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Moskatel LS, Graber-Naidich A, He Z, Zhang N. Long-term persistence to OnabotulinumtoxinA to prevent chronic migraine: Results from 11 years of patient data from a tertiary headache center. Pain Med 2024:pnae020. [PMID: 38518091 DOI: 10.1093/pm/pnae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/26/2024] [Accepted: 03/17/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE To determine if patients with chronic migraine continue onabotulinumtoxinA (onabotA) long-term. METHODS We performed a retrospective cohort analysis using aggregated, de-identified patient data from the Stanford Headache Center. We included patients in California who received at least one prescription for onabotA during the years of 2011-2021. The primary outcome was the number of onabotA treatments each patient received. Secondary outcomes included sex, age, race, ethnicity, body mass index (BMI), distance to the treatment facility, and zip code income quartile. RESULTS A total of 1,551 patients received a mean of 7.60 ± 7.26 treatments and a median of 5 treatments, with 16.2% of patients receiving only one treatment and 10.6% receiving at least 19. Time-to-event survival analysis suggested 26.0% of patients would complete at least 29 treatments if able. Younger age and female sex were associated with statistically significant differences between quartile groups of number of onabotA treatments (p = 0.007, p = 0.015). BMI, distance to treatment facility, and zip code income quartile were not statistically significantly different between quartile groups (p > 0.500 for all). Prescriptions of both triptans and non-onabotA preventive medications showed a statistically significant increase with each higher quartile of number of onabotA treatments (p < 0.001; p < 0.001). DISCUSSION We show long-term persistence to onabotA is high and that distance to treatment facility and income are not factors in continuation. Our work also demonstrates that as patients continue onabotA over time, there may be an increased need for adjunctive or alternative treatments.
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Affiliation(s)
- Leon S Moskatel
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
| | - Anna Graber-Naidich
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, CA, United States
| | - Zihuai He
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, CA, United States
| | - Niushen Zhang
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
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Moskatel LS, Graber-Naidich A, He Z, Zhang N. The introduction of the CGRP monoclonal antibodies and their effect on the prescription patterns of chronic migraine preventive medications in a tertiary headache center: A retrospective, observational analysis. Headache 2024; 64:188-194. [PMID: 37882379 DOI: 10.1111/head.14642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/04/2023] [Accepted: 09/10/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To determine the effect of the introduction of the calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) in 2018 on the prescribing of older medications for the prevention of chronic migraine. BACKGROUND Prior to 2018, the preventive treatment of migraine borrowed from medications intended to treat other illnesses with the last medication, onabotulinumtoxinA, receiving Food and Drug Administration (FDA) approval for the prevention of chronic migraine in 2010. The FDA approval of three CGRP mAbs in 2018 provided the ideal natural experiment to assess how the introduction of these medications, and a fourth in 2020, affected the generally stable migraine preventive medications market. METHODS We performed a retrospective cohort analysis using the aggregated de-identified data of 6595 patients. The percentage of patients with chronic migraine who had been prescribed one of ten most prescribed oral preventive medications or onabotulinumtoxinA, or any of the four CGRP mAbs, were calculated relative to the total number of patients with chronic migraine who received a prescription for any medication from our clinic during the pre-CGRP mAb years of 2015-2017 and post-approval years of 2019-2021. RESULTS We observed a statistically significant decrease in the prescription of the top 10 most prescribed medications after the introduction of the CGRP mAbs overall (1456/3144, 46.3%, to 1995/4629, 43.1%, p = 0.001), as well as with most individual medications, including large decreases in verapamil (230/3144, 7.3%, to 125/4629, 2.7%; p < 0.001), the tricyclic antidepressants (494/3144, 15.7%, to 532/4629, 11.5%; p < 0.001), topiramate (566/3144, 18.0%, to 653/4629, 14.1%; p < 0.001), and onabotulinumtoxinA (861/3144, 27.4%, to 1134/4629, 24.5%; p = 0.001). CONCLUSION The introduction of the CGRP mAbs during 2018 resulted in a decrease in utilization of most oral medications and onabotulinumtoxinA for the prevention of migraine. Future work should continue to observe how the prescription patterns of these medications evolve with time.
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Affiliation(s)
- Leon S Moskatel
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
| | - Anna Graber-Naidich
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California, USA
| | - Zihuai He
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California, USA
| | - Niushen Zhang
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
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Moskatel LS, Zhang N. Alcohol Use Disorder in Patients with Chronic Migraine: A Retrospective, Observational Study. Can J Neurol Sci 2024:1-11. [PMID: 38268310 DOI: 10.1017/cjn.2024.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE The relationship between migraine and alcohol consumption is unclear. We assessed the association between chronic migraine and alcohol use disorder(AUD), relative to chronic disease controls, and in conjunction with common comorbidities. METHODS We conducted a retrospective, observational study. The primary outcome was the odds ratio for AUD in patients with chronic migraine or with chronic migraine and additional comorbidities relative to controls. RESULTS A total of 3701 patients with chronic migraine, 4450 patients with low back pain, and 1780 patients with type 2 diabetes mellitus met inclusion criteria. Patients with chronic migraine had a lower risk of AUD relative to both controls of low back pain (OR 0.37; 95% CI: 0.29-0.47, p < 0.001) and type 2 diabetes mellitus (OR 0.39; 95% CI: 0.29-0.52, p < 0.001). Depression was associated with the largest OR for AUD in chronic migraine (OR 8.62; 95% CI: 4.99-14.88, p < 0.001), followed by post-traumatic stress disorder (OR 6.63; 95% CI: 4.13-10.64, p < 0.001) and anxiety (OR 3.58; 95% CI: 2.23-5.75, p < 0.001). CONCLUSION Patients with chronic migraine had a lower odds ratio of AUD relative to controls. But in patients with chronic migraine, those with comorbid depression, anxiety, or PTSD are at higher risk of AUD. When patients establish care, comorbid factors should be assessed and for those at higher risk, AUD should be screened for at every visit.
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Affiliation(s)
- Leon S Moskatel
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA, USA
| | - Niushen Zhang
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA, USA
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Moskatel LS, Zhang N. Comparative prevalence and characteristics of fabricated citations in large language models in headache medicine. Headache 2024; 64:93-95. [PMID: 37837216 DOI: 10.1111/head.14638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/17/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023]
Affiliation(s)
- Leon S Moskatel
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, California, USA
| | - Niushen Zhang
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, California, USA
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Sia T, Webb T, Li S, Moskatel LS, Chang ALS. An exploratory comparative case series of calcitonin gene-related peptide monoclonal antibodies in patients with migraine with rosacea. Br J Dermatol 2023; 189:776-778. [PMID: 37596936 DOI: 10.1093/bjd/ljad277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/04/2023] [Accepted: 08/03/2023] [Indexed: 08/21/2023]
Abstract
Rosacea is associated with > 50% of cases of migraine. Recent data have shown that calcitonin gene-related peptide (CGRP) is elevated in rosacea skin. CGRP monoclonal antibodies (mAbs) prevent migraine with known safety profiles, but their effect on rosacea is not known. This exploratory retrospective study examined rosacea in patients with migraines, before and after CGRP mAbs. Of 13 eligible patients on stable or unchanged concurrent rosacea medications, the majority experienced improvement after receiving CGRP mAbs. Mean (SD) rosacea severity scores for the periods before and while on CGRP mAbs were, respectively, 1.19 (0.65) and 0.58 (0.70) (P = 0.01). Prospective, placebo-controlled clinical trials are needed to further assess the use of CGRP mAbs in rosacea.
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Affiliation(s)
- Twan Sia
- Department of Dermatology, Stanford University School of Medicine, Redwood City
| | - Taylor Webb
- Department of Dermatology, Stanford University School of Medicine, Redwood City
| | - Shufeng Li
- Department of Dermatology, Stanford University School of Medicine, Redwood City
- Department of Urology, Stanford University School of Medicine, Center for Academic Medicine, Palo Alto
| | - Leon S Moskatel
- Department of Neurology and Neurological Sciences, Stanford Health Care, Stanford, CA, USA
| | - Anne Lynn S Chang
- Department of Dermatology, Stanford University School of Medicine, Redwood City
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Moskatel LS, Smirnoff L. Headache and Dizziness after Roller Coaster Rides: A Case Series of 31 Patients. Can J Neurol Sci 2023; 50:914-917. [PMID: 36329659 DOI: 10.1017/cjn.2022.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Previous literature on roller coaster injuries focuses on catastrophic injuries. We conducted a retrospective study of 31 adults with headache or dizziness after roller coaster rides. Twenty five of 31 (81%) patients presented with new or worsening headache, predominantly migraine (15/25, 60%), including 8/25 (32%) with chronic migraine. Of the chronic migraine patients, 4/8 (50%) already had the diagnosis and presented with an exacerbation. Five of the 25 (20%) were ultimately found to have a cerebrospinal fluid (CSF) leak. While persistent symptoms appear to be relatively rare, patients with chronic migraine and potential CSF leaks should consider skipping these attractions.
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Affiliation(s)
- Leon S Moskatel
- Division of Headache, Department of Neurology, Stanford Health Care, Palo Alto, CA, USA
| | - Liza Smirnoff
- Division of Headache, Department of Neurology, Stanford Health Care, Palo Alto, CA, USA
- Division of Comprehensive Neurology, Department of Neurology, Stanford Health Care, Palo Alto, CA, USA
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Moskatel LS, Zhang N. The Role of Step Therapy in the Treatment of Migraine. Curr Pain Headache Rep 2023; 27:571-577. [PMID: 37542597 DOI: 10.1007/s11916-023-01155-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE OF REVIEW This review examines recent evidence and applies bioethical principles to evaluate the benefits and risks of using step therapy in the treatment of migraine. RECENT FINDINGS With the CGRP mAbs, gepants, and lasmiditan now on the market for up to 5 years, new research, including network meta-analyses and long-term use studies, can evaluate the comparative efficacy, tolerability, and adherence of these medications relative to older acute and preventive medications for the treatment of migraine. Deciding how medications are chosen for patients requires accounting for many factors including sustainability, efficacy, tolerability, and preference. Newer research can help give clarity on the appropriateness of gating certain treatment options behind others.
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Affiliation(s)
- Leon S Moskatel
- Division of Headache, Department of Neurology and Neurological Sciences, Stanford University, 211 Quarry Road, Suite #206, Palo Alto, CA, 94304, USA.
| | - Niushen Zhang
- Division of Headache, Department of Neurology and Neurological Sciences, Stanford University, 211 Quarry Road, Suite #206, Palo Alto, CA, 94304, USA
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Moskatel LS, Graber-Naidich A, He Z, Zhang N. Real world evidence of changes in CGRP monoclonal antibody and onabotulinumtoxinA prescription practices at the start of the COVID-19 pandemic: An observational, retrospective study. Headache 2023; 63:1180-1182. [PMID: 37358470 DOI: 10.1111/head.14585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Leon S Moskatel
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
| | - Anna Graber-Naidich
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California, USA
| | - Zihuai He
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California, USA
| | - Niushen Zhang
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
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Moskatel LS, Slusky DJG. The impact of COVID-19 on alcohol sales and consumption in the United States: A retrospective, observational analysis. Alcohol 2023; 111:25-31. [PMID: 37230334 PMCID: PMC10202895 DOI: 10.1016/j.alcohol.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023]
Abstract
Understanding the COVID-19 pandemic's effect on alcohol sales and consumption is critical in mitigating alcohol abuse and morbidity. We sought to determine how the onset of the COVID-19 pandemic and changes in viral incidence affected alcohol sales and consumption in the United States. We conducted a retrospective observational analysis regressing National Institute on Alcohol Abuse and Alcoholism (NIAAA) alcohol sales data and Behavioral Risk Factor Surveillance System (BRFSS) survey data for 14 states for 2017 to 2020 with COVID-19 incidence in 2020 in the United States. The onset of the pandemic was associated with higher monthly alcohol sales per capita of 1.99 standard drinks (95% Confidence Interval: 0.63 to 3.34, p = 0.007). Increases of one COVID-19 case per 100 were associated with lower monthly alcohol sales per capita of 2.98 standard drinks (95% CI: -4.47 to -1.48, p = 0.001) as well as broad decreases in alcohol consumption, notably 0.17 fewer days per month with alcohol use (95% CI: -0.31 to -0.23, p = 0.008) and 0.14 fewer days per month of binge drinking (95% CI: -0.23 to -0.052, p < 0.001). The COVID-19 pandemic is associated with increased monthly average alcohol purchases, but higher viral incidence is linked to lower alcohol purchases and consumption. Continued monitoring is needed to mitigate the effects of higher population alcohol use during the pandemic.
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Affiliation(s)
- Leon S Moskatel
- Department of Neurology, Stanford Health Care, Palo Alto, CA, United States.
| | - David J G Slusky
- Department of Economics, University of Kansas, Lawrence, KS, United States; National Bureau of Economics Research, Cambridge, MA, United States; IZA Institute of Labor Economics, Bonn, Germany
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Moskatel LS, Zhang N. The utility of ChatGPT in the assessment of literature on the prevention of migraine: an observational, qualitative study. Front Neurol 2023; 14:1225223. [PMID: 37662036 PMCID: PMC10469750 DOI: 10.3389/fneur.2023.1225223] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Abstract
Background It is not known how large language models, such as ChatGPT, can be applied toward the assessment of the efficacy of medications, including in the prevention of migraine, and how it might support those claims with existing medical evidence. Methods We queried ChatGPT-3.5 on the efficacy of 47 medications for the prevention of migraine and then asked it to give citations in support of its assessment. ChatGPT's evaluations were then compared to their FDA approval status for this indication as well as the American Academy of Neurology 2012 evidence-based guidelines for the prevention of migraine. The citations ChatGPT generated for these evaluations were then assessed to see if they were real papers and if they were relevant to the query. Results ChatGPT affirmed that the 14 medications that have either received FDA approval for prevention of migraine or AAN Grade A/B evidence were effective for migraine. Its assessments of the other 33 medications were unreliable including suggesting possible efficacy for four medications that have never been used for the prevention of migraine. Critically, only 33/115 (29%) of the papers ChatGPT cited were real, while 76/115 (66%) were "hallucinated" not real papers and 6/115 (5%) shared the names of real papers but had not real citations. Conclusion While ChatGPT produced tailored answers on the efficacy of the queried medications, the results were unreliable and inaccurate because of the overwhelming volume of "hallucinated" articles it generated and cited.
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Affiliation(s)
- Leon S. Moskatel
- Division of Headache and Facial Pain, Department of Neurology, Stanford University, Palo Alto, CA, United States
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Moskatel LS, Slusky DJG. The Impact of COVID-19 Incidence on Emergency Medical Services Utilization. J Emerg Med 2023; 65:e111-e118. [PMID: 37460386 PMCID: PMC10129907 DOI: 10.1016/j.jemermed.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/03/2023] [Accepted: 04/19/2023] [Indexed: 07/20/2023]
Affiliation(s)
- Leon S Moskatel
- Division of Headache, Department of Neurology, Stanford Health Care, Palo Alto, California.
| | - David J G Slusky
- Department of Economics, University of Kansas, Lawrence, Kansas; National Bureau of Economics Research, Cambridge, Massachusetts; IZA Institute of Labor Economics, Bonn, Germany
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Moskatel LS, Smirnoff L. Protracted headache after COVID‐19: A case series of 31 patients from a tertiary headache center. Headache 2022; 62:903-907. [PMID: 35670231 PMCID: PMC9348335 DOI: 10.1111/head.14337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 12/01/2022]
Abstract
Background Headache can be a prominent feature of Post‐Acute Sequelae of SARS‐Cov2 infection (PASC) and previous studies have centered around PASC headaches that have resolved within a month of infection. Methods We performed a retrospective chart review of 31 adults evaluated at the Stanford Headache Clinic between September 2020 and January 2022 who developed new or worsening headaches after COVID‐19 infection that were unresolved at time of evaluation for demographics, medical history, and headache diagnosis. Results Headache had been present for a mean duration of 7.4±4.8 months after infection. Notably, 25/31 (81%) had a previous history of headache. The specific features of the headache varied considerably, but 23/31 (74%) met International Classification of Headache Disorders, Third Edition (ICHD‐3) criteria for migraine, with 20/31 (65%) meeting ICHD‐3 criteria for chronic migraine, while only 5/31 (16%) met these criteria before COVID infection. Additionally, full‐time employment decreased from 25/31 (81%) to 17/31 (55%). Prior to establishing care at our clinic, 13/18 (72%) of the patients who were started on preventive medications currently indicated for migraine management, reported a decrease in frequency and/or severity of headaches. Conclusions Our study presents a group of patients with protracted headache after COVID‐19 infection that includes both patients with a previously lower headache burden who largely exhibited chronification from episodic to chronic migraine, as well as patients with no previous history of headache who meet ICHD‐3 criteria for headache attributed to a systemic viral illness, mostly with a migrainous phenotype.
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Affiliation(s)
- Leon S. Moskatel
- Division of Headache, Department of Neurology Stanford School of Medicine Palo Alto California USA
| | - Liza Smirnoff
- Division of Headache, Department of Neurology Stanford School of Medicine Palo Alto California USA
- Division of Comprehensive Neurology, Department of Neurology Stanford School of Medicine Palo Alto California USA
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Abstract
PURPOSE OF REVIEW We explore recent developments in the prevention and treatment of migraine through dietary interventions. RECENT FINDINGS Healthier diets (defined in multiple ways), meal regularity, and weight loss are associated with decreased headache burden. Specific diets including the ketogenic diet, the low-glycemic index diet, and the DASH diet are supported by modest evidence for the prevention of migraine. Neither a gluten-free diet, in patients without celiac disease, nor elimination diets have sufficient evidence for their routine consideration. Diet remains a crucial, but underexplored, component of comprehensive migraine management. Multiple interventions exist for providers and patients to consider integrating into their treatment plan. Larger studies are needed to support stronger recommendations for utilization of specific dietary interventions for the prevention and treatment of migraine.
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Affiliation(s)
- Leon S Moskatel
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA.
| | - Niushen Zhang
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
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Migdal CW, Moskatel LS, Schuster NM. Headache Made SIMPAL: A Simple Mnemonic for the Approach to Headache Evaluation and Migraine Treatment. Pain Med 2021; 22:754-758. [PMID: 33735383 DOI: 10.1093/pm/pnaa429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Leon S Moskatel
- Department of Neurology, Stanford Health Care, Palo Alto, California, USA
| | - Nathaniel M Schuster
- Department of Anesthesiology, Center for Pain Medicine, UC San Diego Health System, La Jolla, California, USA
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Moskatel LS, Vo JN, Nayak KR, Crum-Cianflone NF. Staphylococcus intermedius Brain Abscess as a Complication of Pulmonary Arteriovenous Malformation in a Patient With Hereditary Hemorrhagic Telangiectasia. Open Forum Infect Dis 2020; 7:ofaa467. [PMID: 33209954 PMCID: PMC7652099 DOI: 10.1093/ofid/ofaa467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/27/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Staphylococcus intermedius is a rare cause of human infections ranging from skin and soft tissue infections to bacteremia. It is particularly known for its association with exposure to dogs. We report an unusual case of a 73-year-old female with a brain abscess caused by S intermedius who was recently diagnosed with hereditary hemorrhagic telangiectasia and a pulmonary arteriovenous malformation. The patient underwent debridement of the brain abscess followed by a 6-week course of vancomycin and rifampin, after which she made a near complete recovery. This is the first case of a brain abscess in an adult due to S intermedius in the published literature, and we provide a comprehensive review of the literature of all human infections caused by this pathogen and summarize its clinical manifestations, treatment recommendations, and outcomes.
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Affiliation(s)
- Leon S Moskatel
- Department of Internal Medicine, Scripps Mercy Hospital, San Diego, California, USA
| | - Joslyn N Vo
- Department of Internal Medicine, Scripps Mercy Hospital, San Diego, California, USA
| | - Keshav R Nayak
- Department of Cardiology, Scripps Mercy Hospital, San Diego, California, USA
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