Headache and Pain Research

Volume 6(1); June 2005

일반연제-Patent Foramen Ovale in Migraine Patients in Korea:A Transcranial Doppler Study: Ahyun Cho, Sang Beom Jeon , Sun U. Kwon; Published online June 30, 2005

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Abstract PDF: Background
and Objectives: Migraine headaches are common in the general population with signi- ficant morbidity. Migraine, especially with aura is known to increase relative risk of ischemic stroke although the stroke mechanism is unclear. Recent data shows a high prevalence of patent foramen ovale(PFO) in migraine patients and PFO is known to be associated with cryptogenic stroke in young patients. In some studies, migraine headaches were relieved by PFO closure, and randomized controlled trial for that is ongoing. Transcranial Doppler(TCD) study is noninvasive tool and easily available test for detection of right to left shunt. By TCD study, we aimed to investigate the prevalence of PFO in migraine patients and to find the specific subgroup associated with the presence of PFO in Korean. Methods: From February 23, 2005 to April 25, 2005, we prospectively included the patients who had migraine diagnosed by international headache society(IHS) criteria. The clinical features including frequency, and aura were obtained. Headache frequency was divided to low(1 or less per month), moderate(2 to 7), high(8 or more). PFO was assessed with TCD with IV injection of agitated saline. The degree of right to left shunt was divided grade I when the embolic track was 5 or less, grade II when 6 to 15, grade III when above 16. Results: Among 38 patients included, 22(57.9%) patients showed positive results for PFO test by TCD. The most common degree of PFO was grade I(12), followed by Gr II(6), Gr III(4). The prevalence of PFO was not significantly different according to the presence of aura and severity of headache; PFO was positive in the 13/20(65%) of migraine with aura and in the 9/18(50%) of migraine without aura. Frequent headache(>8 per months) was more common in the patients with PFO(38.9%) than in patients without PFO(23.1%). Conclusions: In Korea, more than half of migraine patients were identified to have PFO in TCD study, while the prevalence of PFO in general population has been known as 15～25%. The PFO was more prevalent in patients with higher frequency, although it is not statistically signficant. These findings may suggest that the presence of PFO contributes development and manifestation of migraine.

토피라메이트에 반응을 보인 기저형편두통 1예: Young-Jo Bae, Kyung-Hun Kang, Ho-Won Lee, Doo-Kyo Jung, Chung-Kyu Suh, Sung-Pa Park; Published online June 30, 2005

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Abstract PDF: Basilar-type migraine is a subtype of migraine with aura. Recently, topiramate(TPM) has been demonst- rated to be effective as a monotherapeutic device for migraine prevention. However, there is no report to describe its efficacy on basilar type migraine. A 17-year-old woman admitted to our hospital with basilar type migraine. Her symptoms including aura relieved with TPM of a daily dose of 100mg after four months. There were several adverse events including paresthesia, weight loss or speech problem, even though they were mild and transient. We report a patient with basilar type migraine who responded to TPM. Korean Journal of Headache 6(1):95-98, 2005

대한두통학회 춘계학술대회 2005 일정표: Published online June 30, 2005

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두통을 연구하기 위한 임상 연구의 설계: Sun U. Kwon, Kyun S. Bae; Korean J Headache. 2005;6(1):1-5. Published online June 30, 2005

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Abstract PDF: The clinical research is the only way to give evidences of evidence based medicine which has a major role in the establishing management strategy. Clinical research consists of observational study and clinical trials. Observational studies include cohort study, case-control study, cross sectional study, case series study and others, and they have given numerous valuable informations, such as prevalence, natural history, clinical characteristics, and outcomes of migraine and other headache disorders. In desinging of clinical trials, we should consider not only scientific aspects but also ethical aspects because clinical trials always require dedication of participants. To be scientifically valid and valuable, clinical trials must have social and sicentific needs, methodological validity, and statistical reilability. Considering the requirements, needs and resources, investigators can make a design of clinical trials inclu- ding sample size, blinding methods, how to measure primary and secondary outcomes, statistical methods and others. Well-designed clinical trials only supply credible and useful evidence for evidence based medicine. Korean Journal of Headache 6(1):1-5, 2005

편두통 치료의 병태생리적 접근: Byung Kun Kim; Korean J Headache. 2005;6(1):6-13. Published online June 30, 2005

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Abstract PDF: The pathophysiology of migraine is not fully understood. Neuronal hyperexcitability can explain the interictal status of migraine. Cortical spreading depression appears to underlie the aura phase in patients with migraine aura. The pain of the headache phase is mediated by the trigeminal vascular system and central projection. Preventive medications may target brain excitability, consequently blocking triggers of aura or headache. Acute medications inhibit trigeminal activation from either a peripheral or central location. Triptans ameliorate migraine headache primarily by constricting the dilated cranial blood vessels and by inhibiting the neurogenic inflammation. Recently published clinical study has reported that a selective CGRP receptor antagonist is effective in treating acute migraine attacks without significant side effects. Several new targets will be reviewed in this article. Korean Journal of Headache 6(1):6-13, 2005

트립탄계열 약물을 포함한 급성기 편두통 치료: Heui-Soo Moon; Korean J Headache. 2005;6(1):14-20. Published online June 30, 2005

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Abstract PDF: The objective of abortive treatment of migraine attack is to reduce the intensity and duration of pain with its attendant symptoms and to optimize the patient's ability to function normally. The efficacy of most abortive anti-migrainous drug is probably related to their inhibitory effects on neurogenic inflammation mediated through serotonergic control mechanisms. The migraine specific therapies are representative of new migraine abortive medications, which act as serotonin agonist- triptans and ergots. Treatment choices for acute migraine should be based on headache severity, migraine frequency, associated symptoms, and comorbidities. In this review, I described recent trends in acute migraine therapy with stress on evidence- based guideline for migraine headache in company with some remarks on the various triptans. Korean Journal of Headache 6(1):14-20, 2005

편두통 급성기 치료의 비특이 약물들: Jae-Myun Chung; Korean J Headache. 2005;6(1):21-25. Published online June 30, 2005

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Abstract PDF: Migraine as a chronic, intermittent disabling condition affects physical, mental, and social quality of life. Among various medications being used in acute treatment of migraine, analgesics, nonsteroidal antiinflam- matory drugs(NSAIDs), antiemetics, and opioids constitute nonspecific treatment. Analgesics and NSAIDs are the mainstay of the self-administered treatment options in many migraineurs, and thus have a huge influence on their migraine status, even make them suffer from medication-overuse headache. Antiemetics, especially metoclopramide exert ancillary effect for rapid absorption of other anti-migraine drugs as well as anti-migraine effect by itself. Opioids can be used as a rescue medicine only in special circumstances because of its addictive feature. These nonspecific acute anti-migraine medications should be used accor- ding to practice guideline so that could enhance patients' quality of life. Korean Journal of Headache 6(1):21-25, 2005

편두통 급성기 치료의 실패: 원인과 대책: Jeong Wook Park; Korean J Headache. 2005;6(1):26-33. Published online June 30, 2005

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Abstract PDF: Acute management of migraine attacks is often difficult and many patients show to be refractory to treatment. As therapeutic option multiply, it is increasingly important to understand patients's attitudes and preferences regarding various treatment characteristics. A survey of populaton based sample of mig- raineurs indicated that majority of patients consider complete relief of headache, no recurrence, and rapid onset of action as important attributes of acute migraine therapy. In this paper, we also summarize and categorize the common reasons for treatment failure in acute management. That is, the diagnosis is in- complete or incorrect; important exacerbating factors have been missed; pharmacotherapy has been inade- quate; other factors, including unrealistic expectations and comorbidity. Finally we describe the strategy for swithching the way to care when primary pharmacotherapy was inadequate and suggest drugs that could be used for case of refractory to triptans. Korean Journal of Headache 6(1):26-33, 2005

두통 치료에 있어 항우울제와 항정신병 약제의 역할: Kun-Woo Park; Korean J Headache. 2005;6(1):34-39. Published online June 30, 2005

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Abstract PDF: Antidepressants are included in the major medication group for preventive and adjunct headache treat- ment. Although they have several side effects and are to be caution in older patients, some of them have well-documented efficacy. Amitriptyline has demonstrated a consistent efficacy in prophylactic therapy of migraine and chronic tension type headache. There is fair support for the effectiveness of serotonine reup- take inhibitors in migraine prevention. Neuroleptis and antiemetics have long been used for acute headache treatment. However, they have not been widely used because of general unfamiliarity with them and concern for adverse effects. Neuroleptics are appropriate as second line agents in outpatient clinic such as triptans have failed, and as first line agents in emergency room. Korean Journal of Headache 6(1):34-39, 2005

항고혈압제를 이용한 편두통의 예방 치료: Ki Hyun Cho; Korean J Headache. 2005;6(1):40-46. Published online June 30, 2005

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Abstract PDF: In spite of great effort to make sure the pathogenesis of migraine, it is still remains an enigma, which is reflected by the several number of drugs are used or have been used to treat or prevent migraine attacks. The most important progress in the treatment of migraine in the last decade is the introduction of triptans to abort the acute attack of migraine. However, only about 50% to 60% of patients consis- tently respond to this type of medication. Therefore prophylactic treatments are needed in the patients with inadequate effect of acute treatment and if patients experience 2 or more migraine attacks per month. The prophylactic agents available today have been introduced serendipitously at the beginning and antihypertensive agents are among them. This review focuses on the antihypertensive agents including receptor blocker, calcium channel blocker, angiotensin converting enzyme inhibitor and angiotensin II receptor blocker for the prevention of migraine. Korean Journal of Headache 6(1):40-46, 2005

항경련제의 편두통 예방 요법: Ki-Young Jung; Korean J Headache. 2005;6(1):47-53. Published online June 30, 2005

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Abstract PDF: Migraine and epilepsy are comorbid episodic central nervous system disorders that can have stereoty- ped symptoms with negative and positive phenomena. Controlled trials have demonstrated that anticon- vulsants appear to be both effective in reducing migraine frequency and reasonably well tolerated. There is noticeable variation among individual agents, but there are insufficient data to know whether this is due to chance or variation in true efficacy. Relatively few robust trials are available for agents other than sodium valproate/divalproex sodium. Three recently published and large trials of topiramate demonstrated reasonable efficacy. Anticonvulsants are a useful option for the preventive treatment of migraine. Korean Journal of Headache 6(1):47-53, 2005

두통질환에서 보툴리눔 독소의 활용: Man-Wook Seo; Korean J Headache. 2005;6(1):54-69. Published online June 30, 2005

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Abstract PDF: Botulinum toxin, the most potent biological toxin known to man, was first isolated in 1897. For 2 deca- des, botulinum toxin A has been used for treating various disorders associated with muscular hypertrophy. Current research efforts focus on new areas of application for botulinum toxin A in specific pain therapy, particularly in headache. Clinical data and experience to date have demonstrated that BTX-A is an effec- tive and well-tolerated therapy for various headache disorders. Its long-term action lasting several months obviates the need to remember to take medication several times a day. Although inhibition of neuromus- cular activity may alleviate a portion of the pain associated with headache disorders, it does not fully explain the pain-relief mechanisms mediated by BTX-A. A reduction in afferent sensory activity coming from pericranial and cervical muscles, and inhibition of peripheral and central trigeminal sensitization, may be the potential mechanisms by which BTX-A exerts its therapeutic effect in various headache disor- ders. Further investigations will define the accurate pathophysiologic mechanisms of BTX-A in the head- ache management. Korean Journal of Headache 6(1):54-69, 2005

왜 어떤 편두통 환자는 예방 약물에 반응하지 않을까?: Soo-Jin Cho; Korean J Headache. 2005;6(1):70-73. Published online June 30, 2005

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Abstract PDF: Migraine is a chronic recurrent headache disorder and preventive medications can lessen the burden or disability due to severe migraine attacks. About a half of patients responded(a greater than 50% reduc- tion in either mean migraine frequency or mean numbers of days with migraine) to traditional preventive medications and some gave up the medications due to adverse effect before the maximum effects. Causes of failure to preventive medications were poor compliance or premature discontinuation, inappropriate choice of medications, or neglect the exacerbating factors in habit or environment. The frequency of mig- raine can change purely with time, so non-pharmacological management is worthwhile after comprehen- sive evaluations for primary or secondary headache. The patients with previous failure of several courses of preventive medications can respond to new preventive therapy or combined therapy with previous par- tial effective medications. Korean Journal of Headache 6(1):70-73, 2005

간호사들의 월경관련 편두통 - 한림대학교 간호사 편두통 연구 -: Min-Kyung Chu, Kyung-Ho Yu, Hyeo-Il Ma, Yoon Kim, Joo-Yong Kim, Su-Jin Cho, Cheol-Ho Kim, Byung-Chul Lee; Korean J Headache. 2005;6(1):74-81. Published online June 30, 2005

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Abstract PDF: Background
& Objectives: It is known that migraines in women are associated with menstruation. We analyzed the data of Hallym university migraine in nurses study to identify the prevalence and clinical features of menstruation related migraine in Korean nurses. Method: All 1501 nurses working at Hallym Medical Center were asked 72-item questionnaire on mig- raine including general information, occupational environments and characteristics, characteristics of headache, triggering factors, management of headache and migraine related disabilities. We categorized participants as having menstrually associated migrtaine(MAM) who answered that migraine attacks were associated to menstruation. Results: 89.2% of participants completed the questionnaire. All were female with mean age of 27.5±5.7, 276(17.5%) were classified as having migraine. 59(25.0%) of migraineurs had MAM. 36(61.0%) had migraine attacks in premenstrual period, 13(22.0%) in menstruation period, 1(1.7%) in postmenstrual period. 9(15.3%) of migraineurs reported varying relationship between migraine attacks and menstruation. Headache aggravation by routine physical activity was more common in MAM than non-MAM. There were no signi- ficant difference in attack frequency, headache severity and MIDAS scores between MAM and non-MAM. Conclusion: 25.0% of nurses with migraine had MAM. Migraine attacks occurring in premenstrual period was the most common form of MAM. MAM showed some different clinical features from those of non-MAM. Korean Journal of Headache 6(1):74-81, 2005

경두개 초음파를 이용한 편두통 환자에서의 뇌혈관 반응성 연구: Ki Sung Kim, Yong Soo Shim, Dong Won Yang, Beum Saeng Kim, Young Min Shon; Korean J Headache. 2005;6(1):82-88. Published online June 30, 2005

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Abstract PDF: Background
Transcranial Doppler(TCD), a safe non-invasive method, can evaluate cerebrovascular reac- tivity. Although the vascular theory has many controversies, the patients with migraine show the changes of cerebral blood flow, which seems to contribute the pathophysiology and development of the migraine. In this study, we investigated cerebraovascular reactivity to hypoventilation in migraineurs, and compared their findings with those of normal controls. Methods: According to International Headache Society criteria and a headache paperweight, a total of 46 subjects, including 23 migraineurs and 23 controls were studied. The doppler signals from the middle cerebral artery(MCA) and posterior cerebral artery(PCA) at a depth of 6.0cm and 7.2cm were selected for the evaluation. After the resting baseline mean flow velocities(mFVs) were obtained, all subjects were instructed to hyperventilate for at least 2 minutes, to obtain the mFV in hyperventilation. Then, the subjects were allowed to breathe normally, and returning to the baseline mFV was confirmed. After mean flow velocities(mFVs) as a baseline were obtained, all subjects were instructed to hold breath al least for 30 seconds, and 3rd mFVs were recorded. Results: The significant differences in cerebrovascular reactivity of MCA between normal controls and migraineurs were observed during hypoventilation(40.64±13.20cm/sec vs. 56.58±11.50cm/sec, p<0.01 on Mann-Whitney test). The differences of cerebrovascular reactivity of PCA between normal controls and migraine groups were not significant. Conclusion: The cerebrovascular reactivity(CVR) of MCA in migraineurs was more increased than that in normal controls. Our studies suggest that vasoreactivity to hypoventilation measured by TCD can be an aid for the understanding of the pathophysiology of the migraine and the differentiation from normal subjects. Korean Journal of Headache 6(1):82-88, 2005

만성 두통 환자에서 뇌 자기공명영상의 소견: Ho Won Lee, Sung Pa Park; Korean J Headache. 2005;6(1):89-94. Published online June 30, 2005

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Abstract PDF: Background
Chronic headache is one of the most common symptoms in neurological outpatient clinic. It had low likelihood for discovering significant disease to evaluate chronic headache patients with normal neurological examinations by magnetic resonance imaging(MRI) because previous studies considered silent brain infarct(SBI) as not significant lesion. We investigated the incidence of abnormal findings including SBI in MRI of the brain for the patients who have normal neurological examinations. Methods: We retrospectively reviewed the medical records and MR images of 455 patients with chronic headache between January 2001 and December 2002. Only 212 patients with normal neurological examinations were included in this study. Results: The patients were diagnosed as having tension type headache(76.9%), migraine(25.6%), and atypical type headache(6.1%). Clinical significant abnormalities on MRI were found in 29 patients(13.7 %) which were silent infarct, tumor, AVM and aneurysm. The most common abnormalities on MRI was SBI(n=19, 66.5%). We found that SBI on MRI was related to heart disease, hypertension, and types of chronic headache. Conclusion: These results indicate that patients with chronic headache have higher risk of SBI which may be independent risk factor for symptomatic brain infarcts. Korean Journal of Headache 6(1):89-94, 2005

일반연제-Epidemiology of Headache Disorders in Korea 2004: Chin-Sang Chung, Hyung In Cho, Ki-Young Jung, Hui-Soo Moon, Kyung-Mi Oh, Tae Hoon Kim , Hwan Ho Ha; Korean J Headache. 2005;6(1):101-101. Published online June 30, 2005

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Abstract PDF: Background
There have been only a few epidemiologic studies on migraine in Korea. In Asian count- ries Korea is one of the blank spots on the migraine map. No official data have been reported in Korea. This study is the first Korean government-supported project that surveyed the headache disorders in Korea. Objectives: To investigate the 1-year prevalence of migraine in Korea using the new operational diagnostic criteria of the International Classification of Headache Disorder 2004(ICHD-II) proposed by the International Headache Society(IHS). Methods: A door-to-door survey of headache was conducted by personal face-to-face interviews among the people aged between 15 and 65 years in the Korea except the Cheju island during October 2004. Stra- tified systematic household sampling was performed and the subjects were recruited from 2,038 house- holds. In this study a standardized questionnaire and a diagnostic algorithm applied by lay interviewers were used as the method of data collection. The algorithm was based on the diagnostic criteria of the ICHD-II. This study was supported by a grant of the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea(A020163). Results: The life-time prevalence of headache in Koreans was 31.4%(640/2038, M 27.6%, F 35.3%). The sex- and age-specific 1-year prevalence rate of headache was 21.5%(M 17.1%, F 26.1%). The point prevalence of headache suffering at the time of interview was 12.0%(245/2,038). The 1-year prevalence of migraine was 12.0%(M 9.3%, F 14.7%). The peak prevalence rate was observed in the 30s of age in both genders(M 11.3%, F 16.0%). Another minor peak prevalence was observed in the 50s of age in women but not in men. Conclusions: We conclude that the prevalence rate of migraine in Korea is quite comparable to that observed in other countries except the presence of second minor peak in the 50s in women. Further studies are necessary to elucidate the satisfaction with treatment and overall effectiveness of the medical care system in Korea.

일반연제-Photophobia in Korean Patients with Migraine: Kyungmi Oh, Byung-Kun Kim, Byung-Jo Kim, Jin-Kyu Han, Kun-Woo Park , Dae-Hie Lee; Korean J Headache. 2005;6(1):102-102. Published online June 30, 2005

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Abstract PDF: Background
Although photophobia is a main component of migraine classification and ID-migraine, previous literature reported lower incidence rate(about 40%) in Korean patients with migraine than inte- rnational studies with Caucasian patients Objectives: This study was performed to compare the photophobia incidence rate detected by simple interview in Korean migraineurs with that detected by a specific photophobia questionnaire. Methods: Seventy-four migraine patients with mean age of 39.8±17.36 years were enrolled in this study. After simple interview by a headache specialist, patients were asked to report the questionnaire, which is comprised of 8 items. Seven items are questions about various symptoms, avoidance and as a triggering factor related to light during migraine attacks, and one item is a question if the symptom occurs during interictal period. Results: A total of 40(54.1%) patients noted photophobia through the simple interview, and all of them reported 　yes　 to at least 1 item in the questionnaire. Fifty-three(85.1%) patients were revealed as having photophobia by the questionnaire. Of these 53 patients, 23 had same symptoms in headache-free period. Conclusion: Similar photophobia incidence with Caucasian was revealed by the questionnaire. The questionnaire may be used as sensitive method to help detect photophobia in Korean.

일반연제-Clinical Characteristics of Migraine and Tension-type Headache: The Experience in Eulji Hospital: Byung-Kun Kim, Hee-Jun Bae, Ja-Seong Koo, Oh-Hyun Kwon , Jong-Moo Park; Korean J Headache. 2005;6(1):103-103. Published online June 30, 2005

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Abstract PDF: Objectives
To analyze the epidemiological and clinical characteristics of migraine and tension-type headache(TTH) in secondary general hospital. Methods: Between January 2004 and April 2005, 625 patients(age, mean=42.7 years, ranging from 14 to 79 years; 454 women and 171men), who presented with headache as chief complaints, were recruited prospec- tively. Information on epidemiological and clinical characteristics was collected from the structured questionnaire and registry. The criteria defined by the International Headache Society were used in the diagnosis. A total of 95% of the patients had primary headache: migraine(26.9%, mean age±SD=36.0±11.4 years, 148 women and 20 men), probable migraine(5.1%), episodic TTH(21.3% mean age±SD=45.6±14.2 years, 89 women and 44 men), probable episodic TTH(6.6%), primary chronic daily headache which includes chronic migraine, chronic TTH, hemicrania continua, and new daily-persistent headache(19.4%), and other primary headache(15.7%). We analyze the clinical characteristics of migraine (except chronic migraine) and episodic TTH. Results: Sixteen patients(9.5%) of those with migraine had migraine with aura. The mean age at onset was 24.6±9.2 years in migraine and 37.9±14.5 years in TTH(p<0.05). Female sex was more prevalent in migraine (p<0.05). Migraine headaches were unilateral(57%), pulsating(52%), aggravated by physical activity(80%), and were accompanied by vomiting(58%), photophobia(70%), and phonophobia(76%). TTH were unilateral(55%), pulsating(18%), aggravated by physical activity(23%), and were occasionally accom- panied by photophobia(22%) and phonophobia(33%). The most frequently reported trigger factors for migraine were stress(82%), fatigue(72%), menstruation(36% of women), alcohol(30%), cold or hot weather(27%), missing a meal(24%), weekend(13%), overeating(12%), and food(7%). The most frequently reported trigger factors for TTH were stress(77%), fatigue (62%), missing a meal(20%), cold or hot weather(18%), alcohol(17%), menstruation(11% of women), overeating (8%), weekend(5%), and food(5%). Patients with migraine had a greater prevalence(p<0.05) of medication overuse history. Beck depression inventory score was not different between migraine(22.0±4.8) and TTH(23.4±5.8). Beck anxiety inventory score was significantly higher in TTH group(p<0.05). Sixty percent of migraineurs and 55% of patients with TTH reported receiving a physician diagnosis of headache. However, only 21% of migraineurs and 29% of patients with TTH received a diagnosis of their headache correctly. Sixty-five percent of misdiagnosed migraineurs reported a diagnosis of TTH. Thirty-one percent of misdiagnosed patients with TTH reported a diagnosis of migraine. Conclusions: Migraine and TTH are a common cause of recurrent headache in secondary general hos- pital. Stress and fatigue were most frequent triggering factors for both headache types. Prevalence of depression and unilaterality of headache is not different between two groups. Migraine most frequently misdiagnosed as TTH.

일반연제-Restless Leg Syndrome in Migraineurs- Hallym University Migraine in Nurses Study -: Min-Kyung Chu, Kyung-Ho Yu, Hyeo-Il Ma, Yoon Kim, Joo-Yong Kim, Su-Jin Cho, Cheol-Ho Kim, Hong-Ki Song , Byung-Chul Lee; Korean J Headache. 2005;6(1):104-104. Published online June 30, 2005

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Abstract PDF: Background
and Objectives: Restless leg syndrome(RLS) is a prevalent disease which is often mis- diagnosed or underdiagnosed. RLS and migraine share some clinical features such as depression, sleep disorders, hemodialysis and positive family history of the disease. We analyzed the data of Hallym uni- versity migraine in nurses study to identify the association of RLS and migraine. Method: All 1501 nurses working at Hallym Medical Center were asked 72-item questionnaire on migraine including general information, occupational environments and characteristics, characteristics of headache, triggering factors, management of headache and migraine related disabilities. The diagnosis of RLS was made according to 3-item question set which was incorporated in the above questionnaire. The completed questionnaires were analyzed for the association of RLS and migraine. Results: 1341(89.3%) participants completed the questionnaire. All were female with mean age of 27.5±5.7. Based on ICHD-II, 276(17.5%) had migraine. Among migraineurs, 57(20.6%) have aura. 23(1.7%) had RLS and 9(39.1%) of them had migraine. The prevalence of RLS was significantly higher among migraineurs(3.4%) than non-migraineurs(1.3%). Migraineurs with RLS had tendency to have more aura than migraineurs without RLS. There was no significant difference in attack frequency, headache severity and MIDAS scores between migraineurs with RLS and migraineurs without RLS. Conclusion: There was significantly higher prevalence of RLS among migraineurs. Migraine with RLS showed tendency to have more aura.

일반연제-Trigeminal Neuralgia After Linear Pontine Trigeminal Root Lesion: Seok-Beom Kwon, Sung-Hee Yun, Hee-Jung Suh, San-Jung, Sung-Hee Hwang , Byung-Chul Lee; Korean J Headache. 2005;6(1):105-105. Published online June 30, 2005

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Abstract PDF: Background
Various lesions affecting the trigeminal nerve entry zone may produce trigeminal neuralgia, and include tortuous vessels, aneurysms, arteriovenous malformations, and tumors. However, pontine in- farction or pontine multiple sclerosis(MS) lesion has not been well recognized as a cause of trigeminal neuralgia. Here we report two patients with a pontine lesion(ischemic or demyelinating) transecting the trigeminal pathways resulting with trigeminal neuralgia. These are very rare cases of unusual causes of trigeminal neuralgia. Case: A 55-year-old man presented with severe lacinating pain in the right V2 and V3 distributions. Magnetic resonance imaging of the brain demonstrated a small linear infarct at the root entry zone of the right trigeminal nerve in the pons. The other 30-year-old woman developed electric shocklike pain in the same distributions as a symptom of MS. Brain MRI showed multiple patchy cerebral lesions including right lateral portion of the pons. Conclusion: The mechanism for the trigeminal neuralgia due to pontine lesion may be increased neuronal activity in the trigeminal fascicles and nucleus. Our patients illustrate that the differential diag- nosis of trigeminal neuralgia should include pontine infarction or pontine MS lesion.

일반연제-Catechol-O-methyltransferase Gene polymorphism of Migraine Without Aura in Korean Population: Jeong Wook Park , Kwang Soo Lee; Korean J Headache. 2005;6(1):107-107. Published online June 30, 2005

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Abstract PDF: Background
Following the first clinical and pharmacological suggestion of altered dopaminergic neu- rotransmission in migraine, recent genetic association studies have addressed the possible genetic role of the dopaminergic system in migraine. COMT(Catechol-O-methyltransferase) is an enzyme which play a crucial role in the metabolism of dopamine. This genetic polymorphism is associated with 3～4 fold variation of enzymatic activity. So change in their activity could participated in migraine pathogenesis and its clinical phenotype. Objectives: We assessed the role of the COMT enzyme polymorphism in the genetic susceptibility to migraine and their phenotypical expression in Korean population. Methods: The 77 migraine without aura and 94 healthy volunteers were included in the study. The analysis of COMT polymorphism was performed using PCR. After amplifying COMT genes by PCR and assessed genotype and allele by restriction fragment length polymorphism(RFLP). Results: Result of chi-square statistical analysis indicated that the genotype frequency and allele distri- bution was not different between migraine without aura and control group. Compared to individuals with H/H genotype, migraineurs with L allele showed more severe pain intensity(p=0.001) and over represen- ted the associated nausea/vomiting symptom during migraine attack(94% vs 75%: p=0.031) compared those without L allele. Conclusion: Altered dopaminergic activity due to polymorphism of COMT gene may be one of the mechanisms involved in the contribution to the pain intensity of attack and dopamine related symptom although this polymorphism does not appear to be involved in a genetic predisposition to development of migraine without aura.

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