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Teborg S, Hünefeld L, Gerdes TS. Exploring the working conditions of disabled employees: a scoping review. J Occup Med Toxicol 2024; 19:2. [PMID: 38291467 PMCID: PMC10826256 DOI: 10.1186/s12995-023-00397-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/08/2023] [Indexed: 02/01/2024] Open
Abstract
PURPOSE Disabled people are often overlooked in considerations about work design, which contributes to their exclusion from the labor market. This issue also reflects within research, as the body of knowledge on the working conditions of disabled employees remains relatively limited. METHODS A scoping review was conducted to assess the research landscape concerning the working conditions of disabled employees. Five databases have been searched, focusing on relevant studies published between 2017 and 2022. RESULTS One hundred fourteen studies were included in the review. It was found that social aspects of work appeared within a substantial portion of the examined studies. Furthermore, it became evident that the interplay of accessibility and flexibility provides an important dynamic to make work design both inclusive and feasible. CONCLUSION The recurrent prominence of social aspects, accessibility, and flexibility across the studies shows common challenges and potentials within the work situation of disabled employees. This suggests avenues for future research and inclusive work design.
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Affiliation(s)
- Sophie Teborg
- Federal Institute for Occupational Safety and Health, Unit 1.2 Monitoring Working Conditions, Dortmund, Germany.
| | - Lena Hünefeld
- Federal Institute for Occupational Safety and Health, Unit 1.2 Monitoring Working Conditions, Dortmund, Germany
| | - Tomke S Gerdes
- Department of Rehabilitation Sciences, TU Dortmund University, Dortmund, Germany
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Lee MJ, Park JW, Chu MK, Moon HS, Chung PW, Chung JM, Sohn JH, Kim BK, Kim BS, Kim SK, Song TJ, Choi YJ, Park KY, Oh K, Ahn JY, Lee KS, Bae DW, Cho SJ. Treatment pattern and response for cluster headache in Korea: A prospective multicenter observation study. Cephalalgia 2023; 43:3331024231159627. [PMID: 36855967 DOI: 10.1177/03331024231159627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Only limited data are available regarding the treatment status and response to cluster headache in an Asian population. Therefore, this study aimed to provide a real-world treatment pattern of cluster headache and the response rate of each treatment in an Asian population. METHODS Patients with cluster headache were recruited between September 2016 and January 2019 from 16 hospitals in Korea. At the baseline visit, we surveyed the patients about their previous experience of cluster headache treatment, and acute and/or preventive treatments were prescribed at the physician's discretion. Treatment response was prospectively evaluated using a structured case-report form at 2 ± 2 weeks after baseline visit and reassessed after three months. RESULTS Among 295 recruited patients, 262 experiencing active bouts were included. Only one-third of patients reported a previous experience of evidence-based treatment. At the baseline visit, oral triptans (73.4%), verapamil (68.3%), and systemic steroids (55.6%) were the three most common treatments prescribed by the investigators. Most treatments were given as combination. For acute treatment, oral triptans and oxygen were effective in 90.1% and 86.8% of the patients, respectively; for preventive treatment, evidence-based treatments, i.e. monotherapy or different combinations of verapamil, lithium, systemic steroids, and suboccipital steroid injection, helped 75.0% to 91.8% of patients. CONCLUSION Our data provide the first prospective analysis of treatment responses in an Asian population with cluster headache. The patients responded well to treatment despite the limited availability of treatment options, and this might be attributed at least in part by combination of medications. Most patients were previously undertreated, suggesting a need to raise awareness of cluster headache among primary physicians.
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Affiliation(s)
- Mi Ji Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Wook Park
- Department of Neurology, Uijeongbu St. Mary's Hospital, Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Heui-Soo Moon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pil-Wook Chung
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Myun Chung
- Department of Neurology, Inje University College of Medicine, Seoul, Korea
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Byung-Kun Kim
- Department of Neurology, Eulji University School of Medicine, Seoul, Korea
| | - Byung-Su Kim
- Department of Neurology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Soo-Kyoung Kim
- Department of Neurology and Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | | | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Seoul, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Jin-Young Ahn
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Kwang-Soo Lee
- Department of Neurology, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, Korea
| | - Dae Woong Bae
- Department of Neurology, The Catholic University of Korea, St Vincent's Hospital, Suwon, Republic of Korea
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
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Oliveira A, Bensenor I, Goulart A, Mercante J, Peres M. Socioeconomic and geographic inequalities in headache disability in Brazil: The 2019 National Health Survey. Headache 2023; 63:114-126. [PMID: 36651588 DOI: 10.1111/head.14462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To map the socioeconomic and geographic inequalities in headache disability in Brazil. BACKGROUND Headache disability and its social determinants are poorly investigated in Brazil. METHODS This is a secondary, cross-sectional analysis of the 2019 National Health Survey database, a representative sample of the Brazilian population. Working-aged Brazilians (aged ≥14 years) were included in the analyses (n = 225,563). Headache disability was inquired through questions on the number of days the respondent was unable to perform customary daily activities in the past 2 weeks. Proportion estimates and the mean days lost were compared between socioeconomic categories. Sample weights were used. RESULTS Among 14 disease-related disability groups, headache disability (n = 1228) was the second most prevalent disability in adolescents and fifth among adults aged <50 years. In the headache disability sample, there was a higher proportion of females at 72.4% (95% confidence interval [CI] 68.5%-75.9%), with a mean (95% CI) age of 41.1 (40.1-42.0) years and days lost due to disability of 3.4 (3.2-3.6) days. The sociodemographic distribution across income strata (quartiles) of the headache disability sample showed the highest proportions at the lowest income quartile in the Northeast region (15.4%, 95% CI 12.8%-18.4%), for people of Brown color (17.5%, 95% CI 14.7%-20.7%), and with the lowest education level (l3.6%, 95% CI 11.3%-16.2%). Black people, those from the North region, and those with the lowest education level had more days lost than White people (mean [95% CI] 4.1 [3.5-4.6] vs. 3.1 [2.8-3.4] days, p = 0.008), those from the Southeast region (mean [95% CI] 3.8 [3.4-4.2] vs. 2.8 [2.4-3.3] days, p = 0.022), and people with the highest education level (mean [95% CI] 3.9 [3.6-4.2] vs. 2.8 [2.3-3.3] days, p = 0.005), respectively. CONCLUSION In Brazil, headache disability is one of the leading causes of disability and it is characterized by socioeconomic inequalities.
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Affiliation(s)
- Arão Oliveira
- Center for Clinical and Epidemiological Research, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Isabela Bensenor
- Center for Clinical and Epidemiological Research, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alessandra Goulart
- Center for Clinical and Epidemiological Research, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Juliane Mercante
- Center for Clinical and Epidemiological Research, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mario Peres
- Psychiatric Institute, Universidade de Sao Paulo, Sao Paulo, Brazil
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Mo H, Kim BK, Moon HS, Cho SJ. Real-world experience with 240 mg of galcanezumab for the preventive treatment of cluster headache. J Headache Pain 2022; 23:132. [PMID: 36209047 PMCID: PMC9547445 DOI: 10.1186/s10194-022-01505-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background Galcanezumab of 300 mg monthly is the FDA approved preventive medication for cluster headache (CH) during the cluster period. Compared to the 120 mg galcanezumab syringe for the treatment of migraines, the 100 mg syringe for CH has globally not been as widely available. The aim of our study was to investigate the preventive efficacy and tolerability of two 120 mg galcanezumab doses for episodic CH in clinical practices. Methods We evaluated patients with CH who received at least 1 dose of 240 mg (2 prefilled syringe of 120 mg) of galcanezumab in the 3 university hospitals from February 2020 to September 2021. In the patients with episodic CH, the efficacy and safety data of galcanezumab were analyzed regarding to the presence of the conventional preventive therapy at the timing of therapy of galcanezumab. The data of other subtypes of CH were separately described. Results In 47 patients with episodic CH, galcanezumab was started median 18 days after the onset of current bout (range 1–62 days) and 4 patients (10.8%) received second dose of galcanezumab. The median time to the first occurrence of 100% reduction from baseline in CH attacks per week after galcanezumab therapy was 17 days (25% to 75% quartile range: 5.0 ~ 29.5) in all patients with episodic CH, 15.5 days (3.8 ~ 22.1) in 36 patients with galcanezumab therapy add-on conventional preventive therapy, 21.0 days (12.0 ~ 31.5) in 11 patients started galcanezumab as initial preventive therapy. Among 33 patients with headache diary, the proportion of patients with 50% or more reduction in weekly CH attacks at week 3 from baseline were 78.8%. There was no significant difference in the proportion of patients with a reduction of at least 50% in weekly frequency of CH attacks at week 3 between 24 patients received galcanezumab therapy add-on conventional preventive therapy and 9 patient who received initial galcanezumab therapy. (83.3%, vs 66.7%, p = 0.36). There were no significant differences in proportion of “very much better or “much better” between 36 patients received galcanezumab therapy add-on conventional preventive therapy and 11 patient who received initial GT (86.1%, vs 63.6%, p = 0.18). Conclusion One 240 mg dose of galcanezumab with/without conventional therapy for the prevention of CH is considered effective and safe in clinical practices, as seen in the clinical trial of galcanezumab.
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Affiliation(s)
- Heejung Mo
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Keun Jae Bong-gil 7, Hwaseong, Gyeonggi-do, 18450, South Korea
| | - Byung-Kun Kim
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Daejeon, South Korea
| | - Heui-Soo Moon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Keun Jae Bong-gil 7, Hwaseong, Gyeonggi-do, 18450, South Korea.
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Petersen AS, Lund N, Snoer A, Jensen RH, Barloese M. The economic and personal burden of cluster headache: a controlled cross-sectional study. J Headache Pain 2022; 23:58. [PMID: 35610587 PMCID: PMC9128287 DOI: 10.1186/s10194-022-01427-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Cluster headache is a less-prevalent primary headache disorder but is overrepresented with regards to use of health care and social services. More insight into the socioeconomic impact is required. Methods We investigated both the personal and societal disease burden and cost in 400 patients with well-classified cluster headache according to the ICHD-criteria and 200 sex- and age matched controls. All participants completed a cross sectional questionnaire and semi-structured interview. Results Patients with chronic cluster headache constituted 146 out of 400 (37%). Overall, restriction in personal and/or professional life was reported by 94% of patients during attack periods. Even in remission, nine times as many episodic patients rated their health as poor/very poor compared to controls (9% vs 1%, p = 0.002). For chronic patients, the odds of rating health as good/very good were ten times lower compared to controls (OR:10.10, 95%CI:5.29–18.79. p < 0.001) and three times lower compared to episodic patients in remission (OR:3.22, 95%CI:1.90–5.47, p < 0.001). Additionally, chronic cluster headache patients were 5 times more likely to receive disability pension compared to episodic (OR:5.0, 95%CI:2.3–10.9, p < 0.001). The mean direct annual costs amounted to 9,158€ and 2,763€ for chronic and episodic patients, respectively (p < 0.001). We identified a substantial loss of productivity due to absence from work resulting in a higher indirect cost of 11,809 €/year/patient in the chronic population and 3,558 €/year/patient in the episodic population. Presenteeism could not be quantified but productivity was reduced in patients by 65% in periods with attacks compared to controls. Conclusion Cluster headache has a major negative impact on personal life, self-perceived health, and societal cost. Patients with the chronic variant are vastly more burdened. Patients with the episodic form were still markedly affected during the remission period. This study highlights the need for more effective therapy to lighten the burden on patients and society.
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Affiliation(s)
- Anja Sofie Petersen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark.
| | - Nunu Lund
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Agneta Snoer
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Mads Barloese
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark.,Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Hvidovre Hospital, Hvidovre, Denmark
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6
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Mo H, Chung SJ, Rozen TD, Cho SJ. Oxygen Therapy in Cluster Headache, Migraine, and Other Headache Disorders. J Clin Neurol 2022; 18:271-279. [PMID: 35589316 PMCID: PMC9163947 DOI: 10.3988/jcn.2022.18.3.271] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 11/17/2022] Open
Abstract
Oxygen therapy (OT) can relieve head pain in certain primary headache disorders, including cluster headache (CH). The exact underlying mechanism is currently uncertain, but suggested mechanisms include inhibition of the trigeminoautonomic reflex, modulation of neurotransmitters, and cerebral vasoconstriction. OT is the standard for acute treatment of CH, but patients with CH often experience considerable difficulties accessing home OT due to problems with insurance coverage. Inhalation of 100% oxygen at 6–12 L/min for 15–30 min using a non-rebreather face mask is one of the most effective acute therapies for CH, but several trials have indicated the superiority of higher oxygen flow rates of up to 15 L/min and/or using a demand-valve oxygen mask that can produce very high flow rates. Two randomized controlled trials have demonstrated the efficacy of OT in migraine, but obtaining reliable evidence is considered difficult because of different inhalation protocols, varying outcome measures, and small samples. There are some reports on the efficacy of OT as an adjuvant therapy in hypnic headache, primary headache in the emergency department, and even postdural puncture headache. The goal of this review article is to expand the knowledge regarding the use of oxygen in the treatment of headache disorders.
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Affiliation(s)
- Heejung Mo
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Soo Jie Chung
- Department of Pulmonology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Todd D Rozen
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
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Freeman E, Adair M, Beeler D, Casper R, Herman MP, Reeves D, Reinsch S. Patient-identified burden and unmet needs in patients with cluster headache: An evidence-based qualitative literature review. CEPHALALGIA REPORTS 2022. [DOI: 10.1177/25158163221096866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To qualitatively identify evidence-based literature related to the daily burden and unmet treatment and psychosocial needs of patients with cluster headache (CH). Methods: A literature search was conducted through October 20, 2020 across MEDLINE, EMBASE, CINAHL, and PsychInfo databases exploring quality of life (QoL) and disease burden in adults with CH. The search was restricted to full-text reports in peer-reviewed journals. Methodologic quality was assessed using the Critical Skills Appraisal Program. Results: From 11 identified publications, QoL was reduced in persons living with CH, with significant psychological, social, and socio-economic burdens, and work-related disability. The CH disease trajectory is complex, with patients experiencing the impact of their disease across multiple domains beyond the biological manifestation of the disease including stigma, employment limitations, and suicidal ideation, and with a lack of effective treatment from the patient perspective. Discussion: These findings strengthen comprehension of the CH patient experience, enabling a deeper understanding of the patients’ perspective and experience of their disease andunmet needs, providing a basis for future research into this debilitating condition. Minor limitations of this study include data extraction and study selection biases.
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Andrews JS, Kudrow D, Rettiganti M, Oakes T, Bardos JN, Wenzel R, Kuruppu DK, Gaul C, Martinez JM. Impact of Galcanezumab on Total Pain Burden: A Post Hoc Analysis of a Phase 3, Randomized, Double-Blind, Placebo-Controlled Study in Patients with Episodic Cluster Headache. J Pain Res 2021; 14:2059-2070. [PMID: 34267550 PMCID: PMC8275210 DOI: 10.2147/jpr.s305066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/17/2021] [Indexed: 01/03/2023] Open
Abstract
Purpose In a phase 3 study, galcanezumab significantly reduced the frequency of episodic cluster headache attacks across weeks 1–3 (primary endpoint) compared with placebo. However, multiple pain dimensions may contribute to the total burden of episodic cluster headache pain. This post hoc analysis assessed the impact of galcanezumab on the total pain burden of episodic cluster headache using a composite measure. Patients and Methods Patients with episodic cluster headache were randomized 1:1 to galcanezumab 300 mg or placebo once monthly for 8 weeks. Mean weekly total pain burden was calculated (daily cluster headache attack frequency × average duration × average pain severity summed over 7 days) using data collected in an electronic patient-reported outcomes diary. Change from baseline in weekly total pain burden across weeks 1–3 was compared between galcanezumab and placebo. To explore construct validity, mean weekly total pain burden scores were stratified by Patient Global Impression of Improvement (PGI-I) responses at the week 4 clinic visit. Results The reduction from baseline in mean weekly total pain burden was significantly greater with galcanezumab (N=49) than with placebo (N=57): the least squares mean difference was −11.18 severity-weighted hours (p=0.035). Median weekly total pain burden decreased as PGI-I ratings improved, from 33.6 to 5.0 severity-weighted hours for patients who felt “very much worse” and “very much better,” respectively. Conclusion Galcanezumab significantly reduced mean weekly total pain burden compared with placebo in patients with episodic cluster headache. The composite pain measure demonstrated construct validity. Total pain burden may provide a holistic measure of the pain of episodic cluster headache. Clinical Trials ClinicalTrials.gov, NCT02397473.
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Affiliation(s)
| | - David Kudrow
- California Medical Clinic for Headache, Santa Monica, CA, USA
| | | | - Tina Oakes
- Eli Lilly and Company, Indianapolis, IN, USA
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Kim BK, Chu MK, Yu SJ, Dell'Agnello G, Han JH, Cho SJ. Burden of migraine and unmet needs from the patients' perspective: a survey across 11 specialized headache clinics in Korea. J Headache Pain 2021; 22:45. [PMID: 34030630 PMCID: PMC8146656 DOI: 10.1186/s10194-021-01250-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/29/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Migraine is a neurological, primary headache disorder affecting more than 1 billion people worldwide, with a multi-faceted burden that can significantly impact the everyday life of a patient, both during and between attacks. However, studies on patient awareness, burden, and clinical management of migraine in Korea are limited and outdated. The aim of this study was to comprehensively investigate the current difficulties and unmet needs that Korean patients with migraine encounter from their perspective. METHODS A total of 207 patients with episodic or chronic migraine aged between 15 and 76 years, completed a survey designed to cover the following topics: diagnosis, understanding of the disease, treatment experience, disability, and quality of life. Patients were recruited by their neurologists from 11 specialized headache clinics in Korea and completed the survey between 22 July and 19 August 2019. Validated scales such as the Migraine Disability Assessment (MIDAS) questionnaire and Migraine-Specific Quality of Life Questionnaire version 2.1 (MSQv2.1) were used to assess levels of disability and quality of life, respectively, in patients. RESULTS On average, it took 10.1 years from onset of symptoms to diagnosis and a mean of 3.9 hospitals were visited for treatment prior to the patient's current hospital. There was a lack of understanding among respondents about migraine, with 55.6% believing that unilateral headache is a unique feature of migraine compared with other headache disorders. On average, high levels of disability and poor quality of life were reported by patients, as assessed by MIDAS and MSQv2.1, respectively, but only 23.7% had regularly taken preventive medication in the past. Overall satisfaction with previous doctor-patient relationships was reported by 29.5% of respondents, and satisfaction with preventive and acute medications by only 40.8% and 27.1% of the respondents, respectively. CONCLUSION Korean patients with migraine experience significant disability and reduced quality of life as a result of the disease and have clear unmet needs in terms of diagnosis, understanding of the disease, and disease management including treatment.
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Affiliation(s)
- Byung-Kun Kim
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, South Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University School of Medicine, Seoul, South Korea
| | | | | | | | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea.
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Yang J, Yu SY, Yang J, Kong J, Liang FR, Lv ZT. No Association Between G1246A Polymorphism in HCRTR2 Gene and Risk of Cluster Headache: Evidence From an Updated Meta-Analysis of Observational Studies. Front Genet 2020; 11:560517. [PMID: 33343621 PMCID: PMC7744679 DOI: 10.3389/fgene.2020.560517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/21/2020] [Indexed: 12/23/2022] Open
Abstract
Background: The hypocretin receptor 2 (HCRTR2) gene may play a pathological role in cluster headache (CH). However, the conclusions of published reports on the relationship between the G1246A polymorphism (rs2653349) in the HCRTR2 gene and risk of CH remain controversial. This purpose of this article is to comprehensively study the current evidence and assess the association between G1246A polymorphism (rs2653349) in the HCRTR2 gene and risk of CH. Materials and Methods: Four electronic databases—ISI Web of Science, CNKI, PubMed, and EMBASE—were comprehensively searched on August 2020 to find and pinpoint all observational articles related to this study. The association between G1246A polymorphism in the HCRTR2 gene and risk of CH under five different genetic models was evaluated based on the summary odds ratio and corresponding 95 confidence interval (95% CI). Methodological quality was assessed based on the Newcastle–Ottawa Scale (NOS). To assist the analysis, RevMan 5.3 software was used to perform subgroup and sensitivity analyses. Egger's and Begg's tests were then conducted to evaluate and assess publication bias. Finally, a meta-regression was carried out by residual (restricted) maximum likelihood (REML). Results: Eight observation studies containing 3,161 healthy controls and 1,964 patients with CH were identified and to be used for the meta-analysis. With methodological quality NOS assessment, the incorporated studies showed an average score of 6.4 stars. The pooled data didn't support the association between G1246A polymorphism in the HCRTR2 gene and CH vulnerability in the overall population (OR: 0.85, 95% CI 0.69, 1.03; p = 0.10). Subgroup analysis by ethnicity showed no significant association between G1246A and CH in either Caucasians (OR: 0.89, 95% CI 0.77, 1.01; p = 0.08) or Asians (OR: 1.65, 95% CI 0.80, 3.41; p = 0.18). The robustness of the conclusion was tested and confirmed with the leave-one-out sensitivity analysis. Meta-regression analysis showed that chronological order of publication appeared to be significantly associated with the heterogeneity (t = 2.47, p = 0.039; residual I2 = 0%, adjusted R2 = 100%). Conclusion: Our present study showed that the G1246A polymorphism in the HCRTR2 gene did not appear to be an accomplice and associated with CH predisposition among either the Asian or Caucasian population.
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Affiliation(s)
- Jiao Yang
- The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Si-Yi Yu
- The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jie Yang
- The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jing Kong
- The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fan-Rong Liang
- The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zheng-Tao Lv
- Department of Orthopedics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Pellesi L, De Icco R, Al-Karagholi MAM, Ashina M. Reducing Episodic Cluster Headaches: Focus on Galcanezumab. J Pain Res 2020; 13:1591-1599. [PMID: 32753938 PMCID: PMC7342329 DOI: 10.2147/jpr.s222604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/08/2020] [Indexed: 12/20/2022] Open
Abstract
The involvement of calcitonin gene-related peptide in migraine and cluster headache has led to the recent development of new therapies. Galcanezumab, a novel monoclonal antibody targeting the calcitonin gene-related peptide, is approved for the migraine prevention and has recently been tested for the prevention of cluster headache. Two clinical trials have been conducted to investigate the efficacy and safety of galcanezumab in episodic cluster headache and chronic cluster headache. While efficacy endpoints were not met in the chronic subtype, galcanezumab reduced the weekly frequency of attacks in patients with episodic cluster headaches. In both studies, the antibody was well tolerated. This review summarizes and critically reviews the available data regarding the rationale behind targeting the calcitonin gene-related peptide with galcanezumab for the prevention of cluster headache.
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Affiliation(s)
- Lanfranco Pellesi
- Danish Headache Center, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Roberto De Icco
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Messoud Ashina
- Danish Headache Center, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Danish Headache Knowledge Center, Rigshospitalet Glostrup, Glostrup, Denmark
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12
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Perceptions, experiences, and understandings of cluster headache among GPs and neurologists: a qualitative study. Br J Gen Pract 2020; 70:e514-e522. [PMID: 32482627 DOI: 10.3399/bjgp20x710417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/30/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Cluster headache is a severe primary headache with a similar prevalence to that of multiple sclerosis. Cluster headache is characterised by unilateral trigeminal distribution of pain, ipsilateral cranial autonomic features, and a tendency to circadian and circannual periodicity. AIM To explore the perceptions, experiences, and understandings of cluster headache among GPs and neurologists. DESIGN AND SETTING Qualitative interview study in primary care surgeries and neurology departments in the north of England. METHOD Semi-structured interviews were conducted with GPs and neurologists, recorded, and transcribed. A thematic analysis was applied to the dataset. RESULTS Sixteen clinicians participated in this study: eight GPs and eight neurologists. Four main themes were identified following thematic analysis: challenges with the cluster headache diagnosis; impact of cluster headache; challenges with treatment; and appropriateness of referrals to secondary care. Clinicians recognised the delays in the diagnosis of cluster headache, misdiagnosis, and mismanagement, and were aware of the potential impact cluster headache can have on patients' mental health and ability to remain in employment. Findings highlighted tensions between primary and secondary care around the cost of medication and the remit of prescribing treatment regimens. Patients' anxiety, their need for reassurance, and their insistence about seeing a specialist are some of the reasons for referrals. CONCLUSION Clinicians acknowledged delays in diagnosis, misdiagnosis, and mismanagement of cluster headache. The responsibility of prescribing causes ongoing tensions between primary and secondary care. Clear referral and management pathways for primary headaches are required to improve patient outcomes and healthcare costs.
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Miller JS, Rodriguez-Saona L, Hackshaw KV. Metabolomics in Central Sensitivity Syndromes. Metabolites 2020; 10:E164. [PMID: 32344505 PMCID: PMC7240948 DOI: 10.3390/metabo10040164] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/11/2020] [Accepted: 04/19/2020] [Indexed: 01/09/2023] Open
Abstract
Central sensitization syndromes are a collection of frequently painful disorders that contribute to decreased quality of life and increased risk of opiate abuse. Although these disorders cause significant morbidity, they frequently lack reliable diagnostic tests. As such, technologies that can identify key moieties in central sensitization disorders may contribute to the identification of novel therapeutic targets and more precise treatment options. The analysis of small molecules in biological samples through metabolomics has improved greatly and may be the technology needed to identify key moieties in difficult to diagnose diseases. In this review, we discuss the current state of metabolomics as it relates to central sensitization disorders. From initial literature review until Feb 2020, PubMed, Embase, and Scopus were searched for applicable studies. We included cohort studies, case series, and interventional studies of both adults and children affected by central sensitivity syndromes. The majority of metabolomic studies addressing a CSS found significantly altered metabolites that allowed for differentiation of CSS patients from healthy controls. Therefore, the published literature overwhelmingly supports the use of metabolomics in CSS. Further research into these altered metabolites and their respective metabolic pathways may provide more reliable and effective therapeutics for these syndromes.
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Affiliation(s)
- Joseph S. Miller
- Department of Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin, OH 43016, USA;
| | - Luis Rodriguez-Saona
- Department of Food Science and Technology, Ohio State University, Columbus, OH 43210, USA;
| | - Kevin V. Hackshaw
- Department of Internal Medicine, Division of Rheumatology, Dell Medical School, The University of Texas, 1701 Trinity St, Austin, TX 78712, USA
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14
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D'Amico D, Raggi A, Grazzi L, Lambru G. Disability, Quality of Life, and Socioeconomic Burden of Cluster Headache: A Critical Review of Current Evidence and Future Perspectives. Headache 2020; 60:809-818. [DOI: 10.1111/head.13784] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/06/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Domenico D'Amico
- Neuroalgology Unit and Headache Center Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Licia Grazzi
- Neuroalgology Unit and Headache Center Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Giorgio Lambru
- Guy's and St Thomas' NHS Foundation Trust King's College London London UK
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15
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Sohn JH, Park JW, Lee MJ, Chung PW, Chu MK, Chung JM, Ahn JY, Kim BS, Kim SK, Choi YJ, Kim D, Song TJ, Oh K, Moon HS, Park KY, Kim BK, Bae DW, Chung CS, Cho SJ. Clinical factors influencing the impact of cluster headache from a prospective multicenter study. Sci Rep 2020; 10:2428. [PMID: 32051496 PMCID: PMC7015942 DOI: 10.1038/s41598-020-59366-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 01/23/2020] [Indexed: 01/12/2023] Open
Abstract
Although many patients with cluster headaches (CH) are disabled by their condition, few studies have examined this in detail. This cross-sectional, multicenter observational study prospectively collected demographic and clinical questionnaire data from 224 consecutive patients with CH. We assessed headache impact using the six-item Headache Impact Test (HIT-6) and evaluated the factors associated with the impact of CH. Participants with a HIT-6 score ≥ 60 were classified into a severe impact group. The majority (190, 84.8%) of the participants were classified into the severe impact group. These patients were characterized by younger age, earlier onset of CH, longer duration of each headache attack, higher pain intensity, more cranial autonomic symptoms, a higher proportion of depression or anxiety, higher score of stress, and lower score of quality of life. The anxiety (OR = 1.19, 95% CI: 1.08–1.31, p = 0.006), greater pain intensity (OR = 1.06, 95% CI: 1.02–1.10, p = 0.002), and age (OR = 0.99, 95% CI: 0.99–1.00, p = 0.008) were significant predictors for a severe impact of CH patients. According to the HIT-6 results, most of the CH patients were significantly affected by CH. As well as pain intensity, anxiety and age modulated CH’s impact on their lives.
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Affiliation(s)
- Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si, Korea
| | - Jeong-Wook Park
- Department of Neurology, Uijeongbu St.Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Mi Ji Lee
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pil-Wook Chung
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Myun Chung
- Department of Neurology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jin-Young Ahn
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Byung-Su Kim
- Department of Neurology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Soo-Kyoung Kim
- Department of Neurology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Yun-Ju Choi
- Department of Neurology, Presbyterian Medical Center, Jeonju, Korea
| | - Daeyoung Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Tae-Jin Song
- Department of Neurology, Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Heui-Soo Moon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Byung-Kun Kim
- Department of Neurology, Eulji Hospital, Eulji University, Seoul, Korea
| | - Dae-Woong Bae
- Department of Neurology, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Chin-Sang Chung
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
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16
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Development and Evaluation of a Screening Tool to Aid the Diagnosis of a Cluster Headache. Brain Sci 2020; 10:brainsci10020077. [PMID: 32024213 PMCID: PMC7071485 DOI: 10.3390/brainsci10020077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/25/2020] [Accepted: 01/30/2020] [Indexed: 01/03/2023] Open
Abstract
Cluster headache (CH), a severe primary headache, is often misdiagnosed and mismanaged. The aim of this study was to develop and evaluate a screening tool to aid the diagnosis of CH. We developed a novel 12-item screening tool. This was comprised of four components: (1) images depicting headache pain; (2) pain descriptors; (3) key questions that could differentiate between CH and migraine; and (4) a visual analogue pain scale. The total possible questionnaire score ranged from 3-32. Patients with CH and migraines (control group) were recruited prospectively from a headache centre in the North of England, UK. Two-hundred and ninety-six patients were included in the study: 81 CH patients, 36 of which suffer with episodic CH and 45 with chronic CH; 215 migraine patients, 92 of which suffer with episodic migraine and 123 with chronic migraine. The mean questionnaire score was higher in CH patients versus migraine patients (28.4 versus 19.5). At a cut-off score of >25 out of 32, the screening tool had a sensitivity of 86.4% and a specificity of 92.0% in differentiating between CH and migraine. The screening tool could be a useful instrument to aid the diagnosis of a CH. The images depicting headache pain do not clearly discriminate between CH and migraine.
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17
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Takeshima T, Wan Q, Zhang Y, Komori M, Stretton S, Rajan N, Treuer T, Ueda K. Prevalence, burden, and clinical management of migraine in China, Japan, and South Korea: a comprehensive review of the literature. J Headache Pain 2019; 20:111. [PMID: 31805851 PMCID: PMC6896325 DOI: 10.1186/s10194-019-1062-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/28/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The objective of this review was to determine the unmet needs for migraine in East Asian adults and children. METHODS We searched MEDLINE and EMBASE (January 1, 1988 to January 14, 2019). Studies reporting the prevalence, humanistic and economic burden, and clinical management of migraine in China (including Hong Kong and Taiwan), Japan, and South Korea were included. Studies conducted before 1988 (before the International Headache Society [IHS] first edition of the International Classification of Headache Disorders) were not included. RESULTS We retrieved 1337 publications and 41 met the inclusion criteria (28 from China, 7 from Japan, and 6 from South Korea). The 1-year prevalence of migraine (IHS criteria) among adults ranged from 6.0% to 14.3%. Peak prevalence ranged from 11% to 20% for women and 3% to 8% for men (30- to 49-year-olds). For children, prevalence of migraine increased with age. Information on the economic burden and clinical management of migraine was limited, particularly for children. When reported, migraine was significantly associated with high levels of disability and negative effects on quality of life. Studies suggested low levels of disease awareness/diagnosis within each country. Of individuals with migraine from China, 52.9% to 68.6% had consulted a physician previously, 37.2% to 52.7% diagnosed with headache had not been diagnosed with migraine previously, and 13.5% to 18% had been diagnosed with migraine previously. Of individuals with migraine from Japan, 59.4% to 71.8% had never consulted a physician previously, 1.3% to 7.3% regularly consulted physicians for their headache, and only 11.6% of individuals with migraine were aware that they had migraine. In addition, studies suggested that over-the-counter medication use was high and prescription medication use was low in each country. CONCLUSIONS This review suggests that there are unmet needs for migraine in terms of sufficient and appropriate diagnosis, and better management and therapies for treatment of migraine in East Asia. The findings are limited by a lack of recent information and significant gaps in the literature. More recent, population-based studies assessing disease burden and clinical management of migraine are needed to confirm unmet needs for migraine across East Asia.
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Affiliation(s)
- Takao Takeshima
- Department of Neurology, Headache Center, Tominaga Hospital, Osaka, Japan
| | - Qi Wan
- Department of Neurology, Jiangsu Province Hospital, Nanjing, China
| | | | - Mika Komori
- Medicine Development Unit-Japan, Eli Lilly Japan K.K., 5-1-28, Isogamidori, chuo-ku, Kobe, 651-0086, Japan
| | | | | | - Tamas Treuer
- GPORWE International, Lilly Hungaria Kft, Budapest, Hungary
| | - Kaname Ueda
- Medicine Development Unit-Japan, Eli Lilly Japan K.K., 5-1-28, Isogamidori, chuo-ku, Kobe, 651-0086, Japan.
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18
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Lee MJ, Cho SJ, Park JW, Chu MK, Moon HS, Chung PW, Chung JM, Sohn JH, Kim BK, Kim BS, Kim SK, Song TJ, Choi YJ, Park KY, Oh K, Ahn JY, Woo SY, Kim S, Lee KS, Chung CS. Temporal changes of circadian rhythmicity in cluster headache. Cephalalgia 2019; 40:278-287. [PMID: 31623453 DOI: 10.1177/0333102419883372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the temporal changes of circadian rhythmicity in relation to the disease course in patients with cluster headache. METHODS In this multicenter study, patients with cluster headache were recruited between September 2016 and July 2018. We evaluated the patients for circadian rhythmicity and time of cluster headache attacks in the current bout and any experience of bout-to-bout change in circadian rhythmicity. We analyzed the patterns of circadian rhythmicity in relation to the disease progression (the number of total lifetime bouts, grouped into deciles). RESULTS Of the 175 patients in their active, within-bout period, 86 (49.1%) had circadian rhythmicity in the current bout. The prevalence of circadian rhythmicity in the active period was overall similar regardless of disease progression. Sixty-three (46.3%) out of 136 patients with ≥2 bouts reported bout-to-bout changes in circadian rhythmicity. The most frequent time of cluster headache attacks was distributed evenly throughout the day earlier in the disease course and dichotomized into hypnic and midday as the number of lifetime bouts increased (p = 0.037 for the homogeneity of variance). When grouped into nighttime and daytime, nighttime attacks were predominant early in the disease course, while daytime attacks increased with disease progression (up to 7th deciles of total lifetime bouts, p = 0.001) and decreased in patients with the most advanced disease course (p = 0.013 for the non-linear association). CONCLUSIONS Circadian rhythmicity is not a fixed factor, and changes according to the disease course. Our findings will be valuable in providing a new insight into the stability of functional involvement of the suprachiasmatic nucleus in the pathophysiology of cluster headache.
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Affiliation(s)
- Mi Ji Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Jeong Wook Park
- Department of Neurology, Uijeongbu St. Mary's Hospital, Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Heui-Soo Moon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pil-Wook Chung
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Myun Chung
- Department of Neurology, Inje University College of Medicine, Seoul, Korea
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Byung-Kun Kim
- Department of Neurology, Eulji University School of Medicine, Seoul, Korea
| | - Byung-Su Kim
- Department of Neurology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Soo-Kyoung Kim
- Department of Neurology and Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University College of Medicine, Seoul Hospital, Seoul, Korea
| | - Yun-Ju Choi
- Department of Neurology, Presbyterian Medical Center, Jeonju, Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Seoul, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Jin-Young Ahn
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Sook-Young Woo
- Statistics and Data Center, Samsung Medical Center, Seoul, Korea
| | - Seonwoo Kim
- Statistics and Data Center, Samsung Medical Center, Seoul, Korea
| | - Kwang-Soo Lee
- Department of Neurology, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chin-Sang Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Jumani L, Kumari R, Kataria D, Kumar V, Usama SM, Chandnani A, Zubair U. Depression Among Patients with Chronic Cluster Headaches. Cureus 2019; 11:e5912. [PMID: 31788372 PMCID: PMC6855994 DOI: 10.7759/cureus.5912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction: Chronic headaches account for a significant proportion of people leading a poor quality of life. Chronic cluster headaches can be defined as episodes of headache usually around the eye in the pattern of a cluster lasting 15-180 minutes each followed by multiple similar episodes occurring at a frequency of 1-8 times per day. Method: This cross-sectional study was conducted in Jinnah Postgraduate Medical Center, Karachi. One hundred patients who were diagnosed cases of chronic cluster headaches were asked to fill the Beck Hopelessness Scale (BHS), Headache Impact Test (HIT), and Hospital Anxiety and Depression Scale (HADS). Results: Of our study subjects, 57 were males and 43 were females. The mean HIT-6 score among these patients was found to be 60.5±7.67 (p-value = 0.04). The mean BHS score among these patients was found to be 13±6.87. The mean HADS reporting anxiety (HADS-A) was found to be 12.54 ± 5.65; whereas, the mean HADS reporting depression (HADS-D) was found to be 7.65 ± 4.65. Conclusion: Patients with chronic cluster headaches have higher scores than the general population. There is an association between headache syndromes and depression which require further investigation.
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Affiliation(s)
- Laraib Jumani
- Internal Medicine, Pakistan Institute of Medical Sciences, Islamabad, PAK
| | - Reema Kumari
- Internal Medicine, Chandka Medical College Hospital, Larkana, PAK
| | - Deepak Kataria
- Internal Medicine, Chandka Medical College Hospital, Larkana, PAK
| | - Vinesh Kumar
- Internal Medicine, Ghulam Mohammad Mahar Medical College, Sukkur, PAK
| | | | - Aakash Chandnani
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Ujala Zubair
- Miscellaneous, Dow University of Health Sciences, Karachi, PAK
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20
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Cho SJ, Lee MJ, Kim BK, Moon HS, Chung PW, Sohn JH, Kim SK, Choi Y, Song TJ, Kim JM, Kim D, Park JW, Park KY, Chung JM, Ahn JY, Kim BS, Oh K, Bae DW, Chu MK, Chung CS. 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; 14:e0221155. [PMID: 31449536 PMCID: PMC6709915 DOI: 10.1371/journal.pone.0221155] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 07/31/2019] [Indexed: 01/31/2023] Open
Abstract
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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Affiliation(s)
- Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Mi Ji Lee
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Kun Kim
- Department of Neurology, Eulji University School of Medicine, Seoul, Korea
| | - Heui-Soo Moon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pil-Wook Chung
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Soo-Kyoung Kim
- Department of Neurology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Yunju Choi
- Department of Neurology, Presbyterian Medical Center, Jeonju, Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jae-Moon Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Daeyoung Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jeong Wook Park
- Department of Neurology, Uijeongbu St.Mary’s Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae-Myun Chung
- Department of Neurology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jin-Young Ahn
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Byung-Su Kim
- Department of Neurology, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Dae-Woong Bae
- Department of Neurology, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University School of Medicine, Seoul, Korea
- * E-mail:
| | - Chin-Sang Chung
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Andrée C, Gantenbein AR, Sandor PS, Schoenen J, Pohl H. The EUROLIGHT cluster headache project: Description of methods and the study population – An Internet-based cross-sectional study of people with cluster headache. CEPHALALGIA REPORTS 2019. [DOI: 10.1177/2515816319863123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objective: To present the methodology and to describe the sample of a large, Internet-based survey on the burden of cluster headache (CH). Methods: Participants filled out a questionnaire online. Inclusion criteria were a reported diagnosis of CH and a residency in a European country; exclusion criteria were refusal to give informed consent and to complete the questionnaire. Results: A total of 1514 participants completed the questionnaire. Of these, 66.2% were male and 31.2% reported suffering from chronic CH. The diagnosis was validated based upon the responses in 92.9% of the participants. Other diagnoses seemed more likely in 0.8%. Among the participants with self-reported chronic CH, the International Classification of Headache Disorders-3 beta criteria for chronicity were fulfilled by 90.8%. Conclusions: In this article, we discuss the applied methodology as well as the properties of the sample. The overall accuracy of the self-reported diagnoses was very good as judged by our questionnaire; women and chronic CH were slightly over-represented. We will present the results of more thorough analyses in future articles and believe that these data will provide deeper insights into the burden of CH and will help to give a voice to those who endure this painful disease.
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Affiliation(s)
- Colette Andrée
- Migraine Action Switzerland, Bottmingen, Switzerland
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Andreas R Gantenbein
- RehaClinic Bad Zurzach, Bad Zurzach, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Peter S Sandor
- RehaClinic Bad Zurzach, Bad Zurzach, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Jean Schoenen
- Headache Research Unit, Department of Neurology, Citadelle Hospital, University of Liège, Liège, Belgium
| | - Heiko Pohl
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
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22
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Al-Hashel J, Ibrahim I, Youssry D, Ahmed SF, Goadsby P. Cluster Headache in Kuwait: A Hospital-Based Study. Front Neurol 2019; 10:573. [PMID: 31214109 PMCID: PMC6558162 DOI: 10.3389/fneur.2019.00573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/15/2019] [Indexed: 01/03/2023] Open
Abstract
Background: Cluster headache (CH) is a relatively uncommon primary headache disorder. Few studies in our region described CH. We aimed to study demographics, clinical characteristics and treatment modalities of CH patients referred to Headache Clinic in Kuwait. Materials and Methods: This cross-sectional study included all CH patients who are referred to headache clinic. The diagnosis of CH based on the CH diagnostic criteria of the Headache Classification Committee of the IHS, 3rd edition (beta version) (ICHD-3-beta). The demographics, clinical characteristics and treatment modalities of CH patients were recorded. Results: Forty six patients were diagnosed with CH which constituted 1.7% of all headache patients and 0.1% of all visits to Neurology clinic. Male:Female ratio was 15.3:1. Mean age was 40.1 ± 10.7 years and mean age at onset was 29 years (20-49). Family history was positive in 6.5%. Smoking was seen in 63.0% of patients while 6.5 % reported alcohol intake. CH was episodic in 84.4% and chronic in 15.2%. Seasonal predilection was seen in all patients; the most frequent season was Autumn 47.8%. The mean duration of the cluster bouts was 6 weeks (2-12 weeks). The mean duration of the attack was 60 min (15-180 min). Number of attacks per day ranged from 2 to 10 attacks with a mean of 5 attacks/day. The median of attack severity by Visual Analog Scale (VAS) was 8.5 (7-10). The time taken to diagnose the patients ranged from <1 year to 12 years with a mean of 4 years. Chronic CH have a statically significant relation with smoking (P = 0.036), older age (P = 0.027), and longer time taken to diagnosis (P = 0.026) compared to episodic CH. Conclusion: Our results reported that there is higher proportion of males compared to females and less positive family history. Smoking was a significant risk factor for chronicity in addition to advanced age, higher age at disease onset and a longer time taken till diagnosis.
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Affiliation(s)
- Jasem Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait
- Department of Medicine, Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait
| | - Ismail Ibrahim
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait
| | - Doaa Youssry
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait
- Department of Neurology, Cairo University, Cairo, Egypt
| | - Samar Farouk Ahmed
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait
- Department of Neuropsychiatry, Minia University, Minia, Egypt
| | - Peter Goadsby
- Department of Basic and Clinical Neuroscience, Headache Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, United Kingdom
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Limmer AL, Holland LC, Loftus BD. Zonisamide for Cluster Headache Prophylaxis: A Case Series. Headache 2019; 59:924-929. [PMID: 31038740 DOI: 10.1111/head.13546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is very little literature surrounding the prophylactic use of zonisamide in cluster headaches. The study aims to evaluate the effectiveness of zonisamide for prophylaxis of cluster headache in patients with chronic or episodic cluster headache. BACKGROUND Both chronic and episodic cluster headaches are debilitating disorders which are often refractory to multiple prophylactic medication regimens. There is a scarcity of research in this area, and current prophylactic options for patients are fairly limited, which is troublesome for affected patients. Zonisamide is an established antiepileptic with a multifactorial mechanism of action which has shown to be useful in other headache disorders such as migraine. METHODS Twenty cluster headache patients, both episodic (n = 12; ICHD 3.1.1) and chronic (n = 8; ICHD 3.1.2), who had been or currently were treated with zonisamide, were retrospectively evaluated. Effectiveness of the medication was assessed and identified as headache remission or a reduction in severity or frequency of cluster headache of greater than 50%. Responder status, side effects, and dosage were recorded. RESULTS Fourteen (70%) patients responded to zonisamide treatment, while 6 (30%) did not. Recorded effective plasma zonisamide levels ranged from 10.2 to 31.9 μg/mL. Of the 6 non-responders, 2 stopped the medication due to ineffectiveness, while 4 discontinued the medication secondary to intolerable side effects ranging from gastrointestinal upset to malaise. No more serious adverse events occurred. Eight patients total experienced weight loss/anorexia which many perceived as a positive effect; they lost an average of 10.5% of their body weight in the first 6 months of therapy. CONCLUSIONS Zonisamide appears to be an effective prophylactic treatment for patients with chronic and episodic cluster headache disorders. Further research in this area is clearly warranted.
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Affiliation(s)
| | | | - Brian D Loftus
- McGovern Medical School at UTHealth, Houston, TX, USA.,Bellaire Neurology, PA, Bellaire, TX, USA
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Moon HS, Cho SJ, Kim BK, Lee MJ, Chung PW, Sohn JH, Kim SK, Choi YJ, Song TJ, Kim JM, Park JW, Park KY, Chung JM, Ahn JY, Kim BS, Oh K, Lee KS, Chung CS, Chu MK. 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; 39:900-907. [DOI: 10.1177/0333102419837159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
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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Affiliation(s)
- Heui-Soo Moon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Byung-Kun Kim
- Department of Neurology, Eulji University School of Medicine, Seoul, Korea
| | - Mi Ji Lee
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pil-Wook Chung
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Soo-Kyoung Kim
- Department of Neurology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Yun-Ju Choi
- Department of Neurology, Presbyterian Medical Center, Jeonju, Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jae-Moon Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jeong Wook Park
- Department of Neurology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae-Myun Chung
- Department of Neurology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jin-Young Ahn
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Byung-Su Kim
- Department of Neurology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Kwang-Soo Lee
- Department of Neurology, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chin-Sang Chung
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University School of Medicine, Seoul, Korea
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Song TJ, Lee MJ, Choi YJ, Kim BK, Chung PW, Park JW, Chu MK, Kim BS, Sohn JH, Oh K, Kim D, Kim JM, Kim SK, Park KY, Chung JM, Moon HS, Chung CS, Ahn JY, Cho SJ. Differences in Characteristics and Comorbidity of Cluster Headache According to the Presence of Migraine. J Clin Neurol 2019; 15:334-338. [PMID: 31286705 PMCID: PMC6620459 DOI: 10.3988/jcn.2019.15.3.334] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 01/25/2019] [Accepted: 01/30/2019] [Indexed: 12/16/2022] Open
Abstract
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), p=0.008], a lower frequency of episodic CH (50.0% vs. 73.5%, p=0.010), and a higher frequency of chronic CH (13.3% vs. 3.7%, p=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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Affiliation(s)
- Tae Jin Song
- Department of Neurology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Mi Ji Lee
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun Ju Choi
- Department of Neurology, Presbyterian Medical Center, Jeonju, Korea
| | - Byung Kun Kim
- Department of Neurology, Eulji Hospital, Eulji University, Seoul, Korea
| | - Pil Wook Chung
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Wook Park
- Department of Neurology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Seoul, Korea
| | - Byung Su Kim
- Department of Neurology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Jong Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Daeyoung Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jae Moon Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Soo Kyoung Kim
- Department of Neurology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Kwang Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Seoul, Korea
| | - Jae Myun Chung
- Department of Neurology, Inje University College of Medicine, Seoul, Korea
| | - Heui Soo Moon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chin Sang Chung
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Young Ahn
- Department of Neurology, Seoul Medical Center, Seoul, Korea.
| | - Soo Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
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