Heewon Hwang

Background: Time in headache disorders is crucial for diagnosis and gives insight into headache pathophysiology. Objective: To summarize published studies which describe timing processes in both attack presentation (onset, duration) and disease characterization (age of onset, evolution over time) in primary headache disorders and link to pathophysiology. Methods: A comprehensive search was conducted through Ovid MEDLINE(R) and PubMed, focusing on English-language articles from 1946 to 2023 to write the review. The International Classification of Headache Disorders, 3rd edition provided the framework for the review of primary headache disorders (migraine, tension-type headache and cluster headache). Results: Attack presentation: Migraine attacks exhibit significant circadian and infradian rhythms, influenced by hormonal levels, light sensitivity, and hypothalamic activation. Tension-type headache lacks clear chronobiological patterns, with limited understanding of its underlying mechanisms. Cluster headache displays a distinct circannual pattern, with attacks often occurring at night and relevant involvement of the hypothalamus. Disease characterization: Age of onset exhibits the earliest peak in migraine; frequency and typical features of primary headache disorders decrease over time. Conclusion: This comprehensive analysis of time patterns in primary headache disorders underscores their role in phenotyping, understanding and treating primary headache disorders, offering promising avenues for advancing and tailoring headache management.

Hwang H, et al. J Korean Med Sci. 2024 Jul;39:e257. https://doi.org/10.3346/jkms.2024.39.e257

Distinguishing syncope from epileptic seizures in patients with sudden loss of consciousness is important. Various blood tests have been used to indicate epileptic seizures in patients with impaired consciousness. This retrospective study aimed to predict the diagnosis of epilepsy in patients with transient loss of consciousness using the initial blood test results. A seizure classification model was constructed using logistic regression, and predictors were selected from a cohort of 260 patients using domain knowledge and statistical methods. The study defined the diagnosis of seizures and syncope based on the consistency of the diagnosis made by an emergency medicine specialist at the first visit to the emergency room and the diagnosis made by an epileptologist or cardiologist at the first outpatient visit using the International Classification of Diseases 10th revision (ICD-10) code. Univariate analysis showed higher levels of white blood cells, red blood cells, hemoglobin, hematocrit, delta neutrophil index, creatinine kinase, and ammonia levels in the seizure group. The ammonia level had the highest correlation with the diagnosis of epileptic seizures in the prediction model. Therefore, it is recommended to be included in the first examination at the emergency room.

Kim KM, et al. Korean J Radiol. 2023 Feb;24(2):168-169. https://doi.org/10.3348/kjr.2022.1000

Kim KM, et al. Korean J Radiol. 2022 Nov;23:e72. https://doi.org/10.3348/kjr.2022.0539

Objective: To investigate crystal‐clear days and unclear days in participants with migraine. Background: Migraine affects individuals during the headache‐free period. Therefore, headache‐free days do not indicate migraine symptom‐free days. Crystal‐clear days can be characterized by days without headache and having minimal or no migraine symptoms. In contrast, days without headache, but with more than minimal migraine symptoms, can be defined as unclear days. Methods: We used the baseline respondent data set of the Circannual Change in Headache and Sleep study, a nationwide population survey on headache and sleep. This study was a cross‐sectional and case–control analysis of longitudinally collected data. The number of crystal‐clear days per 30 days was assessed by asking “How many days have you had crystal‐clear days without headache during the previous 30 days?”. We defined headache‐free, but not crystal‐clear days, as unclear days. The number of unclear days per 30 days was calculated as follows: 30 – the number of headache days per 30 days – the number of crystal‐clear days per 30 days. Results: Of 170 participants with migraine, 165 (97.1%) had unclear days. The numbers of crystal‐clear days (median [interquartile range] 20.0 [15.0–25.0] vs. 25.0 [20.0–29.0], p < 0.001) and unclears days (4.0 [0.0–8.0] vs. 1.0 [0.0–7.0], p < 0.001) per 30 days in participants with migraine were significantly lower and higher, respectively, than in those with non‐migraine headache. Headache days (incident rate ratio and 95% confidence interval, 0.94 [0.90–0.97], p < 0.001) and weekly average sleep duration (0.95 [0.91–1.00], p = 0.035) were significant factors for crystal‐clear days. Conclusions: The number of crystal‐clear days were different from that of headache‐free days. Almost all participants with migraine had unclear days. Our findings will facilitate understanding the symptoms and burden of migraine.

Journal of Intraoperative Neurophysiology는 수술중신경계감시 및 관련분야에 종사하는 의사, 보건의료인 및 기초 연구자들을 대상으로 하며, 수술중신경계감시와 관련분야의 모든 연구 결과 및 최신 소견 등을 게재한다. 타 학회지에 이미 게재된 내용의 원고는 게재하지 않으며, 본 학회지에 게재된 것을 임의로 다른 잡지에 게재할 수 없음을 원칙을 한다