Publications by authors named "Jae Moon Kim"

62 Publications

Treatments for Convulsive and Nonconvulsive Status Epilepticus in Adults: An Expert Opinion Survey in South Korea.

J Clin Neurol 2021 Jan;17(1):20-25

Department of Neurology, Chungnam National University Hospital, Daejeon, Korea.

Background And Purpose: The aim of this study was to survey the expert opinions on treatments for convulsive status epilepticus (CSE) and nonconvulsive status epilepticus (NCSE) in adults.

Methods: Forty-two South Korean epileptologists participated in this survey. They completed an online questionnaire regarding various patient scenarios and evaluated the appropriateness of medications used to treat CSE and NCSE.

Results: Initial treatment with a benzodiazepine (BZD) followed by either a second BZD or an antiepileptic drug (AED) monotherapy was the preferred treatment strategy. More than two-thirds of the experts used a second BZD when the first one failed, and consensus was reached for 84.8% of the survey items. The preferred BZD was intravenous (IV) lorazepam for the initial treatment of status epilepticus. IV fosphenytoin and IV levetiracetam were chosen for AED monotherapy after the failure of BZD. The treatments for NCSE were similar to those for CSE. Continuous IV midazolam infusion was the treatment of choice for iatrogenic coma in refractory CSE, but other AEDs were preferred over iatrogenic coma in refractory NCSE.

Conclusions: The results of this survey are consistent with previous guidelines, and can be cautiously applied in clinical practice when treating patients with CSE or NCSE.
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http://dx.doi.org/10.3988/jcn.2021.17.1.20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7840316PMC
January 2021

Antiepileptic Drug Therapy for Status Epilepticus.

J Clin Neurol 2021 Jan;17(1):11-19

Department of Neurology, Keimyung University School of Medicine, Daegu, Korea.

Status epilepticus (SE) is one of the most serious neurologic emergencies. SE is a condition that encompasses a broad range of semiologic subtypes and heterogeneous etiologies. The treatment of SE primarily involves the management of the underlying etiology and the use of antiepileptic drug therapy to rapidly terminate seizure activities. The Drug Committee of the Korean Epilepsy Society performed a review of existing guidelines and literature with the aim of providing practical recommendations for antiepileptic drug therapy. This article is one of a series of review articles by the Drug Committee and it summarizes staged antiepileptic drug therapy for SE. While evidence of good quality supports the use of benzodiazepines as the first-line treatment of SE, such evidence informing the administration of second- or third-line treatments is lacking; hence, the recommendations presented herein concerning the treatment of established and refractory SE are based on case series and expert opinions. The choice of antiepileptic drugs in each stage should consider the characteristics and circumstances of each patient, as well as their estimated benefit and risk to them. In tandem with the antiepileptic drug therapy, careful searching for and treatment of the underlying etiology are required.
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http://dx.doi.org/10.3988/jcn.2021.17.1.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7840311PMC
January 2021

Clinical characteristics of pre-attack symptoms in cluster headache: A large series of Korean patients.

Cephalalgia 2021 Feb 21;41(2):227-236. Epub 2020 Oct 21.

Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea.

Background: Previous studies have reported notable differences in demographic and clinical features of cluster headache between Western and Asian populations, including lower prevalence of the chronic type and in women. Recently, prodromal symptoms of migraine and pre-attack symptoms of cluster headache have drawn attention regarding their potential pathophysiological implications and pre-emptive treatment. However, pre-attack symptoms of cluster headache have not been studied in the Asian population.

Methods: A total of 136 patients with cluster headache (21 first-onset, 110 episodic, and five chronic cases) were recruited in this multi-center study between October 2018 and December 2019. We evaluated the characteristics of pre-attack symptoms in a current bout using a structured questionnaire. Univariable and multivariable logistic regression analyses were performed to evaluate the factors associated with presence of pre-attack symptoms.

Results: Pre-attack symptoms were reported in 71.3% of our patients with cluster headache. When present, pre-attack symptoms occurred at a median of 20 minutes (range 1-120) before the attack. The prevalence of local and painful, local and painless sensory, autonomic, and general symptoms was 58.8%, 14.7%, 11.0%, and 30.1%, respectively. Multivariable logistic regression analysis revealed that higher number of bouts was associated with higher prevalence of pre-attack symptoms (OR = 1.464,  = 0.044).

Conclusions: Pre-attack symptoms were frequently observed in Korean patients with cluster headache, which was consistent with previous Western studies.
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http://dx.doi.org/10.1177/0333102420966983DOI Listing
February 2021

The impact of remission and coexisting migraine on anxiety and depression in cluster headache.

J Headache Pain 2020 May 29;21(1):58. Epub 2020 May 29.

Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Keun Jae Bong-gil 7, Hwaseong, Gyeonggi-do, 18450, South Korea.

Background: Our aim was to investigate the relationship between coexisting cluster headache (CH) and migraine with anxiety and depression during active cluster bouts, and how symptoms change during remission.

Methods: We analyzed data from 222 consecutive CH patients and 99 age- and sex-matched controls using a prospective multicenter registry. Anxiety or depression was evaluated using the Generalized Anxiety Disorder-7 (GAD-7) or Patient Health Questionnaire-9 (PHQ-9), respectively. Moderate-to-severe anxiety or depression was defined as a score of ≥10 at baseline (during a cluster bout). We assessed for changes in anxiety and depression during CH remission periods.

Results: Among the CH patients, the prevalence of moderate-to-severe anxiety and depression was seen in 38.2% and 34.6%, respectively. Compared with controls, CH patients were associated with moderate-to-severe anxiety and depression (multivariable-adjusted odds ratio [aOR] = 7.32, 95% confidence intervals [CI] = 3.35-15.99 and aOR = 4.95, 95% CI = 2.32-10.57, respectively). CH patients with migraine were significantly more likely to have moderate-to-severe anxiety and depression (aOR = 32.53, 95% CI = 6.63-159.64 and aOR = 16.88, 95% CI = 4.16-68.38, respectively), compared to controls without migraine. The GAD-7 and PHQ-9 scores were significantly reduced between cluster bout and remission periods (from 6.8 ± 5.6 to 1.6 ± 2.8; P < 0.001, and from 6.1 ± 5.0 to 1.8 ± 2.4; P < 0.001, respectively).

Conclusions: Our results indicate that CH patients are at increased risk of anxiety and depression, especially in the presence of coexisting migraine. However, the anxiety and depression can improve during remission periods.
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http://dx.doi.org/10.1186/s10194-020-01120-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7257141PMC
May 2020

Factors Associated with Incidental Neuroimaging Abnormalities in New Primary Headache Patients.

J Clin Neurol 2020 Apr;16(2):222-229

Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.

Background And Purpose: Deciding whether or not to perform neuroimaging in primary headache is a dilemma for headache physicians. The aim of this study was to identify clinical predictors of incidental neuroimaging abnormalities in new patients with primary headache disorders.

Methods: This cross-sectional study was based on a prospective multicenter headache registry, and it classified 1,627 consecutive first-visit headache patients according to the third edition (beta version) of the International Classification of Headache Disorders (ICHD-3β). Primary headache patients who underwent neuroimaging were finally enrolled in the analysis. Serious intracranial pathology was defined as serious neuroimaging abnormalities with a high degree of medical urgency. Univariable and multivariable logistic regression analyses were conducted to identify factors associated with incidental neuroimaging abnormalities.

Results: Neuroimaging abnormalities were present in 170 (18.3%) of 927 eligible patients. In multivariable analysis, age ≥40 years [multivariable-adjusted odds ratio (aOR)=3.37, 95% CI=2.07-6.83], male sex (aOR=1.61, 95% CI=1.12-2.32), and age ≥50 years at headache onset (aOR=1.86, 95% CI=1.24-2.78) were associated with neuroimaging abnormalities. In univariable analyses, age ≥40 years was the only independent variable associated with serious neuroimaging abnormalities (OR=3.37, 95% CI=1.17-9.66), which were found in 34 patients (3.6%). These associations did not change after further adjustment for neuroimaging modality.

Conclusions: Incidental neuroimaging abnormalities were common and varied in a primary headache diagnosis. A small proportion of the patients incidentally had serious neuroimaging abnormalities, and they were predicted by age ≥40 years. These findings can be used to guide the performing of neuroimaging in primary headache disorders.
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http://dx.doi.org/10.3988/jcn.2020.16.2.222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7174120PMC
April 2020

Treatment of epilepsy in adults: Expert opinion in South Korea.

Epilepsy Behav 2020 04 9;105:106942. Epub 2020 Mar 9.

Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea. Electronic address:

Objective: The aim of this study was to gather the expert opinions of Korean epileptologists regarding the treatment of adult patients with epilepsy.

Methods: A total of 42 neurologists who specialized in epilepsy were surveyed. They completed an online questionnaire describing multiple patient scenarios. Using these scenarios, they evaluated treatment strategies and gave their preference for specific antiepileptic drugs (AEDs) used to treat genetically mediated generalized epilepsy and focal epilepsy.

Results: Initial AED monotherapy, followed by a second form of alternative monotherapy or an add-on combination therapy, was the preferred treatment strategy. The experts reached consensus for 87.2% of the items. The most commonly selected AEDs for the initial monotherapy for patients with generalized epilepsy were levetiracetam or valproate. For those with focal epilepsy, levetiracetam, oxcarbazepine, or lamotrigine were the most popular selections. Ethosuximide was the treatment of choice only for patients with generalized epilepsy with prominent absence seizures. Levetiracetam was preferred as an add-on therapy for both generalized and focal epilepsy. For special populations of patients, such as elderly adults or those with comorbid diseases, levetiracetam or lamotrigine was selected as the treatment of choice.

Conclusion: Most of the survey results were in accordance with the US expert opinion survey published in 2016. This survey can assist clinicians in making clinical decisions when treating individual adult patients with epilepsy.
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http://dx.doi.org/10.1016/j.yebeh.2020.106942DOI Listing
April 2020

Clinical features of chronic cluster headache based on the third edition of the International Classification of Headache Disorders: A prospective multicentre study.

PLoS One 2019 26;14(8):e0221155. Epub 2019 Aug 26.

Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

The criterion for the remission period of chronic cluster headache (CCH) was recently revised from < 1 month to < 3 months in the third edition of the International Classification of Headache Disorders (ICHD-3). However, information on the clinical features of CCH based on the ICHD-3 criteria is currently limited. The present study aimed to investigate the clinical features of CCH based on ICHD-3 using data from the Korean Cluster Headache Registry (KCHR). The KCHR is a multicentre prospective registry of patients with cluster headache (CH) from 15 hospitals. Among the 250 participants with CH, 12 and 176 participants were classified as having CCH and episodic cluster headache (ECH), respectively. Among 12 participants with CCH, 6 (50%) had remission periods of < 1 month, and the remaining 6 (50%) had a remission period of 1-3 months. Six participants had CCH from the time of onset of CH, and in the other 6 participants, CCH evolved from ECH. CCH subjects had later age of onset of CH, developed the condition after a longer interval after CH onset, and had more migraine and less nasal congestion and/or rhinorrhoea than ECH subjects. Clinical features of CCH with remission periods < 1 month were not significantly different from those of CCH with remission periods of 1-3 months, except for the total number of bouts. More current smoking and less diurnal rhythmicity were observed in participants with CCH evolved from ECH compared to those with ECH. In conclusion, the number of subjects with CCH doubled when the revised ICHD-3 criteria were used. Most of clinical characteristics of CCH did not differ when the previous and current version of ICHD was applied and compared. Some clinical features of CCH were different from those of ECH, and smoking may have a role in CH chronification.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0221155PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709915PMC
March 2020

Differences in Characteristics and Comorbidity of Cluster Headache According to the Presence of Migraine.

J Clin Neurol 2019 Jul;15(3):334-338

Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.

Background And Purpose: Cluster headache (CH) can present with migrainous symptoms such as nausea, photophobia, and phonophobia. In addition, an overlap between CH and migraine has been reported. This study aimed to determine the differences in the characteristics of CH according to the presence of comorbid migraine.

Methods: This study was performed using data from a prospective multicenter registry study of CH involving 16 headache clinics. CH and migraine were diagnosed by headache specialists at each hospital based on third edition of the International Classification of Headache Disorders (ICHD-3). We interviewed patients with comorbid migraine to obtain detailed information about migraine. The characteristics and psychological comorbidities of CH were compared between patients with and without comorbid migraine.

Results: Thirty (15.6%) of 192 patients with CH had comorbid migraine, comprising 18 with migraine without aura, 1 with migraine with aura, 3 with chronic migraine, and 8 with probable migraine. Compared to patients with CH without migraine, patients with CH with comorbid migraine had a shorter duration of CH after the first episode [5.4±7.4 vs. 9.0±8.2 years (mean±standard deviation), =0.008], a lower frequency of episodic CH (50.0% vs. 73.5%, =0.010), and a higher frequency of chronic CH (13.3% vs. 3.7%, =0.033). Psychiatric comorbidities did not differ between patients with and without comorbid migraine. The headaches experienced by patients could be distinguished based on their trigeminal autonomic symptoms, pulsating character, severity, and pain location.

Conclusions: Distinct characteristics of CH remained unchanged in patients with comorbid migraine with the exception of an increased frequency of chronic CH. The most appropriate management of CH requires clinicians to check the history of preceding migraine, particularly in cases of chronic CH.
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http://dx.doi.org/10.3988/jcn.2019.15.3.334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6620459PMC
July 2019

Field testing the diagnostic criteria of cluster headache in the third edition of the International Classification of Headache Disorders: A cross-sectional multicentre study.

Cephalalgia 2019 06 11;39(7):900-907. Epub 2019 Mar 11.

17 Department of Neurology, Severance Hospital, Yonsei University School of Medicine, Seoul, Korea.

Background: *These authors are shared first authors. The recently published third edition of the International Classification of Headache Disorders (ICHD-3) revised the criteria for accompanying symptoms of cluster headache (CH) and the remission period of chronic cluster headache (CCH). This study aimed at testing the validity of the ICHD-3 criteria for CH by using data from the Korean Cluster Headache Registry.

Methods: Consecutive patients with CH and probable cluster headache (PCH) were prospectively recruited from 15 hospitals. We analysed the validity of the revised ICHD-3 criteria for CH against the beta version of the third edition of the ICHD (ICHD-3β).

Results: In total, 193 patients were enrolled: 140 (72.5%), 5 (2.6%) and 22 (11.4%) had episodic cluster headache (ECH), CCH, and PCH, respectively. The remaining 26 (13.5%) had CH with undetermined remission periods. One patient with ECH and one with PCH had only forehead and facial flushing and were diagnosed with PCH and non-cluster headache, respectively, according to the ICHD-3. Four participants with ECH according to the ICHD-3β had remission periods of > 1 month and between 1 and 3 months and were newly diagnosed with CCH according to the ICHD-3.

Conclusion: The change from ICHD-3β to ICHD-3 resulted in few differences in the diagnoses of CH and PCH.
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http://dx.doi.org/10.1177/0333102419837159DOI Listing
June 2019

Associations of Elderly Onset Headache With Occurrence of Poor Functional Outcome, Cardiovascular Disease, and Cognitive Dysfunction During Long-term Follow-up.

Ann Geriatr Med Res 2018 Dec 31;22(4):176-183. Epub 2018 Dec 31.

Department of Neurology, Ewha Womans University College of Medicine, Seoul, Korea.

Background: Although the frequency and intensity of headaches decrease in older adults, headaches in this population are still an important neurological disorder. The purpose of this study was to investigate the associations of headache characteristics in older adults with the development of cardiovascular disease and cognitive dysfunction.

Methods: We prospectively enrolled 125 older (≥65 years old) patients with headache who were making their first visit to outpatient clinics and who had no prior history of cognitive dysfunction from 11 hospitals in Korea between August 2014 and February 2015. We investigated the occurrence of newly developed/or recurrent headache, cardiovascular disease, cognitive dysfunction, and poor functional outcomes.

Results: The mean age of all included patients was 72.6 years, 68.8% were women, and 43 (34.4%) had newly developed/or recurrent headache during follow-up. During a median follow-up of 31 months (interquartile range, 28-34 months), 21 participants (16.8%) experienced cardiovascular disease, and 26 (20.8%) developed cognitive dysfunction. Upon multivariate analysis and after adjusting for sex, age, and other factors, presence of newly developed/or recurrent headache was found to be associated with cardiovascular disease (hazard ratio [HR], 4.03; 95% confidence interval [CI], 1.28-12.61; p=0.017) and frequency of headache for the recent 3 months was related with cognitive dysfunction (HR, 1.05; 95% CI, 1.00-1.09; p=0.017) and poor functional outcomes (HR, 1.06; 95% CI, 1.01-1.11; p=0.011).

Conclusion: Our study demonstrated that there is an increased risk of cardiovascular disease, cognitive dysfunction, and poor functional outcomes in older patients with frequent, newly developed, or recurrent headache.
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http://dx.doi.org/10.4235/agmr.18.0032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387621PMC
December 2018

Unblinded, randomized multicenter trial comparing lamotrigine and valproate combination with controlled-release carbamazepine monotherapy as initial drug regimen in untreated epilepsy.

Seizure 2018 Feb 29;55:17-24. Epub 2017 Dec 29.

Clinical Trial Center, Yonsei University Health System, Severance Hospital, Seoul, Korea.

Purpose: To compare controlled-release carbamazepine monotherapy (CBZ-CR) with lamotrigine and valproate combination therapy (LTG + VPA) in equivalent total drug load, as initial drug regimen in untreated patients with partial and/or generalized tonic-clonic seizures (GTCS).

Methods: This unblinded, randomized, 60-week superiority trial recruited patients having two or more unprovoked seizures with at least one seizure during previous three months. After randomization into CBZ-CR or LTG + VPA, patients entered into eight-week titration phase (TP), followed by 52-week maintenance phase (MP). Median doses of CBZ-CR and LTG + VPA were 600 mg/day and 75 mg/day + 500 mg/day, respectively. Primary outcome measure was completion rate (CR), a proportion of patients who have completed the 60-week study as planned. Secondary efficacy measures included seizure-free rate (SFR) for 52-week of MP and time to first seizure (TTFS) during MP.

Results: Among 207 randomized patients, 202 underwent outcome analysis (104 in CBZ-CR, 98 in LTG + VPA). CR was 62.5% in CBZ-CR and 65.3% in LTG + VPA (p = 0.678). SFR during MP was higher in LTG + VPA (64.1%) than CBZ-CR (47.8%) (P = 0.034). TTFS was shorter with CBZ-CR (p = 0.041). Incidence of adverse effects (AEs) were 57.7% in CBZ-CR and 60.2% in LTG + VPA and premature drug withdrawal rates due to AEs were 12.5% and 7.1%, respectively, which were not significantly different.

Conclusion: CR was comparable between LTG + VPA and CBZ-CR, however, both SFR for 52-week MP and TTFS during MP were in favor of LTG + VPA than CBZ-CR. The study suggested that LTG + VPA can be an option as initial drug regimen for untreated patients with partial seizures and/or GTCS except for women of reproductive age.
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http://dx.doi.org/10.1016/j.seizure.2017.12.008DOI Listing
February 2018

Clinical characterization of unknown/cryptogenic status epilepticus suspected as encephalitis: A multicenter cohort study.

J Neuroimmunol 2018 02 12;315:1-8. Epub 2017 Dec 12.

Department of Neurology, Seoul National University Hospital, Republic of Korea. Electronic address:

Autoimmune and unknown/cryptogenic encephalitis have been increasingly noted in the inflammatory etiology of new-onset status epilepticus (SE). We aimed to investigate clinical characteristics and the potential role of immunotherapy in encephalitis-related adult SE through our multicenter prospective SE registry. Among the 274 patients with SE, 35 (12.8%) patients demonstrated an inflammatory etiology and 19 out of 35 (54.3%) patients demonstrated unknown/cryptogenic cause. Patients with autoimmune and unknown/cryptogenic encephalitis shared similar clinical features. In unknown/cryptogenic encephalitis, the proportion of favorable outcomes (mRS 0-3) showed a different propensity at 3-6months after discharge between patients receiving active immunotherapy and not receiving any immunotherapy, although it was not statistically significant (at admission 28.6% vs 20%, p=0.603; at discharge 57.1% vs 60%, p=0.570; at 3-6months after discharge 90% vs 60%, p=0.214 in patients treated with active immunotherapy or without immunotherapy, respectively). Extensive autoantibody screening should be carried out and empirical immunotherapy may be potentially helpful even in patients without antibodies, although longer term and multi-national studies may be necessary to make a stronger recommendation.
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http://dx.doi.org/10.1016/j.jneuroim.2017.12.004DOI Listing
February 2018

Ketogenic diet: Old treatment, new beginning.

Authors:
Jae-Moon Kim

Clin Neurophysiol Pract 2017 24;2:161-162. Epub 2017 Jul 24.

Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, 282, Munhwa-ro, Jung-gu, Daejeon 35015, South Korea.

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http://dx.doi.org/10.1016/j.cnp.2017.07.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123870PMC
July 2017

Anti-melanogenic effect of gomisin N from Schisandra chinensis (Turcz.) Baillon (Schisandraceae) in melanoma cells.

Arch Pharm Res 2017 Jul 10;40(7):807-817. Epub 2017 Jul 10.

College of Pharmacy, Chungbuk National University, 1 Chungdae, Seowon, Cheongju, Chungbuk, 28644, South Korea.

Overproduction and accumulation of melanin in the skin can lead to pigmentation disorders, such as freckles and melasma. Many researchers are studying the regulation of melanogenesis in the skin with the aim of developing whitening cosmetics. In this study, bioactivity-guided separation of the hexane fraction of Schisandra chinensis (Turcz.) Baillon extract yielded five major compounds, β-chamigrenal, α-ylangenol, gomisin N, gomisin A, and schisandrin. The structures were identified by using H-NMR and C-NMR spectroscopy and comparing the spectral data with published data. Melanogenesis inhibitory activity assay in alpha-melanocyte-stimulating hormone (α-MSH)-induced B16F10 mouse melanoma cells revealed that gomisin N was the active component and significantly inhibited melanin synthesis in a concentration-dependent manner. Thus, we evaluated the mechanism underlying its anti-melanogenic effect. Gomisin N inhibited the expression of tyrosinase and microphthalmia-associated transcription factor (MITF) in B16F10 cells, while it did not affect cAMP response element binding protein (CREB) phosphorylation. Additionally, gomisin N activated AKT phosphorylation, which inhibits MITF expression. Thus, our results strongly suggest that the active compound, gomisin N, has potential for use in cosmetics to reduce hyperpigmentation.
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http://dx.doi.org/10.1007/s12272-017-0903-4DOI Listing
July 2017

Evolution and Persistence of Torsional Downbeat Nystagmus in Lateral Medullary Infarction.

Can J Neurol Sci 2017 09 2;44(5):615-617. Epub 2017 May 2.

3Department of Rehabilitation Medicine,School of MedicineChungnam National University,Daejeon,Korea.

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http://dx.doi.org/10.1017/cjn.2017.34DOI Listing
September 2017

Clinical Features of Cluster Headache Patients in Korea.

J Korean Med Sci 2017 Mar;32(3):502-506

Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.

Cluster headache (CH) is a rare underdiagnosed primary headache disorder with very severe unilateral pain and autonomic symptoms. Clinical characteristics of Korean patients with CH have not yet been reported. We analyzed the clinical features of CH patients from 11 university hospitals in Korea. Among a total of 200 patients with CH, only 1 patient had chronic CH. The average age of CH patients was 38.1 ± 8.9 years (range 19-60 years) and the average age of onset was 30.7 ± 10.3 years (range 10-57 years). The male-to-female ratio was 7:1 (2.9:1 among teen-onset and 11.7:1 among twenties-onset). Pain was very severe at 9.3 ± 1.0 on the visual analogue scale. The average duration of each attack was 100.6 ± 55.6 minutes and a bout of CH lasted 6.5 ± 4.5 weeks. Autonomic symptoms were present in 93.5% and restlessness or agitation was present in 43.5% of patients. Patients suffered 3.0 ± 3.5 (range 1-25) bouts over 7.3 ± 6.7 (range 1-30) years. Diurnal periodicity and season propensity were present in 68.5% and 44.0% of patients, respectively. There were no sex differences in associated symptoms or diurnal and seasonal periodicity. Korean CH patients had a high male-to-female ratio, relatively short bout duration, and low proportion of chronic CH, unlike CH patients in Western countries.
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http://dx.doi.org/10.3346/jkms.2017.32.3.502DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290111PMC
March 2017

Characteristics of Elderly-Onset (≥65 years) Headache Diagnosed Using the International Classification of Headache Disorders, Third Edition Beta Version.

J Clin Neurol 2016 Oct;12(4):419-425

Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.

Background And Purpose: New-onset headache in elderly patients is generally suggestive of a high probability of secondary headache, and the subtypes of primary headache diagnoses are still unclear in the elderly. This study investigated the characteristics of headache with an older age at onset (≥65 years) and compared the characteristics between younger and older age groups.

Methods: We prospectively collected demographic and clinical data of 1,627 patients who first visited 11 tertiary hospitals in Korea due to headache between August 2014 and February 2015. Headache subtype was categorized according to the International Classification of Headache Disorders, Third Edition Beta Version.

Results: In total, 152 patients (9.3%, 106 women and 46 men) experienced headache that began from 65 years of age [elderly-onset group (EOG)], while the remaining 1,475 patients who first experienced headache before the age of 65 years were classified as the younger-age-at-onset group (YOG). Among the primary headache types, tension-type headache (55.6% vs. 28.8%) and other primary headache disorders (OPH, 31.0% vs. 17.3%) were more common in the EOG than in the YOG, while migraine was less frequent (13.5% vs. 52.2%) (p=0.001) in the EOG. Among OPH, primary stabbing headache (87.2%) was more frequent in the EOG than in the YOG (p=0.032). The pain was significantly less severe (p=0.026) and the frequency of medication overuse headache was higher in EOG than in YOG (23.5% vs. 7.6%, p=0.040).

Conclusions: Tension-type headache and OPH headaches, primarily stabbing headache, were more common in EOG patients than in YOG patients. The pain intensity, distribution of headache diagnoses, and frequency of medication overuse differed according to the age at headache onset.
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http://dx.doi.org/10.3988/jcn.2016.12.4.419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5063867PMC
October 2016

Accuracy of MEG in localizing irritative zone and seizure onset zone: Quantitative comparison between MEG and intracranial EEG.

Epilepsy Res 2016 11 16;127:291-301. Epub 2016 Aug 16.

Department of Neurology, Samsung Medical Center, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Samsung Biomedical Research Institute, Seoul, Republic of Korea. Electronic address:

Background: We conducted the study to examine accuracy of the magnetoencephalography (MEG) spike source localization in presurgical evaluation of patients with medically refractory focal epilepsy.

Methods: Ten consecutive patients with refractory focal epilepsy who were candidates for two-stage surgery with long-term intracranial electroencephalography (ICEEG) monitoring were enrolled. Interictal MEG recordings with simultaneous scalp EEG were obtained within 7days before the ICEEG electrode implantation. The location of each MEG spike source was quantitatively compared with ICEEG spike foci (focal area of interictal spikes) and ICEEG ictal foci (earliest cortical origin of seizures). Gyral-width concordance and sublobar concordance were also determined for all MEG spike sources. Gyral-width concordance was defined by distance of 15mm or less between MEG spike sources and ICEEG spike foci or ICEEG ictal foci.

Results: Visual analyses of the MEG traces of all 10 patients revealed 292 spikes (29.2±24.0 per patient). Spike yield of the MEG was similar to the simultaneously recorded scalp EEG. MEG spike sources were closely located with ICEEG spike foci (distance: 9.3±10.8mm). Clustered MEG spike sources were even closer to ICEEG spike foci (distance: 7.3±6.4mm). MEG spike sources, even clustered ones, were less concordant with ICEEG ictal foci and had significant longer distance from ICEEG ictal foci (distance: 21.5±15.6mm for all sources, 19.7±13.7mm for clustered sources). Gyral-width concordance rate and sublobar concordance rate were also higher with ICEEG interictal spike foci than with ICEEG ictal foci. On the other hand, 53.4% of interictal spike foci from ICEEG were not detected by interictal MEG recordings.

Conclusions: MEG spike sources, especially clustered ones, from interictal recording could localize the irritative zone of ICEEG with a high accuracy. However, MEG spike sources have relatively poor correlation with seizure onset zone and lower sensitivity in identifying all irritative zones of ICEEG. This limitation should be considered in the interpretation of MEG results.
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http://dx.doi.org/10.1016/j.eplepsyres.2016.08.013DOI Listing
November 2016

Characteristics of W Doped Nanocrystalline Carbon Films Prepared by Unbalanced Magnetron Sputtering.

J Nanosci Nanotechnol 2016 May;16(5):4989-92

Nanocrystalline tungsten doped carbon (WC) films were prepared by unbalanced magnetron sputtering. Tungsten was used as the doping material in carbon thin films with the aim of application as a contact strip in an electric railway. The structural, physical, and electrical properties of the fabricated WC films with various DC bias voltages were investigated. The films had a uniform and smooth surface. Hardness and frication characteristics of the films were improved, and the resistivity and sheet resistance decreased with increasing negative DC bias voltage. These results are associated with the nanocrystalline WC phase and sp(2) clusters in carbon networks increased by ion bombardment enhanced with increasing DC bias voltage. Consequently, the increase of sp(2) clusters containing WC nanocrystalline in the carbon films is attributed to the improvement in the physical and electrical properties.
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http://dx.doi.org/10.1166/jnn.2016.12183DOI Listing
May 2016

Chronic Daily Headache and Medication Overuse Headache in First-Visit Headache Patients in Korea: A Multicenter Clinic-Based Study.

J Clin Neurol 2016 Jul;12(3):316-22

Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.

Background And Purpose: Chronic daily headache (CDH) is defined as a headache disorder in which headaches occur on a daily or near-daily basis (at least 15 days/month) for more than 3 months. Chronic migraine (CM) and medication overuse headache (MOH) are very disabling headaches that remain underdiagnosed. The aim of this study was to establish the frequency of CDH and its various subtypes, and examine the associations with MOH among first-visit headache patients presenting at neurology outpatient clinics in Korea.

Methods: Eleven neurologists enrolled first-visit patients with complaints of headaches into outpatient clinics for further assessment. Headache disorders were classified according to the International Classification of Headache Disorder (third edition beta version) by each investigator.

Results: Primary CDH was present in 248 (15.2%) of the 1,627 included patients, comprising CM (143, 8.8%), chronic tension-type headache (CTTH) (98, 6%), and definite new daily persistent headache (NDPH) (7, 0.4%). MOH was associated with headache in 81 patients (5%). The association with MOH was stronger among CM patients (34.5%) than patients with CTTH (13.3%) or NDPH (14.3%) (p=0.001). The frequency of CDH did not differ between secondary and tertiary referral hospitals.

Conclusions: The frequencies of CDH and MOH diagnoses were 15.2% and 5%, respectively in first-visit headache patients presented at secondary or tertiary referral hospitals in Korea. CM was the most common subtype of CDH and was most frequently associated with MOH.
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http://dx.doi.org/10.3988/jcn.2016.12.3.316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4960216PMC
July 2016

Analysis of Trigger Factors in Episodic Migraineurs Using a Smartphone Headache Diary Applications.

PLoS One 2016 22;11(2):e0149577. Epub 2016 Feb 22.

Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.

Background: Various stimuli can trigger migraines in susceptible individuals. We examined migraine trigger factors by using a smartphone headache diary application.

Method: Episodic migraineurs who agreed to participate in our study downloaded smartphone headache diary application, which was designed to capture the details regarding headache trigger factors and characteristics for 3 months. The participants were asked to access the smartphone headache diary application daily and to confirm the presence of a headache and input the types of trigger factors.

Results: Sixty-two participants kept diary entries until the end of the study. The diary data for 4,579 days were analyzed. In this data set, 1,099 headache days (336 migraines, 763 non-migraine headaches) were recorded; of these, 772 headache events had with trigger factors, and 327 events did not have trigger factors. The common trigger factors that were present on headache days included stress, fatigue, sleep deprivation, hormonal changes, and weather changes. The likelihood of a headache trigger was 57.7% for stress, 55.1% for sleep deprivation, 48.5% for fatigue, and 46.5% for any trigger. The headaches with trigger factors were associated with greater pain intensity (p<0.001), headache-related disability (p<0.001), abortive medication use (p = 0.02), and the proportion of migraine (p < 0.001), relative to those without trigger factors. Traveling (odd ratios [OR]: 6.4), hormonal changes (OR: 3.5), noise (OR: 2.8), alcohol (OR: 2.5), overeating (OR: 2.4), and stress (OR:1.8) were significantly associated with migraines compared to non-migraine headaches. The headaches that were associated with hormonal changes or noise were more often migraines, regardless of the preventive medication. The headaches due to stress, overeating, alcohol, and traveling were more often migraines without preventive medication, but it was not evident with preventive medication.

Conclusion: Smartphone headache diary application is an effective tool to assess migraine trigger factors. The headaches with trigger factors had greater severity or migraine features. The type of triggers and the presence of preventive medication influenced the headache characteristics; hence, an investigation of trigger factors would be helpful in understanding migraine occurrences.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0149577PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4764678PMC
July 2016

Short-term diagnostic stability of probable headache disorders based on the International Classification of Headache Disorders, 3rd edition beta version, in first-visit patients: a multicenter follow-up study.

J Headache Pain 2016 19;17:13. Epub 2016 Feb 19.

Department of neurology, Gyeongsang National University School of Medicine, Jinju, South Korea.

Background: A "Probable headache disorder" is diagnosed when a patient's headache fulfills all but one criterion of a headache disorder in the 3rd beta edition of the International Classification of Headache Disorder (ICHD-3β). We investigated diagnostic changes in probable headache disorders in first-visit patients after at least 3 months of follow-up.

Methods: This was a longitudinal study using a prospective headache registry from nine headache clinics of referral hospitals. The diagnostic change of probable headache disorders at baseline was assessed at least 3 months after the initial visit using ICHD-3β.

Results: Of 216 patients with probable headache disorders at baseline, the initial probable diagnosis remained unchanged for 162 (75.0 %) patients, while it progressed to a definite diagnosis within the same headache subtype for 45 (20.8 %) by fulfilling the criteria during a median follow-up period of 6.5 months. Significant difference on the proportions of constant diagnosis was not found between headache subtypes (P < 0.935): 75.9 % for probable migraine, 73.7 % for probable tension-type headache (TTH), and 76.0 % for probable other primary headache disorders (OPHD). Among patients with headache recurrence, the proportion of constant diagnosis was higher for probable migraine than for probable TTH plus probable OPHD (59.2 vs. 23.1 %; P < 0.001). The proportions of constant diagnosis did not significantly differ by follow-up duration (>3 and ≤ 6 months vs. > 6 and ≤ 10 months) in probable migraine, probable TTH, and probable OPHD, respectively.

Conclusions: In this study, a probable headache diagnosis, based on ICHD-3β, remained in approximately three-quarters of the outpatients; however, diagnostic stability could differ by headache recurrence and subtype. Probable headache management might have to consider these differences.
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http://dx.doi.org/10.1186/s10194-016-0605-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4759261PMC
October 2016

Prevalence and Features of a Probable Diagnosis in First-Visit Headache Patients Based on the Criteria of the Third Beta Edition of the International Classification of Headache Disorders: A Prospective, Cross-Sectional Multicenter Study.

Headache 2016 Feb 1;56(2):267-75. Epub 2016 Feb 1.

Department of Neurology, Dongtan Sacred Heart Hopital, Hallym University College of Medicine, Hwaseong, Korea.

Objectives: This study aimed to determine the characteristics and significance of a probable diagnostic entity for primary headache disorder (PHD).

Background: A diagnosis of probable primary headache disorder (PPHD) is given when a patient's headache fulfills all but one criteria of the third beta edition of the international classification of headache disorder (ICHD-3β). Despite the uncertainty regarding this diagnosis, the inclusion of a probable diagnosis entity in this manual may aid in the accurate classification of headache disorders and allow effective treatment strategies to be started at the patient's initial visit.

Methods: This cross-sectional multicenter registry study assessed first-visit patients with complaints of headaches who presented at the outpatient clinics of 11 neurologists in Korea. The classification of a headache disorder was made according to the criteria of the ICHD-3β by each investigator based on the initial evaluation of the patient or by a consensus meeting for uncertain cases. The rates of a probable diagnosis among PPHD patients were assessed and the clinical characteristics of these patients were compared with those of patients with a diagnosis of definite primary headache disorder (DPHD).

Results: A total of 1429 patients were diagnosed with PHD, and 305 (21.3%) of these patients had PPHD. The proportions of PPHD differed among the subtypes of DPHD as follows: migraines (16.1%), tension-type headaches (TTH; 33%), trigeminal autonomic cephalalgia (TAC; 40.9%), and other PHD (14%, P < .001). Patients with PPHD had less severe headache intensity than patients with DPHD (5.8 ± 2.2 vs. 6.5 ± 2.1, respectively, P < .001) as well as a shorter duration of headache from onset (median: 1 vs. 4 months, respectively, P < .001). The most common criteria missing for a definite diagnosis in the PPHD patients were total frequency (52.1%), duration of attack (14.4%), and accompanying symptoms (13.1%).

Conclusions: A probable diagnosis was given to 21.3% of the first-visit PHD patients due to incomplete or atypical presentations of the headaches. The incorporation of a probable diagnosis into the ICHD-3β may be useful for reducing the diagnoses of unspecified headaches.
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http://dx.doi.org/10.1111/head.12742DOI Listing
February 2016

Transient Positive Horizontal Head Impulse Test in Pregabalin Intoxication.

J Epilepsy Res 2015 Dec 31;5(2):101-3. Epub 2015 Dec 31.

Department of Neurology, Chungnam National University Hospital, Daejeon, Korea.

Head impulse test (HIT) is helpful to understanding high-frequency vestibulo-ocular reflex in patients with dizziness and imbalance. There are some reports on abnormal HITs in cerebellar disorder. To our knowledge, there was no report of transient bilateral positive head impulse related to antiepileptic drugs. A 65-year-old woman developed dizziness and imbalance after treatment with pregabalin for pain control of radiation cystitis. Neurological examination exhibited positive bilateral HIT results, in addition to ataxia and gaze-evoked rebound nystagmus. Pregabalin intoxication can evoke transient positive horizontal head impulse test as another indicator of cerebellar dysfunction.
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http://dx.doi.org/10.14581/jer.15017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4724849PMC
December 2015

Comprehensive Application of the International Classification of Headache Disorders Third Edition, Beta Version.

J Korean Med Sci 2016 Jan 24;31(1):106-13. Epub 2015 Dec 24.

Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

The purpose of this study was to test the feasibility and usefulness of the International Classification of Headache Disorders, third edition, beta version (ICHD-3β), and compare the differences with the International Classification of Headache Disorders, second edition (ICHD-2). Consecutive first-visit patients were recruited from 11 headache clinics in Korea. Headache classification was performed in accordance with ICHD-3β. The characteristics of headaches were analyzed and the feasibility and usefulness of this version was assessed by the proportion of unclassified headache disorders compared with ICHD-2. A total of 1,627 patients were enrolled (mean age, 47.4±14.7 yr; 62.8% female). Classification by ICHD-3β was achieved in 97.8% of headache patients, whereas 90.0% could be classified by ICHD-2. Primary headaches (n=1,429, 87.8%) were classified as follows: 697 migraines, 445 tension-type headaches, 22 cluster headaches, and 265 other primary headache disorders. Secondary headache or painful cranial neuropathies/other facial pains were diagnosed in 163 patients (10.0%). Only 2.2% were not classified by ICHD-3β. The main reasons for missing classifications were insufficient information (1.6%) or absence of suitable classification (0.6%). The diagnoses differed from those using ICHD-2 in 243 patients (14.9%). Among them, 165 patients were newly classified from unclassified with ICHD-2 because of the relaxation of the previous strict criteria or the introduction of a new diagnostic category. ICHD-3β would yield a higher classification rate than its previous version, ICHD-2. ICHD-3β is applicable in clinical practice for first-visit headache patients of a referral hospital.
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http://dx.doi.org/10.3346/jkms.2016.31.1.106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712567PMC
January 2016

Migraine and restless legs syndrome are associated in adults under age fifty but not in adults over fifty: a population-based study.

J Headache Pain 2015 13;16:554. Epub 2015 Aug 13.

Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.

Background: Recent studies have shown an association between migraine and restless legs syndrome (RLS). However, migraine prevalence peaks from the 20s to 40s whereas RLS prevalence peaks after the 50s. Despite this, reports on how migraine and RLS may be associated by age is limited. Therefore, the purpose of this study is to investigate the comorbidity between migraine and RLS according to age.

Methods: We selected a stratified random population sample of Koreans aged 19 to 69 years and evaluated them with a 60-item semi-structured interview designed to identify RLS, headache type, and clinical characteristics of migraine. To assess the association between migraine and RLS according to age, we divided participants into 5 age groups (19-29, 30-39, 40-49, 50-59, and 60-69 years) and analysed each group.

Results: Subjects with migraine showed an increased RLS prevalence in the 19-29 (Odds ratio [OR] = 6.6, 95 % confidence interval [CI] = 1.2-36.8) and 40-49 (OR = 6.7, 95 % CI = 1.5-33.5) age groups compared to non-headache controls but failed to showed a significant association in the 50-59 (OR = 1.1, 95 % CI = 0.2-5.6) and 60-69 (OR = 0.4, 95 % CI = 0.1-4.0) age groups. Migraineurs with 1-10 (12.5 %, OR = 2.0, 95 % CI = 1.3-3.2, p = 0.003) and >10 (12.5 %, OR = 2.5, 95 % CI = 1.0-5.6, p = 0.038) attacks per month showed an increased RLS prevalence compared to migraineurs with <1 attack per month (2.1 %). Subjects with non-migraine headaches showed an increased odds for RLS (OR = 1.8, 95 % CI = 1.3-2.7) compared to non-headache controls. There was no significant difference (9.1 % vs. 6.9 %, p = 0.339) in the RLS prevalence between migraineurs and non-migraine headache subjects.

Conclusions: Our results suggest that migraine and RLS are differently associated according to age.
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http://dx.doi.org/10.1186/s10194-015-0554-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4536239PMC
February 2016

Vestibular migraine in multicenter neurology clinics according to the appendix criteria in the third beta edition of the International Classification of Headache Disorders.

Cephalalgia 2016 Apr 29;36(5):454-62. Epub 2015 Jul 29.

Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Korea

Background: Vestibular migraine (VM), the common term for recurrent vestibular symptoms with migraine features, has been recognized in the appendix criteria of the third beta edition of the International Classification of Headache Disorders (ICHD-3β). We applied the criteria for VM in a prospective, multicenter headache registry study.

Methods: Nine neurologists enrolled consecutive patients visiting outpatient clinics for headache. The presenting headache disorder and additional VM diagnoses were classified according to the ICHD-3β. The rates of patients diagnosed with VM and probable VM using consensus criteria were assessed.

Results: A total of 1414 patients were enrolled. Of 631 migraineurs, 65 were classified with VM (10.3%) and 16 with probable VM (2.5%). Accompanying migraine subtypes in VM were migraine without aura (66.2%), chronic migraine (29.2%), and migraine with aura (4.6%). Probable migraine (75%) was common in those with probable VM. The most common vestibular symptom was head motion-induced dizziness with nausea in VM and spontaneous vertigo in probable VM. The clinical characteristics of VM did not differ from those of migraine without VM.

Conclusion: We diagnosed VM in 10.3% of first-visit migraineurs in neurology clinics using the ICHD-3β. Applying the diagnosis of probable VM can increase the identification of VM.
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http://dx.doi.org/10.1177/0333102415597890DOI Listing
April 2016

Factors associated with disability and impact of tension-type headache: findings of the Korean headache survey.

J Headache Pain 2015 4;16:524. Epub 2015 May 4.

Department of Neurology, Bundang Jesaeng General Hospital, Daejin Medical Center, Kwandong University College of Medicine, Seongnam, South Korea,

Background: Although mostly mild in symptom severity, tension-type headache (TTH) can cause disability. However, factors associated with disability of TTH have been rarely reported. This study sought to assess the factors associated with TTH-related disability and impact.

Methods: We analyzed data form the Korean Headache Survey, a nation-wide survey regarding headache in all Korean adults aged 19-69 years. TTH-related disability was measured by surveying actual disability and Headache Impact Test-6 (HIT-6). Actual disability was defined as having one or more days of activity restriction or missed activity due to headache in the last 3 months. The HIT-6 score ≥ 50 was regarded as significant headache impact associated with TTH. We assessed factors associated with TTH-related disability and impact using logistic regression analyses adjusting for sociodemographic variables and headache characteristics.

Results: Among 1507 individuals, the 1-year prevalence rate of TTH was 30.7% (n = 463), of which 4.8% reported actual disability and 21.3% had headache impact, respectively. In univariate analyses, sociodemographic variables were not associated with actual disability and headache impact, respectively. There were relationships between several headache characteristics and actual disability/headache impact. After adjustment of potential confounders, moderate headache intensity was correlated with actual disability (odds ratio [OR]: 4.41, 95% confidence interval [CI]: 1.46-13.27), while an inverse association was observed between no aggravation by routine activity and actual disability (OR: 0.32, 95% CI: 0.12-0.88). Multivariate analyses showed that ORs for headache impact were increased in those with higher headache frequency (OR: 2.54, 95% CI: 1.47-4.39 for 1-14 days/month; OR: 23.83, 95% CI: 5.46-104.03 for ≥ 15 days/month), longer headache time duration (OR: 1.84, 95% CI: 1.04-3.25 for ≥ 1 and < 4 hours; OR: 2.44 95% CI: 1.17-5.11 for ≥ 4 hours), and phonophobia (OR: 1.73, 95% CI: 1.02-2.95), whereas decreased in those with no aggravation by routine activity (OR: 0.32, 95% CI: 0.12-0.88).

Conclusions: Several headache characteristics were associated with actual disability and headache impact among TTH individuals. Our findings suggest that there needs to be consideration careful of troublesome headache characteristics for TTH individuals suffering from disability and impact.
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http://dx.doi.org/10.1186/s10194-015-0524-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434242PMC
December 2015

Combination of anxiety and depression is associated with an increased headache frequency in migraineurs: a population-based study.

BMC Neurol 2014 Dec 14;14:238. Epub 2014 Dec 14.

Department of Neurology, Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.

Background: Although anxiety and depression have been classified as distinct traits of affective disorders, previous studies have reported their co-occurrence in subjects with migraine. However, few reports are available on the clinical implications of this comorbidity. This study is to assess the comorbidity of anxiety and depression in subjects with migraine and its clinical implications in a population-based sample from Korea.

Methods: We selected Korean subjects aged 19-69 years by the stratified random sampling method, and evaluated them using a semi-structured interview, designed to identify headache type, anxiety, and depression. We used Goldberg Anxiety Scale questions and Patient Health Questionnnaire-9 for the diagnosis of anxiety and depression, respectively.

Results: Of the 2,762 participants who completed the interview, 147 subjects (5.4%) were classified as having a migraine during the previous year. Among these 147 subjects, 17 (11.6%) had anxiety and depression, 28 (19.0%) had anxiety alone, 9 (6.1%) had depression alone, and 93 (63.3%) had neither anxiety nor depression. Headache frequency per month was remarkably higher in subjects having migraine with anxiety and depression (median [25-75 percentile values], 8.0 [2.5-21.0]) than in those having migraine with anxiety alone (2.0 [1.0-5.0], p = 0.003), migraine with depression alone (1.0 [0.3-4.0], p = 0.001), and migraine without anxiety or depression (1.0 [0.3-3.0], p < 0.001). The migraine with anxiety alone (7.0 [6.0-8.0], p = 0.011) group and migraine with anxiety and depression (7.0 [5.0-9.0], p = 0.018) group showed higher Visual Analogue Scale scores for pain intensity compare to migraine without anxiety or depression (6.0 [5.0-7.0]) group.

Conclusions: Approximately 1/3 of migraineurs with anxiety had depression and 2/3 of migraineurs with depression had anxiety. Combination of anxiety and depression was associated with an increased headache frequency. Anxiety was associated with exacerbation of headache intensity.
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http://dx.doi.org/10.1186/s12883-014-0238-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4279894PMC
December 2014