• Journal of Oral Medicine and Pain
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• 제39권3호
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• pp.115-118
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• 2014

A 50-year-old female patient with severe unilateral pain in the right eye, head, and face accompanied by lacrimation and drooping of the right eye and rhinorrhea from the right nose, which developed immediately after extraction of the maxillary right first and second molars, was successfully treated with oral administration of sumatriptan and prednisolone, or verapamile. Although the clinical characteristics are similar to those reported in cluster headache except the temporal feature, the probable cluster headache, the hemicrania continua and the acute migraine headache should be included in the list of differential diagnoses.

• 문화기술의 융합
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• 제9권4호
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• pp.503-508
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• 2023

트립탄 유도체는 급성 편두통을 치료하는 물질로 크로마토그래피, 전기화학, 분광학 및 모세관 전기영동학 등의 분석법과 관련된 연구가 많이 진행되었다. 최근 분석화학자들의 약물 분석과 생물학적 중요성에 대한 근본적인 문제 해결에 더욱 관심이 깊어지고 있다. 따라서 본 연구에서는 트립탄 유도체의 분자단위 수준의 구조적 특성을 알아보기 위하여 HyperChem8.0의 반경험적 PM3 방법을 이용하여 수마트립탄, 리자트립탄, 나라트립탄 그리고 엘레트립탄의 전체에너지, 밴드갭, 정전포텐셜, 전하량을 계산하여 각 유도체의 분자 구조적 변화에 따른 화학적 특성을 조사하였다. 본 연구의 결과 수마트립탄, 나라트립탄 그리고 엘레트립탄의 경우 황 원자에 결합된 산소와 질소 원자를 중심으로 화학작용이 진행될 것으로 예상된다. 또한, 황원자가 없는 리자트립탄의 경우는 5원헤테로 고리화합물의 17, 19번 질소에서 화학작용이 진행될 것으로 나타났다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제21권5호
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• pp.379-396
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• 2021

Background: Trigeminal neuralgia (TN) is characterized by brief, unilateral, sharp, stabbing, and shooting pain of the fifth cranial nerve. The objective of this systematic review with meta-analysis was to determine the effect of medications compared to placebo in adult patients with TN. Methods: Review authors identified randomized placebo-controlled trials (RCTs) from PubMed, Web of Science, Cochrane, and EMBASE up to February 2021. We assessed the inclusion and exclusion criteria as well as the risk of bias of the studies based on the Cochrane Handbook. A total of 324 unduplicated references were scanned independently and reduced to eight relevant RCTs, with 89 patients included. Medications investigated included oral carbamazepine, subcutaneous sumatriptan, lidocaine (intranasal, 8% spray on the oral mucosa or intravenous), buprenorphine (ganglionic local opioid analgesia), and oral Nav1.7, a selective sodium channel blocker. Results: Meta-analyses showed that overall patients receiving lidocaine reported a significantly lower post-treatment intensity of pain -3.8 points on a 0-10 scale (95% Cl = -4.653 to -2.873; P < 0.001). Patients who received lidocaine were 8.62 times more likely to have pain improvement than patients on placebo (P < 0.001). In one RCT, patients receiving oral carbamazepine showed a significant improvement in pain intensity of -32% compared to the placebo (P < 0.001). In one trial, patients receiving 3 mg subcutaneous sumatriptan had a significantly lower intensity of pain on average -6.1 points on a scale of 0-10 compared to placebo (P < 0.001) and a significant improvement in pain intensity of -75% compared to the improvement in the placebo group (P < 0.001). Patients who received subcutaneous sumatriptan were 10 times more likely to have pain improvement than those who received placebo (P = 0.001) in one study. Due to the unclear/high risk of bias and small sample size, the quality of the evidence for lidocaine in the treatment of TN was low. Conclusion: Further studies are needed for carbamazepine, sumatriptan, buprenorphine, and oral Nav1.7 sodium channel blockers, as only one study reported outcomes.

• 한국임상약학회지
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• 제15권2호
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• pp.160-164
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• 2005

수마트립탄은 뇌혈관에 분포되어 있는 5-HT1B/1D수용체에 특이적이고 선택적으로 작용하여 뇌혈관 수축 작용을 나타내어 편두통의 치료에 널리 쓰이는 약물이다. 본 연구는 수마트립탄 제제인 이미그란(50 mg tablet, GSK사)을 대조약으로 하여 시험약인 명인 제약의 수마트란 50mg정의 생물학적 동등성 평가를 하기 위해 22명의 건강한 지원자를 모집하였다. 지원자를 두 군으로 나누어 1정씩 투여하였고 $2{\times}2$ 교차시험을 실시하였다. 수마트립탄의 혈장 중의 농도를 정량하기 위하여 발리데이션된 HPLC/FD를 사용하였다. 채혈 시간은 투약 전 및 투약 후 0.5, 1, 1.5, 2, 2.5, 3,4, 5, 7, 9, 12시간에 걸쳐 총 12시점에 걸쳐 시행하였다. 생물학적 동등성을 판정하기 위한 파라미터로 12시간까지의 혈장 중 농도 곡선 하 면적$(AUC_{12hr})$ 최고 혈중 농도$(C_{max})$를 사용하였다. $AUC_{12hr}$의 평균은 $137.87ng{\cdot}ml/hr$(시험약)과 $130.12ng{\cdot}ml/hr$(대조약)으로 나타났다. $C_{max}$의 경우 각 각 29.30 ng/ml(시험약)과 29.25ng/m1(대조약)으로 관찰되었다. $AUC_{12hr}$의 경우 로그변환 한 평균치 차의 90% 신뢰구간이 log0.95-log1.24이었고, $C_{max}$의 경우 log0.90-log1.149로 계산되 어 두 항목 모두 log0.8-log1.25이어야 한다는 식품의 약품 안전청 과 FDA의 기준을 모두 만족시켰다. 이상의 결과를 종합하면 시험약 수마트란 정 50 mg은 대조약 이미그란 정 50 mg에 대하여 생물학적으로 동등한 것으로 판정되었다.

• Journal of Oral Medicine and Pain
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• 제43권3호
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• pp.92-96
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• 2018

A 39-year-old male presented with severe pain in right posterior mandibular teeth and temporal area. Initially, the pain in the mandibular teeth was moderate, but the concomitant headache was unbearably severe. His medical history was non-contributory. The clinical and radiographic examination failed to reveal any pathology in the region. There was no tenderness to palpation in the temporalis and masseter muscles or temporomandibular joints. The clinical impression was migraine. The pain in the teeth and headache were aborted using ergotamine tartrate and sumatriptan succinate. Atenolol prevented further pain, while amitriptyline and imipramine had no effect. Migraine can present as non-odontogenic pain in the mandibular teeth, although not as frequently as in the maxillary teeth. A correct diagnosis is essential to avoid unnecessary dental treatments and to manage pain effectively. Clinicians should be able to identify migraine with non-odontogenic dental pain and establish a proper diagnosis through a comprehensive evaluation.

• 정신신체의학
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• 제7권2호
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• pp.263-273
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• 1999

두통은 인류의 가장 흔한 호소 중의 하나로 임상에서 흔히 보는 장애이다. 두통은 뇌막염, 뇌출혈, 또는 뇌종양과 같은 다른 질환의 증상일수 있으나, 또한 편두통이나 군발두통 등과 같은 질병 자체로 표현된다. 일차적으로 두통 장애의 역학이나 국제 두통학회의 진단기준을 이해하고 흔치 않으나 심각한 이차적인 두통장애와 감별에 관심을 둬야 한다. 환자가 일차 두통장애의 기준에 맞으면 신경학적 진단검사의 보충이 없어도 치료를 시작한다. 두통 유형, 표현 양상, 동통기간과 강도 등에 따라 진통소염제나 혼합진통제, 혈관작용의 항편두통 약물 또는 신경이완제나 corticosteroid등을 선택한다. 편두통의 빈도와 강도에 따라 예방치료가 보통 4~6개월간 조절한다. 긴장형 두통은 발작성과 만성두통으로 구분되나 치료적으로는 급성완화와 예방치료로 시도된다. 많은 만성매일두통 환자들이 진통제나 ergotamine을 과용하고 있으며 그들의 의존성과 내재된 갈등조절, 수면장애, 우울등으로 과용된 약물의 제한이 쉽지 않다. 치료의 첫단계는 약물을 끊고 조심스럽게 대치요법을 시행한다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제18권4호
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• pp.224-229
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• 2015

Cyclic vomiting syndrome (CVS) is a functional disorder characterized by stereotypical episodes of intense vomiting separated by weeks to months. Although it can occur at any age, the most common age at presentation is 3-7 years. There is no gender predominance. The precise pathophysiology of CVS is not known but a strong association with migraine headaches, in the patient as well as the mother indicates that it may represent a mitochondriopathy. Studies have also suggested the role of an underlying autonomic neuropathy involving the sympathetic nervous system in its pathogenesis. CVS has known triggers in many individuals and avoiding these triggers can help prevent the onset of the episodes. It typically presents in four phases: a prodrome, vomiting phase, recovery phase and an asymptomatic phase until the next episode. Complications such as dehydration and hematemesis from Mallory Wise tear of the esophageal mucosa may occur in more severe cases. Blood and urine tests and abdominal imaging may be indicated depending upon the severity of symptoms. Brain magnetic resonance imaging and upper gastrointestinal endoscopy may also be indicated in certain circumstances. Management of an episode after it has started ('abortive treatment') includes keeping the patient in a dark and quiet room, intravenous hydration, ondansetron, sumatriptan, clonidine, and benzodiazepines. Prophylactic treatment includes cyproheptadine, propranolol and amitriptyline. No mortality has been reported as a direct result of CVS and many children outgrow it over time. A subset may develop other functional disorders like irritable bowel syndrome and migraine headaches.

• The Korean Journal of Pain
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• 제18권1호
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• pp.64-68
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• 2005

Migraine is a disabling headache that can occur with or without aura. We present here a case of migraine that was effectively managed by a series of cervical epidural blocks. A 41-year-old woman who had suffered from severe headache on her left temporal area for 12 years visited our pain clinic. Her 11-point numeric pain rating scale was 10 out of 10 at the first visit and the symptoms were associated with homonymous visual disturbances, paresthesia on the left face, shoulder and arm, and general weakness. For the first 5 years after the headaches began, her headache was relatively well controlled by acetaminophen; after then, the acetaminophen wasn't effective. After wandering from this hospital to the next one in search of relief, she managed to visit our pain clinic. We tried several blocks including cervical epidural block, and she was continuously medicated with sumatriptan. Her headache was gradually relieved. Now, her 11-point numeric rating scale is 1-2 out of 10 at the most during her headache attacks.

• 한국임상약학회지
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• 제31권1호
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• pp.35-43
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• 2021

Background: Migraine is a common neurological disorder that affects the quality of life and causes several health problems. Preventive migraine treatment can reduce migraine frequency, headache severity, and health care costs. This study aimed to estimate the utilization of migraine preventive therapy and associated factors in eligible patients. Methods: We studied 534 patients with migraine who were eligible for migraine preventive therapy using 2017 National Patient Sample (NPS) data from the Health Insurance Review and Assessment Service (HIRA). We estimated the migraine days by calculating the monthly average number of defined daily dose (DDD) of migraine-specific acute drug. Patients with a monthly average number of DDD of 4 or more were considered as subjects for preventive treatment. Chi-square test and multiple logistic regression analysis were used to determine the association between the preventive therapy and the influencing variables. Results: Less than half of the eligible patients for prophylaxis (n=234, 43.8%) were prescribed preventive therapy. Multiple logistic regression results show that migraine preventive therapy was influenced by age, the type of migraine, and some comorbidities. Patients over the age of 50 tend to receive less prophylactic treatment than under the age of 40. On the other hand, migraine patients with epilepsy or depression were more likely to receive preventive therapy. Sumatriptan was the most preferred medication for acute treatment, and propranolol was the most commonly prescribed drug for prevention. Conclusions: More than half of the patients who were candidates for migraine prophylaxis were not receiving suitable preventive treatment. Positive factors affecting the use of migraine prevention were the presence of comorbidities such as epilepsy and depression.

• 한국보건간호학회지
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• 제16권1호
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• pp.176-189
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• 2002

The purpose of this study were to illustrate the various medication error types and causes and identified to related drugs to provide basic data for preventing nurses' medication error by analysing 73 cases of AJN 'medication Error' column(1993, Oct -2000, Nov). Nurses' types of medication error were classified into 7 types. The most frequent error types are wrong medication$(21.9\%)$ and the wrong dose$(21.9\%)$ together. The others are wrong $time(4.1\%)$, $omission(2.7\%)$, mechanical $error(2.7\%)$, incorrect IV $rate(1.4\%)$. wrong route $administration(1.4\%)$ in order. Nurses' causes of medication error were 9 kinds. The most frequent type is confusing between similar drug shape, color, size, name, injection devices and patient's $name(43.9\%)$ and the others are lack of knowledge about $drugs(26.8\%),\; slips(7.3\%),\; miscalculating\;dose(4.9\%)$, incorrect adjusts $devices(4.9\%)$, difficulty to read or illegible decimal $point(4.9\%),$ $abbreviation(2.4\%)$, fatigue with $overwork(2.4\%)$ and no communication with $patient(2.4\%)$ in order. Related drugs with medication error are as follows. - dose unit(IU. minims. mcg/min. mEq) : Heparin. insulin. synthetic calcitonin, some enzymes and hormones, vitamins, some antibiotics, tuberculin injection. MgSO4 injection. nitroglycerin - similar size, color and shape drug : $0.9\%$ N/S and acetic acid $0.25\%$ for irrigation. premixed 2mg lidocaine sol. and $0.9\%$ N/S, gentamycin 20mg/2mL for children and 80mg/2mL for adult, dextroamphetamine 5mg and 10mg capsule. sedatives chloral hydrate 250mg/5mL and 500mg/5mL - similar name :Aredia(pamidronate disodium) and Adriamycin(doxorubicin), Lamictal (lamotrigine) and Lamisil 250mg. Elderpryl and enalapril, cefotaxime and cefoxitin, carboplatin and cisplatin, sumatriptan and zolmitriptan, Celebrex and Celexa, Humulin and Humalog, Percodan and Percocet, Diabeta and Diabinese, Epivir and Retrovir, Xanax(alprazolam) and Zantac(ranitidine) - decimal point : low molecular weight warfarin, methotrexate - unfamiliar drug uses of familiar drug ; methotrexate. droperidol, imipramine, propranolol - number of drug name(misleading chemical name) : 6-thioguanine, 6-mercaptopurine, 5-fluorouracil - type of administration route : Oxycodone(OxyContin). - administration time : acarbose(Precose). - injection way (Z-track method): hydroxyzine - epidural cathether : LMWHs(enoxaparin, dalteparin), - ADD Vantage self contained delivery system : ceftriaxone(Rocephin)