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Journal of Neurotrauma Apr 2024The first aim of the Australian Traumatic Brain Injury Initiative (AUS-TBI) encompasses development of a set of measures that comprehensively predict outcomes for people... (Review)
Review
The Australian Traumatic Brain Injury Initiative: Systematic Review and Consensus Process to Determine the Predictive Value of Pre-existing Health Conditions for People with Moderate-Severe Traumatic Brain Injury.
The first aim of the Australian Traumatic Brain Injury Initiative (AUS-TBI) encompasses development of a set of measures that comprehensively predict outcomes for people with moderate-severe TBI across Australia. This process engaged diverse stakeholders and information sources across six areas: social, health, and clinical factors; biological markers; treatments; and longer-term outcomes. Here, we report the systematic review of pre-existing health conditions as predictors of outcome for people with moderate-severe TBI. Standardized searches were implemented across databases until March 31, 2022. English-language reports of studies evaluating association between pre-existing health conditions and clinical outcome in at least 10 patients with moderate-severe TBI were included. A predefined algorithm was used to assign a judgement of predictive value to each observed association. The list of identified pre-existing health conditions was then discussed with key stakeholders during a consensus meeting to determine the feasibility of incorporating them into standard care. The searches retrieved 22,217 records, of which 47 articles were included. The process led to identification of 88 unique health predictors (homologized to 21 predictor categories) of 55 outcomes (homologized to 19 outcome categories). Only pre-existing health conditions with high and moderate predictive values were discussed during the consensus meeting. Following the consensus meeting, 5 out of 11 were included (migraine, mental health conditions, ≥4 pre-existing health conditions, osteoporosis, and body mass index [BMI]) as common data elements in the AUS-TBI data dictionary. Upon further discussion, 3 additional pre-existing health conditions were included. These are pre-existing heart disease, frailty score, and previous incidence of TBI.
PubMed: 38450564
DOI: 10.1089/neu.2023.0462 -
Phytomedicine : International Journal... May 2024Intranasal administration has been adopted in traditional medicine to facilitate access to the bloodstream and central nervous system (CNS). In modern medicine, nasal...
BACKGROUND
Intranasal administration has been adopted in traditional medicine to facilitate access to the bloodstream and central nervous system (CNS). In modern medicine, nasal drug delivery systems are valuable for disease treatment because of their noninvasiveness, good absorption, and fast-acting effects.
OBJECTIVE
This study aimed to systematically organize preclinical and clinical studies on intranasal herbal medicines to highlight their potential in drug development.
METHODS
A comprehensive search for literature until February 2023 was conducted on PubMed and the Web of Science. From the selected publications, we extracted key information, including the types of herbal materials, target diseases, intranasal conditions, methods of toxicity evaluation, main outcomes, and mechanisms of action, and performed quality assessments for each study.
RESULTS
Of the 45 studies, 13 were clinical and 32 were preclinical; 28 studies used herbal extracts, 9 used prescriptions, and 8 used natural compounds. The target diseases were rhinosinusitis, influenza, fever, stroke, migraine, insomnia, depression, memory disorders, and lung cancer. The common intranasal volumes were 8-50 µl in mice, 20-100 µl in rats, and 100-500 µl in rabbits. Peppermint oil, Ribes nigrum folium, Melia azedarach L., Elaeocarpus sylvestris, Radix Bupleuri, Da Chuan Xiong Fang, Xingnaojing microemulsion, and Ginsenoside Rb1 emerged as potential candidates for rapid intranasal therapy. The in vivo toxicity assessments were based on mortality, body weight, behavioral changes, mucociliary activity, histopathology, and blood tests. Most intranasal treatments were safe, except for Cyclamen europaeum, Jasminum sambac, Punica granatum L., and violet oil, which caused mild adverse effects. At lower doses, intranasal herbal treatments often show greater effects than oral administration. The actions of intranasal herbal medicine mainly involve regulating inflammation and neurotransmission, with the olfactory bulb and anterior cingulate cortex to be relevant brain regions.
CONCLUSION
Intranasal delivery of herbal materials holds promise for enhancing drug delivery efficacy and reducing treatment duration, offering a potential future perspective for developing intranasal therapies for various diseases.
Topics: Animals; Administration, Intranasal; Brain; Fever; Plant Extracts; Humans
PubMed: 38442431
DOI: 10.1016/j.phymed.2024.155484 -
Seizure Apr 2024Epilepsy, one severe prevalent brain disorder, primarily relies on drug treatment. However, approximately one-third of patients with epilepsy do not achieve effective... (Meta-Analysis)
Meta-Analysis
PURPOSE
Epilepsy, one severe prevalent brain disorder, primarily relies on drug treatment. However, approximately one-third of patients with epilepsy do not achieve effective control with current medications, underscoring the need for more innovative treatment approaches. Notably, melatonin has gained attention for its anti-seizure properties and favourable safety profile. This systematic review aimed to evaluate the efficacy and safety of melatonin as an add-on treatment for epilepsy.
METHODS
We searched for articles published before June 2023 in Web of Science, Cochrane Library, and PubMed. We used RevMan 5.4 software to compute relative risks (RRs) and 95 % confidence intervals (CIs). Key outcomes included total sleep time, wakefulness after sleep onset, sleep latency, seizure frequency, seizure severity, and safety. The quality of randomised controlled studies (RCTs) was assessed using the Cochrane Risk of Bias tool.
RESULTS
Of the 264 publications retrieved, 10 RCTs were included in the meta-analysis. Add-on melatonin treatment improved sleep latency (RR: 0.56; 95 %CI: 0.10-1.02; P = 0.02) and seizure severity (RR: 0.33; 95 %CI: 0.04-0.62; P = 0.03) compared with placebo treatment. Adverse events (increased headache severity in children with a history of migraines, bronchitis, ear infections, agitation, and urinary frequency) were reported in only one trial.
CONCLUSION
This systematic review found that add-on melatonin therapy improved sleep latency and seizure severity in patients with epilepsy. However, several of the included studies did not systematically assess sleep quality, seizures, and safety and lacked long-term follow-up data. Further RCTs with extended follow-up periods are required to definitively determine the efficacy and safety of melatonin.
Topics: Melatonin; Humans; Epilepsy; Anticonvulsants; Drug Therapy, Combination
PubMed: 38417212
DOI: 10.1016/j.seizure.2024.02.016 -
Singapore Medical Journal Feb 2024Patients with migraines, particularly those with auras, may present with stroke. Atrial fibrillation is a known risk factor for stroke. With common pathophysiological...
BACKGROUND
Patients with migraines, particularly those with auras, may present with stroke. Atrial fibrillation is a known risk factor for stroke. With common pathophysiological factors between migraines and atrial fibrillation, we aimed to clarify the association between migraine and atrial fibrillation in this systematic review and meta-analysis.
METHODS
A literature search was conducted in EMBASE, PubMed, Scopus and Cochrane electronic bibliographic databases from inception to 5 September 2022 with the following inclusion criteria: (a) cohort or cross-sectional studies; (b) studies that included only patients aged ≥18 years; and (c) studies that examined the association between atrial fibrillation and migraines. Exclusion criteria were case-control studies and the studies that included patients with previous diagnosis of atrial fibrillation or nonmigrainous headache. The Newcastle-Ottawa Scale was used to assess the quality of studies.
RESULTS
Six studies were included, demonstrating a pooled prevalence of atrial fibrillation of 1.61% (95% confidence interval [CI] 0.51, 3.29) in migraine with aura and 1.32% (95% CI 0.17, 3.41) in migraine without aura. The overall prevalence of atrial fibrillation in migraine was 1.39% (95% CI 0.24, 3.46).
CONCLUSION
In this systematic review and meta-analysis, the overall prevalence of atrial fibrillation in patients with migraine was low. Further studies are needed to clarify this relationship.
PubMed: 38409761
DOI: 10.4103/singaporemedj.SMJ-2022-114 -
Cureus Jan 2024The majority of women experience dysmenorrhea during their lifetime. The current standard-of-care treatment consists of nonsteroidal anti-inflammatory drugs, oral... (Review)
Review
The majority of women experience dysmenorrhea during their lifetime. The current standard-of-care treatment consists of nonsteroidal anti-inflammatory drugs, oral contraceptive pills, or intrauterine devices. Osteopathic manipulative treatment (OMT) is a beneficial tool for improving non-musculoskeletal (non-MSK) conditions such as migraines, gastroesophageal reflux disease (GERD), and anxiety. OMT should be utilized to improve other non-MSK conditions, such as dysmenorrhea. The current review aims to evaluate the effects of OMT in women with dysmenorrhea. An extensive search was conducted in Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Biomedical Reference Collection: Comprehensive, and Nursing & Allied Health Collection: Comprehensive from inception to June 2022. Studies evaluating the use of OMT in patients with dysmenorrhea were included, while editorial/opinion articles were excluded. Three independent reviewers evaluated the studies. Ten studies evaluating the use of OMT in patients with dysmenorrhea were included. Overall, OMT was shown to provide relief of symptoms, including back and menstrual pain; however, there was no guideline on which OMT techniques are the most successful. Numerous positive effects were found, including a reduction in the duration of pain, reduction of pain intensity, and reduction of analgesic use. However, the low number of studies supports the need for further investigations. Dysmenorrhea patients could benefit from a prospective randomized controlled trial targeting spinal facilitation and viscerosomatic reflexes to decrease pain duration, pain intensity, and analgesic use. Non-MSK-focused OMT has a large body of mostly anecdotal evidence for relief of conditions such as migraine, GERD, and anxiety. It has helped when traditional standards of care have failed. Non-MSK-focused OMT research represents a relatively untouched field of research that can have a profound and positive global impact, particularly in areas with poor income/healthcare access.
PubMed: 38389612
DOI: 10.7759/cureus.52794 -
Environmental Monitoring and Assessment Feb 2024Some studies have shown the effect of air pollution on migraine. However, it needs to be confirmed in larger-scale studies, as scientific evidence is scarce regarding... (Review)
Review
Some studies have shown the effect of air pollution on migraine. However, it needs to be confirmed in larger-scale studies, as scientific evidence is scarce regarding the association between air pollution and migraine. Therefore, this systematic review aims to determine whether there are associations between outdoor air pollution and migraine. A literature search was performed in Scopus, Medline (via PubMed), EMBASE, and Web of Science. A manual search for resources and related references was also conducted to complete the search. All observational studies investigating the association between ambient air pollution and migraine, with inclusion criteria, were entered into the review. Fourteen out of 1417 identified articles met the inclusion criteria and entered the study. Among the gaseous air pollutants, there was a correlation between exposure to nitrogen dioxide (NO) (78.3% of detrimental relationships) and carbon monoxide (CO) (68.0% of detrimental relationships) and migraine, but no apparent correlation has been found for sulfur dioxide (SO) (21.2% of detrimental relationships) and ozone (O) (55.2% of detrimental relationships). In the case of particulate air pollutants, particulate matter with a diameter of 10 μm or less (PM) (76.0% of detrimental relationships) and particulate matter with a diameter of 2.5 μm or less (PM) (61.3% of detrimental relationships) had relationships with migraine. In conclusion, exposure to NO, CO, PM, and PM is associated with migraine headaches, while no conclusive evidence was found to confirm the correlation between O and SO with migraine. Further studies with precise methodology are recommended in different cities around the world for all pollutants with an emphasis on O and SO.
Topics: Humans; Nitrogen Dioxide; Environmental Monitoring; Air Pollution; Air Pollutants; Ozone; Particulate Matter; Sulfur Dioxide; Migraine Disorders; Environmental Exposure
PubMed: 38363415
DOI: 10.1007/s10661-024-12376-w -
Cureus Jan 2024Headaches are very common and often a common reason people visit emergency departments. Their prevalence among Saudi medical students was higher than the global average... (Review)
Review
Headaches are very common and often a common reason people visit emergency departments. Their prevalence among Saudi medical students was higher than the global average but aligned more closely with rates in certain countries. This regional variation may be attributed to factors such as academic pressures, lifestyle, and genetics. This systematic review and meta-analysis focused on assessing the prevalence of migraines among medical students in Saudi Arabia. Six cross-sectional studies were ultimately included in the meta-analysis, reporting a wide range of prevalence rates among Saudi medical students, from 5% to 26%. The pooled prevalence estimate was 23%, indicating a substantial burden of migraines among this population. The findings underscore the importance of tailored strategies and support systems within medical schools to address the impact of migraines on students' academic journey and overall well-being. Standardized diagnostic criteria and awareness programs are essential to effectively managing this condition among medical students. In conclusion, this study sheds light on the significant prevalence of migraines among medical students in Saudi Arabia, emphasizing the need for comprehensive management approaches and further research to refine prevalence estimates and develop targeted interventions.
PubMed: 38347996
DOI: 10.7759/cureus.52086 -
World Journal of Clinical Cases Jan 2024Yangxue Qingnao Granules (YXQN) is a Chinese patent medicine that has been commonly used in the clinical treatment of migraine.
BACKGROUND
Yangxue Qingnao Granules (YXQN) is a Chinese patent medicine that has been commonly used in the clinical treatment of migraine.
AIM
To assess the efficacy and safety of YXQN alone for the treatment of migraine.
METHODS
We searched 10 databases to identify relevant randomized controlled trials (RCTs) published before September 2022. Two review authors independently searched and screened the literature, extracted the data, and assessed the methodological quality of the studies using criteria from ROB 2.0, and analyzed the data using Review Manager 5.4 software.
RESULTS
A total of 12 RCTs including 767 participants with migraine met the selection criteria. We divided these studies into comparisons of YXQN with placebo, routine treatment drugs, and other Chinese patent medicines. The meta-analysis showed the following: (1) Efficacy: The YXQN group outperformed the placebo group [relative risk (RR) = 0.29, 95% confidence interval (95%CI): 0.15-0.43, < 0.00001], routine treatment group (RR = 0.18, 95%CI: 0.09-0.27, < 0.0001), and Chinese patent medicine group (RR = 0.27, 95%CI: 0.13-0.41, < 0.001); (2) frequency of headache: There was a significant difference between YXQN placebo [mean difference (MD) = -1.25, 95%CI: -1.60 to -0.90, < 0.00001], routine treatment drugs (MD = -0.85, 95%CI: -1.15 to -0.56, < 0.00001), and Chinese patent medicine (MD = -0.91, 95%CI: -1.35 to -0.46, < 0.0001); (3) headache duration: We found great heterogeneity between studies, with no differences between YXQN and placebo (MD = -0.61, 95%CI: -1.53 to -0.31, = 0.19) and routine treatment drugs (MD = -0.22, 95%CI: -0.89 to 0.46, < 0.53). YXQN was more effective than other Chinese patent medicines in reducing headache duration (MD = -1.24, 95%CI: -1.70 to -0.77, < 0.00001); and (4) headache severity: There was no significant difference between YXQN placebo (MD = -1.67, 95%CI: -3.52 to 0.19, = 0.08), routine treatment drugs (MD = -0.53, 95%CI: -2.02 to 0.96, = 0.68), and other Chinese patent medicines (MD = -0.49, 95%CI: -2.83 to 1.85, = 0.68). Mild gastrointestinal adverse reactions were reported in three cases.
CONCLUSION
This study revealed that YXQN is effective and safe for treatment of migraine.
PubMed: 38313632
DOI: 10.12998/wjcc.v12.i2.335 -
The Journal of Headache and Pain Feb 2024To compare the outcomes associated with the use of lasmiditan, rimegepant, ubrogepant, and zavegepant for the acute management of migraine headaches. (Meta-Analysis)
Meta-Analysis Review
Comparison of effectiveness and safety of lasmiditan and CGRP-antagonists for the acute treatment of migraine in adults: systematic review and network meta-analysis of randomised trials.
OBJECTIVE
To compare the outcomes associated with the use of lasmiditan, rimegepant, ubrogepant, and zavegepant for the acute management of migraine headaches.
METHODS
We searched four electronic databases from database inception to August 31, 2023, to identify randomized controlled trials (RCTs) that report efficacy and safety for the acute treatment of migraine. The risk of bias in the included RCTs was evaluated according to the Cochrane tool, and the certainty of evidence using the CINeMA approach. We conducted frequentist network meta-analyses (NMA) to summarise the evidence. Data were analyzed using R-4.3.1.
RESULTS
A total of 18 eligible studies including 10 different types of interventions with 22,429 migraine patients were included. NMA results showed that compared to ubrogepant (25 mg and 50 mg) and zavegepant, lasmiditan (100 mg and 200 mg) exhibits an elevated probability of achieving pain relief within a 2-hour interval. Similarly, relative to zavegepant, rimegepant (75 mg) and ubrogepant (50 mg and 100 mg) demonstrate an enhanced likelihood of sustaining pain relief over a 24-hour period. Furthermore, in contrast to ubrogepant (25 mg) and lasmiditan (50 mg), rimegepant (75 mg) presents a heightened probability of achieving freedom from photophobia within 2 h. Regarding safety, lasmiditan carries the highest risk of adverse events, which are associated with an increased incidence of adverse effects, including dizziness, somnolence, asthenia, paresthesia, and fatigue.
CONCLUSIONS
In this NMA, a spectrum of evidence ranging from very low to high levels underscores the favorable efficacy and tolerability of rimegepant 75 mg and ubrogepant 100 mg, positioning them as potential candidates for the acute management of migraine. Concurrently, lasmiditan (100 mg and 200 mg) exhibits notable efficacy, albeit accompanied by an increased susceptibility to adverse events. These findings should still be approached with caution, primarily due to the intrinsic limitations associated with indirect comparisons.
Topics: Adult; Humans; Benzamides; Calcitonin Gene-Related Peptide; Migraine Disorders; Network Meta-Analysis; Pain; Piperidines; Pyridines; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 38311738
DOI: 10.1186/s10194-024-01723-4 -
Journal of Research in Medical Sciences... 2023Calcitonin gene-related peptides (CGRP) have been considered a new effective means to prevent and treat migraine. Eptinezumab is a new class of CGRP antagonists that has... (Review)
Review
BACKGROUND
Calcitonin gene-related peptides (CGRP) have been considered a new effective means to prevent and treat migraine. Eptinezumab is a new class of CGRP antagonists that has been ratified for clinical treatment. The purpose of this systematic review was to assess and contrast the therapeutic effect and safety of eptinezumab in the management of migraine in comparison with a placebo.
MATERIALS AND METHODS
We systematically searched PubMed, Embase, Cochrane Library, and the US National Institutes of Health Clinical Trials Registry from the earliest date to February 16, 2023, for randomized controlled trials (RCTs). The mean difference (MD) and risk ratio (RR) were chosen to assess clinical indicators.
RESULTS
In total, there were 2, 739 patients in four RCTs, who were ultimately included. Our summarized results showed that eptinezumab had better healing efficacy compared to placebo with respect to monthly migraine days (MD = -1.56, 95% confidence interval [CI]: -2.32, -0.79, < 0.001), improving ≥75% migraine responder rate (RR = 1.80, 95% CI: 1.40, 2.33, < 0.001), ≥50% migraine responder rate (RR = 1.46, 95% CI: 1.33, 1.61, < 0.001), and 100% migraine responder rate (RR = 2.41, 95% CI: 1.08, 5.38, < 0.001). Furthermore, compared with placebo, there was no significant increase for treatment-related adverse events (RR = 1.01, 95% CI 0.94, 1.10, = 0.71) and serious AEs (RR = 0.93, 95% CI 0.46, 1.90, = 0.84). It was found that all dosages except for 10 mg had significant efficacy compared with placebo, especially 300 mg ( < 0.001).
CONCLUSION
Eptinezumab has good healing efficacy and insignificant adverse effects in treating migraine, particularly the dosage of 300 mg.
PubMed: 38292336
DOI: 10.4103/jrms.jrms_306_22