Headache and Pain Research

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

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Abstract PDF Supplementary 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.

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

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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.

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Toward Precision Migraine Care: Genetics, Symptoms, and Big-Data-Driven Approaches
Soo-Jin Cho
Headache and Pain Research.2025; 26(3): 171. 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

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Abstract 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.

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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

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

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Abstract 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.

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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

Sleep Disorders in Headache Patients: Hye Jeong Lee, Hee-Jin Im, Soo-Jin Cho, Min Kyung Chu; Korean J Headache. 2023;24(1):1-10. Published online June 30, 2023

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Abstract PDF: Headache disorders and sleep problems are common conditions with a high prevalence in the general population, and impose a considerable socio-economic burden. They show a close association with headache disorders through various relationship. The prevalence of sleep problems is elevated in individuals with headache, especially for migraine. In most headache disorders, sleep problems are accompanied by the deterioration of clinical characteristics of headache disorders. The sharing brain structures and neurotransmitters involved in the pathogenesis of headache disorders and sleep disorders may be an explanation for the close relationship between two disorders. In this article, we briefly review the relationship of headache disorders with sleep disorders including insomnia, sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders, parasomnias, and sleep related movement disorders.

Comorbid Medical Conditions in Patients with Medication Overuse Headache: Multicenter Prospective Medication Overuse Headache Registry Analysis: Yooha Hong, Soo-Jin Cho, Min Kyung Chu, Sun-Young Oh, Heui-Soo Moon, Tae-Jin Song, Mi Ji Lee, Jin-Ju Kang, Hong-Kyun Park; Published online December 31, 2021

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Abstract PDF: 약물과용두통 환자에서 동반 이환되는 내과적 문제: 국내 다기관 전향적 약물과용두통 등록체계

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

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Abstract PDF: 국내 군발두통의 진단지연

Cluster-like Headache in a Patient with Border-zone Infarction and Internal Carotid Artery Stenosis: Ki-Moon Jang, Hye-jeong Lee, Seo-yeon Gwak, Min Kyung Chu; Published online December 31, 2019

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Abstract PDF: 경계구역 뇌경색과 경동맥 협착이 동반된 환자에서 나타난 군발유사두통

Does Caffeine Trigger Migraine Attack? A Smartphone Headache Diary Study: Hyun Suk Kim, Kee Hwan Pae, Dong Jin Shin, Hyeon Mi Park, Seok Hong Choi, Hyun Joon Lee, Du Hwan Kim, Jae Hoon Chung, Sung Jong Eun, Min Kyung Chu, Dong Hoon Shin; Published online December 31, 2019

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Abstract PDF: 카페인 섭취가 편두통을 유발하는가? 스마트폰 두통일기를 이용한 연구

A Case of Spontaneous Intracranial Hypotension Presenting Normal Cerebrospinal Fluid Pressure: Bo Kyu Choi, Jae Wook Jung, Han Kyu Na, Tae Won Kim, Min Kyung Chu; Published online December 31, 2019

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Abstract PDF: 정상 뇌척수압을 보인 자발두개내저압 1례

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

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Abstract PDF: 두통 초진 환자에서 이차두통의 임상적 예측인자: 다기관 연구

The Frequency and Characteristics of Other Primary Headache Disorders in First-Visit Headache Patients in Korea: A Multicenter Study: 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

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Abstract PDF: 신경과 외래를 방문한 두통 초진 환자에서 기타 원발두통의 빈도와 특징 - 다기관 연구

A Case of Short-lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing (SUNCT) which Showed a Favorable Response with Rregabalin: Bohm Choi, Myung Jin Son, Donggook Kang, Min Kyung Chu; Published online June 30, 2016

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Abstract PDF: 프레가발린에 효과적으로 반응한 단기지속편측신경통형두통 발작 1례

Clinical Factors Influencing Headache Impact Test-6 in Migraine and Tension-type Headache Patients: Jong Hee Sohn, Min Kyung Chu, Soo-Jin Cho; Published online December 31, 2015

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Abstract PDF: 편두통과 긴장형두통 환자에서 HIT-6에 영향을 미치는 임상 요인

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

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Abstract PDF: 한국인 편두통 인구에서 일상신체활동에 의한 두통의 악화와 관련 인자

The Prevalence and Associated Clinical Factors of Dizziness in Migraine and Tension-type Headache - Preliminary Study: Jong Hee Sohn, Min Kyung Chu, Soo-Jin Cho; Published online December 31, 2014

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Abstract PDF: 편두통과 긴장형두통 환자에서 어지럼 동반 빈도와 관련된 임상요인-예비 연구

Physical Activity in Migraine and Tension-type Headache: Si-Won Eum, Min Kyung Chu, Jong Hee Sohn, Min-Woo Koo, Soo-Jin Cho; Published online June 30, 2014

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Abstract PDF: 편두통, 긴장형두통과 신체활동

Clinical Characteristics of Migraine Subjects with Nausea and Vomiting:An Analysis of Data from the Korean Headache Survey: Byung-Su Kim, Chin-Sang Chung, Chung-Bin Lee, Min Kyung Chu; Published online December 31, 2013

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Abstract PDF: 구역, 구토를 가진 편두통 환자의 임상적 특성: Korean Headache Survey 자료 분석

A Preliminary Study of Compliance and Satisfaction to Headache Diary in the Patients with Migraine: Kee-Hoon Choi, Suk Yun Kang, Joo Yong Kim, Ki-Han Kwon, Min Kyung Chu, Soo-Jin Cho; Published online June 30, 2013

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Abstract PDF: A Preliminary Study of Compliance and Satisfaction to Headache Diary in the Patients with Migraine

개연적 편두통과 편두통: 연속 질환 범주로서의 접근: Gyoung Im Suh, Byung-Kun Kim, Min Kyung Chu, Soo-Jin Cho; Published online December 31, 2012

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Abstract PDF: 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

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Abstract PDF: 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

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Abstract PDF: 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.

한국인 인구집단에서 교육수준이 긴장형두통의 유병률에 미치는 영향: Dong-Won Lee, Yang-Ki Minn, Min Kyung Chu, Kyung-Mi Oh, Byung-Kun Kim, Kwang Soo Lee, Soo-Jin Cho; Korean J Headache. 2011;12(1):57-60. Published online June 30, 2011

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Abstract PDF: Objective: Education reflects socioeconomic status and may influence pain modulation or thresholds in primary headache disorders. Tension-type headache(TTH) is the most common type of primary headache and the influence of education on the prevalence of TTH has not been well evaluated. The aims of this study were to evaluate the asso- ciation between education level and the prevalence of TTH and the influence of other contributors. Methods: For this study, a stratified random population sample of Koreans, over the age of 19, was selected and evalua- ted using a 12-item, semi-structured interview designed to identify headache type using ICHD-2 criteria. Education levels were classified into college, high school, and middle school or below. Household income and occupation were evaluated as contributors. Results: Among 1507 participants, 463(30.7%) were diagnosed with TTH; 228 were frequent episodic TTH, 224 were infrequent episodic TTH, and 11 were chronic TTH. College level was associated with a lower prevalence of tension-type headache(25.8% vs 33.8% in high school, 32.9% in middle school or below, p=0.006). Prevalence of frequent episodic TTH was lower in college graduate(p=0.002). After adjusting age, gender, and income, education level is the significant contributor for prevalence of TTH. Conclusions: Among variables of socioeconomic status, education is the important modulator of TTH, especially in women.

한국인 인구집단에서 고빈도 삽화성 긴장형두통의 영향: Soo-Jin Cho, Min Kyung Chu, Byung-Kun Kim, Jae-Myun Chung, Kwang Soo Lee; Korean J Headache. 2010;11(2):91-94. Published online December 31, 2010

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Abstract PDF: Background
Frequent episodic tension-type headache (ETTH) is a subtype of tension-type headache (TTH) based upon ICHD-2 criteria. ETTH is generally considered as mild primary headache disorder but the impact of frequent ETTH has not been evaluated separately from infrequent ETTH. Therefore, this study evaluated the impact of frequent ETTH. Method: For this study, a stratified random population sample of Koreans, over the age of 19, was selected and evaluated using a 12-item, semi-structured interview designed to identify headache type using ICHD-2 criteria. The burden of the headache was evaluated by the headache impact test-6 (HIT-6). Results: Among 1507 participants, 463 (30.7%) were diagnosed with TTH; 228 were diagnosed with frequent ETTH, 224 were infrequent ETTH, and 11 were chronic TTH. Thirty-two patients (6.9%) with TTH had substantial to severe impact in HIT-6 (≥56); 22 had frequent ETTH, 7 had infrequent TTH, and 3 had chronic TTH (p<0.01). Frequent TTH, severity of pain by visual analogue scales, aggravation with physical activity, moderate or severe intensity, and phonophobia influenced on total scores of HIT-6. Conclusion: Frequent ETTH is a common headache disorder and had significant impact, so medical and social attentions are promptly needed.

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