Smoking History and Clinical Features of Cluster Headache: Results from the Korean Cluster Headache Registry

정필욱,김병수,박정욱,손종희,이미지,김병건,주민경,안진영,최윤주,송태진,배대웅,김대영,김재문,김수경,박광열,정재면,문희수,오경미,정진상,조수진 대한신경과학회 2021 Journal of Clinical Neurology Vol.17 No.2

Background and Purpose Epidemiologic data suggest that cluster headache (CH) is significantly associated with cigarette smoking. The aim of this study was to determine differences in features between patients with a smoking history and those who are never-smokers, using data from a prospective multicenter registry. Methods Data used in this study were obtained from the Korean Cluster Headache Registry that collected data from consecutive patients diagnosed with CH. We compared clinical and demographic features between ever-smokers (current or former smokers) and never-smokers. Results This study enrolled 250 patients who were diagnosed with CH, of which 152 (60.8%) were ever-smokers and 98 (39.2%) were never-smokers. The age at CH onset was significantly lower in the never-smoker group than in the ever-smoker group [27.1±12.9 years vs. 30.6± 10.9 years (mean±standard deviation), p=0.024]. Seasonal rhythmicity (58.1% vs. 44.7%, p= 0.038) and triptan responsiveness (100% vs. 85.1%, p=0.001) were higher in never-smokers, while other clinical features such as pain severity, duration, attack frequency, and associated autonomic symptoms did not differ significantly between the groups. The male-to-female ratio was markedly higher in ever-smokers (29.4:1) than in never-smokers (1.7:1). Conclusions Most of the clinical features did not differ significantly between patients with a smoking history and never-smokers. However, the age at CH onset, sex ratio, and seasonal rhythmicity were significantly associated with smoking history.

임상추론: 심한 일측성 두통으로 방문한 51세의 여성

정필욱,문희수 대한신경과학회 2019 대한신경과학회지 Vol.37 No.4

Development and Validation of the Cluster Headache Screening Questionnaire

정필욱,조수진,김병건,김수경,이미지,최윤주,박정욱,김병수,오경미,문희수,송태진,강단비,조주희,정진상 대한신경과학회 2019 Journal of Clinical Neurology Vol.15 No.1

diagnosis is delayed. We addressed this issue by developing the self-administered Cluster Headache Screening Questionnaire (CHSQ). Methods Experts selected items from the diagnostic criteria of CH and the characteristics of migraine. The questionnaire was administered to first-visit headache patients at nine headache clinics. The finally developed CHSQ included items based on the differences in responses between CH and non-CH patients, and the accuracy and reliability of the scoring model were assessed. Results Forty-two patients with CH, 207 migraineurs, 73 with tension-type headache, and 18 with primary stabbing headache were enrolled. The CHSQ item were scored as follows: 3 points for ipsilateral eye symptoms, agitation, and duration; 2 points for clustering patterns; and 1 point for the male sex, unilateral pain, disability, ipsilateral nasal symptoms, and frequency. The total score of the CHSQ ranged from 0 to 16. The mean score was higher in patients with CH than in non-CH patients (12.9 vs. 3.4, p<0.001). At a cutoff score of >8 points, the CHSQ had a sensitivity, specificity, positive predictive value, and negative predictive value of 95.2%, 96%, 76.9%, and 99.3%, respectively. Conclusions The CHSQ is a reliable screening tool for the rapid identification of CH.

군발두통 무작위대조시험에서의 남녀 성비율의 변화에 대한 연구

정필욱,문희수 대한두통학회 2023 두통 Vol.24 No.2

Background: Although cluster headache (CH) is well known as a disorder of predominantly young males, the male to female ratio decreased from 5-7:1 before 1980s to -2:1 in the 2000s and afterward in Western observational studies. It is unclear whether this represents a true rise of CH in women or better recognition of CH in women. We sought to assess whether the sex ratio of CH were changing or not in randomized controlled trials (RCTs) over time in accordance with observational studies. Methods: We included RCTs regarding pharmacologic medication, as well as procedural and surgical treatment, devices. Time trend of sex ratio was compared among 3 different publication era (1985-2000 vs 2001-2010 vs 2011-). Sex ratio between different cluster headache type (Episodic vs Chronic) was also compared. Results: 22 acute treatment trials and 25 preventive treatment trials were initially selected for inclusion. 5 acute treatment trials and 10 preventive treatment trials were excluded due to small sample size (n<20) and/or no demographic information. All studies were underwent in western countries. Of 32 trials finally included, 10 studies were published between 1985 to 2000 (1st era), 8 studies from 2001 to 2010 (2nd era), 14 studies after 2010 (3rd era). Of the 2,476 patients, 80% were male. Secular tendency of decreasing male predominance was shown over time. 542 of 623 patients (87%) were male in 1st era, while 83% were male in 2nd era, and 75.3% were male in 3rd era (p<0.001). Male to female ratio was 6.7:1 in 1st era, 4.9:1 in 2nd era, and 3:1 in 3rd era. In chronic CH, 28% of subjects were female, while in episodic CH, 14.6% were female (p<0.001) Conclusions: As suggested by observational and registry data, the population enrolled in the RCT also exhibited a decreasing trend in male predominance over time in CH.

소뇌실조증으로 발현된 HIV 감염증 1예

정필욱,문희수,김용범,안재영 대한신경과학회 2005 대한신경과학회지 Vol.23 No.1

HIV encephalopathy usually presents with progressive dementia. However the spectrum of neurological manifestations of HIV infection is wide. A 46-year-old man presented with gait disturbance and dysarthria. He was given a neurological examination, which indicated dysarthria, cerebellar ataxia, and pyramidal tract signs. The patient's cognitive functions were intact. On serological study, HIV test was positive. Brain MRI and CSF analyses showed no evidence of tumor or other CNS infection. The patient was treated with highly active anti-retroviral therapy. Three months after treatment, cerebellar ataxia was much improved.

철결핍성 빈혈과 동반된 심부뇌정맥 혈전증

정필욱,홍석찬,이광호,정진상 대한신경과학회 1999 대한신경과학회지 Vol.17 No.5

Methotrexate 저용량 정맥 요법 후 발생된 미만성 백질뇌병증 1예

정필욱,오경미,김한영,문소영,서대원 대한신경과학회 2000 대한신경과학회지 Vol.18 No.1

내경동맥폐쇄성질환환자에서의안동맥을통한측부순환의분석

정필욱 대한뇌졸중학회 2004 Journal of stroke Vol.6 No.2

B a c k g ro u n d: Transcranial Doppler ultrasonography(TCD) is a non-invasive and easily applicable method toevaluate the ophthalmic artery flow and cerebral hemodynamics. The aim of this study is to evaluate the signifi-cance of ophthalmic artery(OA) flow detected by TCD in the assessment of cerebral hemodynamics in patientswith internal carotid artery (ICA) occlusive disease. Methods: Eighty-five patients with unilateral ICA occlusionor stenosis confirmed by cerebral angiography were enrolled in this study. We evaluated the patterns of OA flowby TCD, patterns of cerebral ischemic changes on MRI, and degree of carotid stenosis assessed by angiography.The flow direction of OA were compared with degree of carotid stenosis and patterns of ischemic changes.Results: OA signals were reversed in 17(80.9%) out of 21 patients with ICA occlusion. Among the patients with90~99% ICA stenosis, OA signals were reversed in 20 patients(74%). Only one out of 29 patients showedreversed OA signal in less than 90% stenosis group. The frequency of reversal of OA flow was not significantlydifferent between positive MRI lesion (presence of territorial infarction or borderzone infarction in ICA territory)group and negative MRI lesion group in both ICA occlusion (p=0.498) and 90~99% stenosis(p=0.175) patients.Conclusion: Reversed OA flows on TCD indicate severe ICA stenosis of more than 90%. But OA collateral flowhas little significance in cerebral hemodynamic status.

뇌교경색으로 발현된 성인 모야모야병

정필욱 대한뇌졸중학회 2005 Journal of stroke Vol.7 No.1

Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of MedicineWe report a 38-year-old woman presenting with left hemiparesis and dysarthria. Brain magnetic resonance imaging showed acute right pontine infarction. Magnetic resonance angiography and conventional angiography revealed bilateral occlusion of distal internal carotid artery and middle cerebral artery with prominent leptomeningeal collaterals compatible with moyamoya disease. Pontine infarction may develop as an initial manifestation of adult moyamoya disease.

소뇌경색으로 발현된 후하소뇌동맥류내 자발혈전증

김홍직,정필욱,김용범,문희수,서범천,윤태원,남궁동욱,박인우 대한신경과학회 2017 대한신경과학회지 Vol.35 No.2

Ischemic stroke caused by spontaneous thrombosis of posterior inferior cerebellar artery (PICA) aneurysm has been rarely reported. A 52-year-old man presented with sudden headache, dizziness, and gait disturbance. Diffusion-weighted MRI showed acute infarction in left PICA territory. A saccular aneurysm with internal thrombus at the distal PICA was detected by CT angiography and conventional angiography. The thrombus resolved spontaneously at 2 months after stroke onset with aspirin medication. At that time, endovascular coiling was underwent successfully to prevent aneurysmal rupture.