID-19), which caused a global pandemic and then became an endemic condition. COVID-19 infection may be associated with clinical manifestations such as respiratory symptoms and systemic diseases, including neurological disorders, notably headaches. Headaches are a common neurological symptom in individuals infected with COVID-19. Furthermore, with the transition to endemicity, COVID-19 infection-related headaches may reportedly persist in the acute phase of COVID-19 infection and in the long term after COVID-19 infection resolves. Persistent headaches after COVID-19 infection can be a significant concern for patients, potentially leading to disability. The present review discusses the clinical characteristics and potential underlying mechanisms of COVID-19 infection-related headaches.

Citations

Citations to this article as recorded by  
  • Unclosing Clinical Criteria and the Role of Cytokines in the Pathogenesis of Persistent Post-COVID-19 Headaches: A Pilot Case-Control Study from Egypt
    Ahmed Abualhasan, Shereen Fathi, Hala Gabr, Abeer Mahmoud, Diana Khedr
    Clinical and Translational Neuroscience.2025; 9(1): 5.     CrossRef
  • Exploring Secondary Headaches: Insights from Glaucoma and COVID-19 Infection
    Soo-Kyoung Kim
    Headache and Pain Research.2025; 26(1): 3.     CrossRef
  • Calcitonin Gene-Related Peptide Monoclonal Antibody Treatment in Nine Cases of Persistent Headache Following COVID-19-Infection
    Soyoun Choi, Yooha Hong, Mi-Kyoung Kang, Tae-Jin Song, Soo-Jin Cho
    Journal of Korean Medical Science.2025;[Epub]     CrossRef
  • A Prospective Multicenter Study on the Evaluation of Frequency of Idiopathic Intracranial Hypertension in Korea
    Byung-Su Kim, Soo-Jin Cho, Kyung-Hee Cho, Seol-Hee Baek, Jong-Hee Sohn, Tae-Jin Song, Wonwoo Lee, Hong-Kyun Park, Soohyun Cho, Junhee Han, Soolienah Rhiu, Myoung-Jin Cha, Mi Ji Lee, Min Kyung Chu
    Journal of Korean Medical Science.2025;[Epub]     CrossRef
  • Global, regional, and national burden of headache disorders, 1990–2021, with forecasts to 2050: A Global Burden of Disease study 2021
    Tissa Wijeratne, Jiyeon Oh, Soeun Kim, Yesol Yim, Min Seo Kim, Jae Il Shin, Yun-Seo Oh, Raon Jung, Yun Seo Kim, Lee Smith, Hasan Aalruz, Rami Abd-Rabu, Deldar Morad Abdulah, Richard Gyan Aboagye, Meysam Abolmaali, Dariush Abtahi, Ahmed Abualhasan, Rufus A
    Cell Reports Medicine.2025; 6(10): 102348.     CrossRef
Original Article
Associations of Migraine and Tension-type Headache with Glaucoma
Jong-Ho Kim, Young-Suk Kwon, Sang-Hwa Lee, Jong-Hee Sohn
Headache Pain Res. 2024;25(1):54-62.   Published online March 29, 2024
DOI: https://doi.org/10.62087/hpr.2024.0002
  • 4,189 View
  • 61 Download
  • 4 Citations
AbstractAbstract PDF
Purpose: It remains unclear whether primary headaches, particularly migraine, are associated with glaucoma. We investigated potential associations between primary headaches, including migraine and tension-type headache (TTH), and primary glaucoma, including open-angle glaucoma (OAG) and closed-angle glaucoma (CAG).
Methods
We used data from the Clinical Data Warehouse collected between 2008 and 2023 to investigate whether migraine and TTH influence the risk of primary glaucoma. We compared the prevalence of primary glaucoma, including OAG, CAG, other glaucoma, and total glaucoma (TG), among patients with migraine, those with TTH, and controls.
Results
This study analyzed 46,904 patients with migraine, 48,116 patients with TTH, and 455,172 controls. Controls were selected based on propensity score matching (PSM). After adjustment for covariates and PSM, the fully adjusted odds ratios (ORs) for patients with migraine were 1.83 for OAG (95% confidence interval [95% CI], 1.33–2.51; p<0.004) and 1.55 for TG (95% CI, 1.26–1.91; p<0.004) compared to controls. Furthermore, in patients with TTH, the ORs for CAG were 2.20 (95% CI, 1.40–3.47; p<0.004) compared to controls. Additionally, patients with migraine had fully adjusted ORs of 1.71 for OAG (95% CI, 1.24–2.36; p<0.004) and 1.41 for TG (95% CI, 1.15–1.73; p<0.004) compared to those with TTH.
Conclusion
Migraine is associated with primary glaucoma, particularly OAG.

Citations

Citations to this article as recorded by  
  • Exploring Secondary Headaches: Insights from Glaucoma and COVID-19 Infection
    Soo-Kyoung Kim
    Headache and Pain Research.2025; 26(1): 3.     CrossRef
  • Association between migraine and primary open-angle glaucoma: A two-sample Mendelian randomization study
    Dima L Chaar, Aliya Yakubova, Chen Jiang, Thomas J Hoffmann, Alice Pressman, Denis Plotnikov, Hélène Choquet
    Cephalalgia Reports.2025;[Epub]     CrossRef
  • The association between migraine and glaucoma diseases: A retrospective cohort study
    Matan Bar, Ido Peles, Gal Ifergane, Erez Tsumi, Assaf Kratz
    Headache: The Journal of Head and Face Pain.2025;[Epub]     CrossRef
  • Subjective Cognitive Decline Patterns in Patients with Migraine, with or without Depression, versus Non-depressed Older Adults
    Sun Hwa Lee, Soo-Jin Cho
    Headache and Pain Research.2024; 25(2): 103.     CrossRef
Neuroimage
Invasive Aspergillosis Manifesting as Painful Ophthalmoplegia
Sorae Lee, Sumin Kim, Sanggyu Han, So-Ei Ann, Pil-Wook Chung, Bum Chun Suh, Jun-Sang Sunwoo
Korean J Headache. 2023;24(2):84-86.   Published online December 31, 2023
  • 596 View
  • 6 Download
PDF
Review Article
New Targeted Drugs for Acute Treatment of Migraine
Heui-Soo Moon, Pil-Wook Chung, Byung-Kun Kim
Korean J Headache. 2023;24(2):56-65.   Published online December 31, 2023
  • 844 View
  • 23 Download
AbstractAbstract PDF
Acute migraine treatments primarily aim to relieve headache pain and address accompanying symptoms such as photophobia, phonophobia, and nausea. Triptans have traditionally been the first-line treatment for moderate to severe migraine attacks. Nevertheless, they have several limitations, such as causing temporary vasoconstriction of blood vessels, contraindications in patients with cardiovascular issues, and distinctive side effects like chest tightness. Medication overuse is another concern with triptans, prompting research into new antimigraine drugs targeting calcitonin gene-related peptide (CGRP) or 5-HT1F receptors. Lasmiditan, an agonist at the 5-HT1F receptor, has emerged as a safe and effective option for abortive treatment in acute migraine attacks. It lacks the vasoconstrictive effects associated with triptans, making it a safer choice for individuals with contraindications to triptans. However, it may lead to central nervous system-related adverse effects, particularly dizziness and paresthesia. Gepants, which are CGRP antagonists, offer an innovative approach by targeting CGRP receptors which is believed to be central in migraine pathophysiology. These medications have demonstrated efficacy in alleviating migraine symptoms, providing alternatives to traditional treatments like triptans and ergots. Ubrogepant and rimegepant are the first approved oral gepants for acute migraine treatment, while Zavegepant is the first approved intranasal gepant. The most common treatment-related adverse events are gastrointestinal symptoms, including nausea. No vascular or hepatic concerns have emerged to date. In this review, we delve into the development of ditans and gepants for acute migraine treatment in adults and discuss their potential advantages and disadvantages in clinical use.
Case Report
Unilateral Retro-orbital Headache Secondary to Septic Cavernous Sinus Thrombosis: A Case Report
Sumin Kim, Sorae Lee, Jun-Sang Sunwoo
Korean J Headache. 2023;24(2):80-83.   Published online December 31, 2023
  • 535 View
  • 9 Download
AbstractAbstract PDF
Septic cavernous sinus thrombosis (SCST) is a rare but fatal central nervous system infectious disease affecting the cavernous sinuses. Here, we report a case of 51-year-old woman presenting with new-onset unilateral retro-orbital headache lasting for 3 weeks and subsequent ipsilateral abducens nerve palsy. Brain magnetic resonance imaging revealed enlargement of the cavernous sinus with dural enhancement and ring-enhancing abscess in the adjacent temporal lobe. Although blood and cerebrospinal fluid cultures were negative, the patient was successfully treated with empirical antibiotic therapy. Although SCST is a possible cause of painful ophthalmoplegia, it should be kept in mind that in the early stage it may present only with headache without ocular symptoms.
Review Article
Treatment Strategies of Medication Overuse Headache
Mi-Kyoung Kang, Jong-Hee Sohn
Korean J Headache. 2023;24(2):33-38.   Published online December 31, 2023
  • 1,026 View
  • 50 Download
AbstractAbstract PDF
Medication overuse headache (MOH) is a common secondary headache disorder in which chronic headaches develop or worsen due to frequent and excessive intake of medications used for acute headache treatment. While the concept of MOH is widely recognized among headache specialists, ongoing debates exist regarding its causes, diagnostic criteria, and treatment strategies. Treating MOH has traditionally been challenging, and there is currently no universal consensus on how to effectively manage patients with MOH. Furthermore, a specific treatment approach based on well-powered randomized trials is still lacking. The treatment strategy for MOH typically involves several steps: patient education and counseling, withdrawal of overused medications, preventive drug therapy, and non-pharmacological prevention. It is recommended that all patients discontinue the overused medication, which can be carried out on an outpatient or inpatient basis. Additionally, topiramate, Botox, and anti-calcitonin gene-related peptide monoclonal antibodies have shown potential in reducing headache and migraine frequency, as well as acute drug consumption, even without active drug withdrawal. However, many aspects of MOH management require further investigation through properly designed and adequately powered randomized controlled trials.
Original Articles
Secular Trend of Sex Ratio in Participants under Randomized Controlled Trials for Cluster Headache
Pil-Wook Chung, Heui-Soo Moon
Korean J Headache. 2023;24(2):70-76.   Published online December 31, 2023
  • 640 View
  • 8 Download
AbstractAbstract PDF
Background
Although cluster headache (CH) is well known as a disorder of predominantly young males, the male to female ratio decreased from 5-7:1 before 1980s to -2:1 in the 2000s and afterward in Western observational studies. It is unclear whether this represents a true rise of CH in women or better recognition of CH in women. We sought to assess whether the sex ratio of CH were changing or not in randomized controlled trials (RCTs) over time in accordance with observational studies.
Methods
We included RCTs regarding pharmacologic medication, as well as procedural and surgical treatment, devices. Time trend of sex ratio was compared among 3 different publication era (1985-2000 vs 2001-2010 vs 2011-). Sex ratio between different cluster headache type (Episodic vs Chronic) was also compared.
Results
22 acute treatment trials and 25 preventive treatment trials were initially selected for inclusion. 5 acute treatment trials and 10 preventive treatment trials were excluded due to small sample size (n<20) and/or no demographic information. All studies were underwent in western countries. Of 32 trials finally included, 10 studies were published between 1985 to 2000 (1st era), 8 studies from 2001 to 2010 (2nd era), 14 studies after 2010 (3rd era). Of the 2,476 patients, 80% were male. Secular tendency of decreasing male predominance was shown over time. 542 of 623 patients (87%) were male in 1st era, while 83% were male in 2nd era, and 75.3% were male in 3rd era (p<0.001). Male to female ratio was 6.7:1 in 1st era, 4.9:1 in 2nd era, and 3:1 in 3rd era. In chronic CH, 28% of subjects were female, while in episodic CH, 14.6% were female (p<0.001)
Conclusions
As suggested by observational and registry data, the population enrolled in the RCT also exhibited a decreasing trend in male predominance over time in CH.
A Survey on Headache Education Curriculum in College of Dentistry
Jin Kyu Kang, Ji-Won Ryu, Seong-Taek Kim
Korean J Headache. 2023;24(2):66-69.   Published online December 31, 2023
  • 760 View
  • 17 Download
AbstractAbstract PDF
Background
Headache is a common pain condition encountered in clinical practice. Many patients visit a doctor or dentist complaining of headaches accompanied by toothaches or facial pain. However, it has been reported that education on headaches is insufficient in medical schools, which is believed to be a more serious problem in dental schools.
Methods
We surveyed the current status of headache education curriculum in 11 dental schools in Korea.
Results
In most dental schools, headache education was provided as part of orofacial pain course within the oral medicine program. Only two universities covered headache as an in-depth postgraduate course. Lectures were delivered by oral medicine faculty, and only one university included a neurologist as part of the team teaching. Dental textbooks still described headaches based on the 2nd edition of the International Classification of Headache Disorders.
Conclusion
Currently, headache education in dental schools in Korea is inadequate and outdated. Considering the specificity of dentists who are in charge of pain in oral and facial region, continuous discussions and mutual cooperation with the neurology department are necessary to ensure sufficient education related to headaches during the undergraduate course.
Review Article
Diagnosis and Treatment of Hemicrania Continua, Paroxysmal Hemicrania, Short-lasting Unilateral Neuralgiform Headache Attacks
Sang-Hwa Lee, Mi-Kyoung Kang, Soo-Jin Cho
Korean J Headache. 2023;24(2):39-44.   Published online December 31, 2023
  • 673 View
  • 28 Download
AbstractAbstract PDF
Chronic paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua are rare headache disorders characterized by severe unilateral headache accompanied by ipsilateral autonomic symptoms. Accurate diagnosis and specific treatment approaches for these conditions are crucial for appropriate management. This article covers the clinical features, diagnostic criteria, and treatment strategies of each disorder, aiming to differentiate them from other major headaches and provide targeted treatment strategies to improve patient outcomes.
Headache and Pain Research : Headache and Pain Research
© The Korean Headache Society.
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