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Original Articles
- 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
- 495 View
- 7 Download
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Abstract
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.
- 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
- 7,925 View
- 191 Download
- 8 Citations
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Abstract
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
Citations to this article as recorded by
- 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
- One-Year Compliance After Calcitonin Gene-Related Peptide Monoclonal Antibody Therapy for Migraine Patients in a Real-World Setting: A Multicenter Cross-Sectional Study
- Driving Induced Neck Pain in a Patient with Retropharyngeal Calcific Tendinitis
- Yunju Choi, Seung-Han Lee
- Published online June 30, 2016
- 592 View
- 47 Download
- Spontaneous Chronic Subdural Hematoma Presenting as Migraine-like Headache
- Yunju Choi, Seung-Han Lee, Myeong-Kyu Kim
- Published online June 30, 2016
- 643 View
- 80 Download
- Headache Attributed to Calvarial Metastasis Presenting as Paroxysmal Hemicrania
- Deok-Sang Yoo, Yun-Ju Choi, Gwan-Yeol Cho, Seung-Han Lee, Myeong-Kyu Kim
- Published online June 30, 2013
- 1,035 View
- 67 Download
- 줄넘기에 의해 유발된 원발운동두통
- Yun-Ju Choi, Jae-Myung Kim, Seung-Han Lee, Myeong-Kyu Kim
- Published online December 31, 2012
- 1,515 View
- 117 Download
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Abstract
PDF
- Primary exertional headache(PEH) is brought on by prolonged physical exercise. Bilateral, severe, throbbing nature is most common feature of the PEH. Valsalva’s phenomenon and dilation of cerebral vasculatures seems to be a patho- mechanism of PEH. Jumping rope could evoke PEH due to this mechanism like swimming or previous known PEH- evoking exercises.
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