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Review Articles
- Vestibular Migraine: Challenges in Diagnosis and Management
- Byung-Kun Kim
- Received February 2, 2025 Accepted April 7, 2025 Published online June 11, 2025
- DOI: https://doi.org/10.62087/hpr.2025.0001 [Epub ahead of print]
- 429 View
- 18 Download
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Abstract
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.
- 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
- 455 View
- 20 Download
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Abstract
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- 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.
- Clinical Characteristics of Reversible Cerebral Vasoconstriction Syndrome: A Large Korean Multicenter Study
- Soohyun Cho, Byung-Kun Kim, Mi Ji Lee
- Published online December 31, 2022
- 373 View
- 48 Download
- Calcitonin Gene-Related Peptide Antibodies: New Era for Migraine Prophylaxis
- Byung-Kun Kim, Ph.D.
- Published online June 30, 2020
- 457 View
- 130 Download
- Diagnostic Delay of Cluster Headache in Korea
- Byung-Su Kim, Soo-Kyoung Kim, Pil-Wook Chung, Byung-Kun Kim, Mi Ji Lee, Min Kyung Chu, Jin-Young Ahn, Dae Woong Bae, Tae-Jin Song
- Published online June 30, 2020
- 538 View
- 154 Download
- Characteristic Image Findings In A Patient With Deep Cerebral Venous Thrombosis Presented With Headache And Cognitive Decline
- Jung-Ju Lee, Ohyun Kwon, Jong Moo Park, Kyusik Kang, Woong-Woo Lee, Jung Whan Yoon, Byung-Kun Kim
- Published online June 30, 2018
- 353 View
- 59 Download
- A Case of Superior Orbital Fissure Syndrome Attributed to Sinusitis Presenting Unilateral Throbbing Headache
- Byung-Su Kim, Byung-Kun Kim, Soo-Kyoung Kim, Jae-Moon Kim, Heui-Soo Moon, Kwang-Yeol Park, Jong-Hee Sohn, Tae-Jin Song, Min Kyung Chu, Myoung-Jin Cha, Soo-Jin Cho, J
- Published online December 31, 2017
- 531 View
- 111 Download
- The Frequency and Characteristics of Other Primary Headache Disorders in First-Visit Headache Patients in Korea: A Multicenter Study
- Myoung-Jin Cha, Byung-Kun Kim, Byung-Su Kim, Jong-Hee Sohn, Soo-Kyoung Kim, Heui-Soo Moon, Tae-Jin Song, Jae-Moon Kim, Jeong Wook Park, Min Kyung Chu, Kwang-Yeol Park
- Published online December 31, 2017
- 532 View
- 89 Download
- Acute Ischemic Stroke with Prominent Headache Symptom: A Case Series Study
- Jae-Hyeok Heo, Min-Uk Jang, Byung-Kun Kim, Jin-Young Ahn
- Published online December 31, 2016
- 398 View
- 63 Download
- The Influence of Initial Headache as a Prognostic factor in Spinal Cord Decompression Sickness
- Dong-Gyu Lim, Hee-Tae Kim, Byung-Kun Kim, Jin-Young Ahn
- Published online December 31, 2016
- 479 View
- 45 Download
- Aggravation by Routine Physical Activity and Associated Factors in the Korean Migraine Population
- Byung-Su Kim, Min Kyung Chu, Byung-Kun Kim, Jae-Moon Kim
- Published online June 30, 2015
- 1,015 View
- 181 Download
- 개연적 편두통과 편두통: 연속 질환 범주로서의 접근
- Gyoung Im Suh, Byung-Kun Kim, Min Kyung Chu, Soo-Jin Cho
- Published online December 31, 2012
- 778 View
- 133 Download
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Abstract
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- A considerable proportion of individuals suffering from headache were classified as probable migraine, which is fulfilling all but one criterion for migraine. In the continuum severity theory, the mild end is thought to be tension type headache which transform into migraine with increasing severity of condition and the gray zone of headache occupies the middle ground of the continuum. Because of dichotomous diagnostic criteria between migraine and tension type headache, the position of probable migraine also could be located at this gray zone.
- 한국인구집단에서 체질량지수와 편두통: Korean Headache Survey 자료 분석
- Soo Hwan Yim, Byung-Kun Kim, Kwang-Soo Lee, Kyungmi Oh, Min Kyung Chu
- Korean J Headache. 2012;13(1):7-12. Published online June 30, 2012
- 676 View
- 117 Download
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Abstract
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- Objective: Obesity and underweight are known to be exacerbating factors for migraine in Western countries. In Asian countries including Korea, migraine prevalence and body mass index (BMI) are often lower than Western countries. To investigate the relationship of BMI to the prevalence, frequency, duration and severity of migraine in Korea.
Methods
We selected a stratified random population sample of Koreans over age 18 and evaluated them with a 12-item semi-structured interview designed to identify headache type using ICHD-2 criteria. The participants were divided into 4 categories based on the World Health Organization BMI categories for Asian populations: underweight (<18.5), normal weight (18.5-22.9), overweight (23.0-24.9) and obese (≥25.0).
Results
Of 1,507 participants, 71 were underweight (4.8%), 768 had a normal BMI (51.3%), 326 were overweight (21.8%) and 330 were obese (22.1%). Prevalence varied by headache type for migraine (6.0%) and PM (11.5%). Migraine, prevalence did not vary with BMI, but migraine attack frequency per month was higher both in the underweight (8.6±9.1) and the obese groups (7.3±11.2) in comparison with the normal weighted (2.5±2.7). Duration of headache attack and pain intensity (VAS score) were not significantly different between these groups.
Conclusions
In Koreans, obesity and underweight are associated with migraine attack frequency.
- 한국인구집단에서 편두통환자의 냄새공포증과 편두통 대체진단기준의 타당도 평가
- Yeo Jin Kim, Soo-Jin Cho, Byung-Kun Kim, Kwang-Soo Lee, Byung-Chul Lee, Min Kyung Chu
- Korean J Headache. 2011;12(2):91-96. Published online December 31, 2011
- 1,079 View
- 60 Download
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Abstract
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- Objective: Osmophobia, intolerance to smell, is often reported by migraine patients during headache attack and is included as an item of alternative diagnostic criteria for migraine in the appendix of ICHD-2. Most of previous reports on osmo- phobia were hospital-based studies and osmphobia of migraineurs across population sample was not reported yet. The aims of this study are to assess osmophobia in migraineurs across Korean populationand to assess validity of alternative diagnostic criteria of migraine. Methods: We used data of Korean Headache Survey(KHS), a population-based study by a stratified random sampling in Korean population over age 19, and totally 1,507 were evaluated. Demographic profile, headache characteristics and impact of headache were assessed with a 12-item semi-structured interview. Headache type was identified according to ICHD-2. We assessed osmophobia by a question ‘Do you feel changes in your sense of smell during headache?(stronger or differently)’. Results: Prevalence for migraine was 6.1%. 50.5% of migraineurs reported osmophobia during migraine attack. Mig- raineurs with osmophobia had more headache aggravation by routine physical activity, phonophobia and higher HIT-6 score than migraineurs without osmophobia. There were no significant difference in unilaterality of pain, pain intensity in VAS score, pulsating quality and photophobia between migraineurs with osmophobia and migraineurs without osmo- phobia. The sensitivity of alternative criteria was 0.95[95% confidence interval(CI), 0.87-0.98] and specificity was 0.99(95% CI, 0.98-0.99). Conclusions: Approximately half of migraineurs across Korean population sample reported osmophobia. Alternative criteria showed good specificity and sensitivity.
- 원발벼락두통의 임상양상
- Jiyeon Kim, Byung-Kun Kim, Gun-Sei Oh, Jae Myun Chung, Kyungmi Oh, Jeong Wook Park, Soo-Jin Cho
- Korean J Headache. 2011;12(2):85-90. Published online December 31, 2011
- 1,689 View
- 148 Download
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Abstract
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- Objective: Thunderclap headache is a sign of a medical emergency such as a life-threatening subarachnoid hemorrhage (SAH). However, it also may occur in primary headache conditions such as cough, physical exertion, sexual activity and even without any provoking factors. International Headache Society classified thunderclap headache disorders into four different subtypes: (1) primary thunderclap headache(PTH); (2) primary cough headache(PCH); (3) primary exertional headache (PEH); and (4) primary headache associated with sexual activity(PSH). Subtypes of thunderclap headaches are reported to share many common characteristics, although studies on the clinical features and triggering factors of thunderclap headaches are limited. Methods: Seventy and two patients with thunderclap headache were prospectively enrolled from March 2008 to June 2010. The patients presented sudden severe headaches, reaching maximal intensity within 1 minute, without focal neu- rologic deficit. SAH and other organic disorders were excluded in this study. We described clinical features, triggering factors and vasospasm, and compared between the four subtypes of thunderclap headache. Results: Of the 72 recruited patients, PTH(n=25, 34.7%) was the most frequent thunderclap headache subtype, followed by PCH(n=23, 31.9%), PSH(n=15, 20.1%) and PEH(n=9, 12.5%). 49(68.1%) patients suffered recurrent thunderclap head- ache attacks at presentation. 49(68.1%) patients had more than one provoking factor. Defecation(n=13, 16.0%) was the most frequent provoking factor followed by sexual intercourse(n=11, 13.7%). Mean age was 45.1±12.6 years(range: 15-70). PEH group (36.6 years old) was younger than other groups. Overall male to female ratio in this study was 1:1.7. Mean duration of headache was 40.7±56.3 minutes(range: 0.17-720). The headache duration was shorter in PEH(25.2±14.2 minutes) than other groups. Vasospasm was documented in 10 patients(13.9%). Conclusions: More than two-thirds of patients with thunderclap headache have more than one provoking factor at presentation. Contrary to the previous studies, vasospasm was associated in small proportion of patients.
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