Pediatric suicide was an emerging public health crisis prior to COVID-19, and recent data indicate that pediatric suicide attempts continued to increase during the pandemic.¹ In October 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association declared a national state of emergency for pediatric mental health because of a surge in youth suicide attempts.² Isolation mediated by the degradation of community and exacerbated by the pandemic, has been identified as a contributor to increasing pediatric suicidality.

It is impossible to understand this current public health crisis and to seek solutions without recognizing the ways in which the degradation of community and consequent social isolation play a central role. While the degradation of community and the isolation epidemic that preceded COVID-19 have been mediated by multiple factors, one factor associated with mental health problems in youth is electronic media use.³ During COVID-19, when physical distancing and virtual learning have been necessary to curb the spread, electronic media use has increased exponentially in the pediatric demographic. Some of this increase in screen time has been attributable to virtual schooling, but electronic devices also have become the only means by which kids can stay in contact with one another. While electronic communication has been viewed as an antidote to isolation, disturbing consequences associated with electronic media use have also been noted in our pediatric population.

In the health care system where I (P.L.L.) work as a pediatrician and a child and adolescent psychiatrist, electronic media use has been implicated in more than 90% of our inpatient admissions for suicidal ideation. Use of electronic devices has contributed to suicidal thoughts and attempts in most patients admitted to our acute crisis stabilization unit over the past year. Even more concerning, removal of cell phone privileges has also contributed to suicidal thoughts and attempts in many of our patients. During the pandemic, and in the absence of meaningful interpersonal interactions, many in our pediatric population have become even more dependent on electronic devices to cope with isolation. This has created an often-devastating irony, where the very devices already associated with mental health problems in youth are now being endorsed as “necessary” by mental health professionals.

So how does electronic media use relate to isolation and the continued degradation of community, and why might electronic media use be exacerbating pediatric suicide? One way we have coped with the deterioration of our communities has been the creation of the synthetic community-substitutes found on electronic devices. Unfortunately, our electronic devices create only an illusion of community, where interpersonal interaction occurs by way of inanimate objects, and by electronic text and ideograms. These become substitutes for genuine intimacy, personal contact, and reciprocity. Instead of engaging with one another, our youth are spending hours daily in isolation engaging with a piece of plastic. The mirage generated by pixels on a plastic screen creates an illusion of connectivity, but in reality, this only increases the isolation of our youth.
 

Human evolution and connection

Intimate social connectivity, woven together in our communities, was a fundamental mechanism for human survival. Historically, for our hunter-gatherer ancestors, the community provided access to our fundamental needs, such as safety from predators and access to substantive nutrition.⁴ Community allowed our ancestors to survive and procreate, and facilitated their triumph over predation and disease.⁵ Our distinction as the dominant species on Earth has been afforded by our social connectivity. Unfortunately, in the virtual worlds of our electronic devices the intimate social connectivity of community is absent. Our children wander in isolation, left to navigate age-old evolutionary pressures in the absence of the fundamental advantage for our survival as a species.

Unlike the living, breathing bears and wolves that threatened our ancestors, in the virtual world of the electronic device children are stalked by invisible predators seeking sexual or monetary exploitation. Children are being consumed by digital advertising and social media platforms that perpetually reinforce the requirement of perfection, and they fall prey to cyberbullies who mercilessly disparage their imperfections. In their virtual worlds, where their value is predicated upon anonymous others’ opinions, they succumb to the idea that they will never be enough.⁶ Their fundamental needs of competence and relatedness go unmet, and they lose their sense of purpose, belonging, and often their will to live. More importantly, absent from their children’s virtual worlds, and preoccupied within their own, parents cannot protect their children from online predators, deflect the vicious attacks of cyberbullies, or reframe their children’s imperfections as distinctive or empowering. They are unable to provide their children with the substantive interpersonal contact necessary for resilience and that bolsters their self-worth.

Human beings are inherently social creatures, who regardless of era require community to meet their fundamental needs. As the duration of daily screen time steadily increases, our youth are spending more and more of their waking hours living in isolation in an electronic world. Without the protective social connectivity of community, they are hunted by online predators, and they are consumed by the predatory culture of perfectionism that is contradictory to the reciprocal caretaking necessary to support their healthy development. Evolutionary biology informs us that, when children are isolated, they are susceptible to predation and disease. And in the socialized isolation of their electronic worlds, they are succumbing to predation and to the depressive diseases that are exacerbating the pediatric mental health crisis.

Creating and building community amid a pandemic has been challenging at best. However, now that we have better tools to fight COVID, it is important to encourage our young patients to reduce their nonacademic screen time, and to get outside and engage with others. Their mental health depends on it.

Dr. Loper is a pediatrician and child and adolescent psychiatrist at Prisma Health–Midlands in Columbia, S.C. He is an assistant professor in the department of neuropsychiatry and behavioral science at the University of South Carolina, Columbia. Dr. Loper has no conflicts of interest. Dr. Kaminstein is an adjunct assistant professor at the graduate school of education and affiliated faculty in the organizational dynamics program, School of Arts and Sciences, at the University of Pennsylvania, Philadelphia. He is a social psychologist who has been studying groups and organizations for more than 40 years. He has no conflicts of interest.

References

1. MMWR. 2021 Jun 18;70(24):888-94.

2. Ray G. “Pediatricians, Child and Adolescent Psychiatrists and Children’s Hospitals Declare National Emergency in Children’s Mental Health.” Childrenshospitals.org. 2021 Oct 19.

3. JAMA Netw Open. 2020(8):e2011381.

4. Am J Phys Anthropol. 2018 April:165(4):777-800.

5. The influence of predation on primate and early human evolution: Impetus for cooperation, in “Origins of Altruism and Cooperation. Developments in Primatology: Progress and Prospects.” (Basingstoke, England: Springer Nature, 2011, pp. 19-40).

6. Media Psychology. 2020;23(1):52-78.

Pediatric suicide was an emerging public health crisis prior to COVID-19, and recent data indicate that pediatric suicide attempts continued to increase during the pandemic.¹ In October 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association declared a national state of emergency for pediatric mental health because of a surge in youth suicide attempts.² Isolation mediated by the degradation of community and exacerbated by the pandemic, has been identified as a contributor to increasing pediatric suicidality.

It is impossible to understand this current public health crisis and to seek solutions without recognizing the ways in which the degradation of community and consequent social isolation play a central role. While the degradation of community and the isolation epidemic that preceded COVID-19 have been mediated by multiple factors, one factor associated with mental health problems in youth is electronic media use.³ During COVID-19, when physical distancing and virtual learning have been necessary to curb the spread, electronic media use has increased exponentially in the pediatric demographic. Some of this increase in screen time has been attributable to virtual schooling, but electronic devices also have become the only means by which kids can stay in contact with one another. While electronic communication has been viewed as an antidote to isolation, disturbing consequences associated with electronic media use have also been noted in our pediatric population.

In the health care system where I (P.L.L.) work as a pediatrician and a child and adolescent psychiatrist, electronic media use has been implicated in more than 90% of our inpatient admissions for suicidal ideation. Use of electronic devices has contributed to suicidal thoughts and attempts in most patients admitted to our acute crisis stabilization unit over the past year. Even more concerning, removal of cell phone privileges has also contributed to suicidal thoughts and attempts in many of our patients. During the pandemic, and in the absence of meaningful interpersonal interactions, many in our pediatric population have become even more dependent on electronic devices to cope with isolation. This has created an often-devastating irony, where the very devices already associated with mental health problems in youth are now being endorsed as “necessary” by mental health professionals.

So how does electronic media use relate to isolation and the continued degradation of community, and why might electronic media use be exacerbating pediatric suicide? One way we have coped with the deterioration of our communities has been the creation of the synthetic community-substitutes found on electronic devices. Unfortunately, our electronic devices create only an illusion of community, where interpersonal interaction occurs by way of inanimate objects, and by electronic text and ideograms. These become substitutes for genuine intimacy, personal contact, and reciprocity. Instead of engaging with one another, our youth are spending hours daily in isolation engaging with a piece of plastic. The mirage generated by pixels on a plastic screen creates an illusion of connectivity, but in reality, this only increases the isolation of our youth.
 

Human evolution and connection

Intimate social connectivity, woven together in our communities, was a fundamental mechanism for human survival. Historically, for our hunter-gatherer ancestors, the community provided access to our fundamental needs, such as safety from predators and access to substantive nutrition.⁴ Community allowed our ancestors to survive and procreate, and facilitated their triumph over predation and disease.⁵ Our distinction as the dominant species on Earth has been afforded by our social connectivity. Unfortunately, in the virtual worlds of our electronic devices the intimate social connectivity of community is absent. Our children wander in isolation, left to navigate age-old evolutionary pressures in the absence of the fundamental advantage for our survival as a species.

Unlike the living, breathing bears and wolves that threatened our ancestors, in the virtual world of the electronic device children are stalked by invisible predators seeking sexual or monetary exploitation. Children are being consumed by digital advertising and social media platforms that perpetually reinforce the requirement of perfection, and they fall prey to cyberbullies who mercilessly disparage their imperfections. In their virtual worlds, where their value is predicated upon anonymous others’ opinions, they succumb to the idea that they will never be enough.⁶ Their fundamental needs of competence and relatedness go unmet, and they lose their sense of purpose, belonging, and often their will to live. More importantly, absent from their children’s virtual worlds, and preoccupied within their own, parents cannot protect their children from online predators, deflect the vicious attacks of cyberbullies, or reframe their children’s imperfections as distinctive or empowering. They are unable to provide their children with the substantive interpersonal contact necessary for resilience and that bolsters their self-worth.

Human beings are inherently social creatures, who regardless of era require community to meet their fundamental needs. As the duration of daily screen time steadily increases, our youth are spending more and more of their waking hours living in isolation in an electronic world. Without the protective social connectivity of community, they are hunted by online predators, and they are consumed by the predatory culture of perfectionism that is contradictory to the reciprocal caretaking necessary to support their healthy development. Evolutionary biology informs us that, when children are isolated, they are susceptible to predation and disease. And in the socialized isolation of their electronic worlds, they are succumbing to predation and to the depressive diseases that are exacerbating the pediatric mental health crisis.

Creating and building community amid a pandemic has been challenging at best. However, now that we have better tools to fight COVID, it is important to encourage our young patients to reduce their nonacademic screen time, and to get outside and engage with others. Their mental health depends on it.

Dr. Loper is a pediatrician and child and adolescent psychiatrist at Prisma Health–Midlands in Columbia, S.C. He is an assistant professor in the department of neuropsychiatry and behavioral science at the University of South Carolina, Columbia. Dr. Loper has no conflicts of interest. Dr. Kaminstein is an adjunct assistant professor at the graduate school of education and affiliated faculty in the organizational dynamics program, School of Arts and Sciences, at the University of Pennsylvania, Philadelphia. He is a social psychologist who has been studying groups and organizations for more than 40 years. He has no conflicts of interest.

References

1. MMWR. 2021 Jun 18;70(24):888-94.

2. Ray G. “Pediatricians, Child and Adolescent Psychiatrists and Children’s Hospitals Declare National Emergency in Children’s Mental Health.” Childrenshospitals.org. 2021 Oct 19.

3. JAMA Netw Open. 2020(8):e2011381.

4. Am J Phys Anthropol. 2018 April:165(4):777-800.

5. The influence of predation on primate and early human evolution: Impetus for cooperation, in “Origins of Altruism and Cooperation. Developments in Primatology: Progress and Prospects.” (Basingstoke, England: Springer Nature, 2011, pp. 19-40).

6. Media Psychology. 2020;23(1):52-78.

Pediatric suicide was an emerging public health crisis prior to COVID-19, and recent data indicate that pediatric suicide attempts continued to increase during the pandemic.¹ In October 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association declared a national state of emergency for pediatric mental health because of a surge in youth suicide attempts.² Isolation mediated by the degradation of community and exacerbated by the pandemic, has been identified as a contributor to increasing pediatric suicidality.

It is impossible to understand this current public health crisis and to seek solutions without recognizing the ways in which the degradation of community and consequent social isolation play a central role. While the degradation of community and the isolation epidemic that preceded COVID-19 have been mediated by multiple factors, one factor associated with mental health problems in youth is electronic media use.³ During COVID-19, when physical distancing and virtual learning have been necessary to curb the spread, electronic media use has increased exponentially in the pediatric demographic. Some of this increase in screen time has been attributable to virtual schooling, but electronic devices also have become the only means by which kids can stay in contact with one another. While electronic communication has been viewed as an antidote to isolation, disturbing consequences associated with electronic media use have also been noted in our pediatric population.

In the health care system where I (P.L.L.) work as a pediatrician and a child and adolescent psychiatrist, electronic media use has been implicated in more than 90% of our inpatient admissions for suicidal ideation. Use of electronic devices has contributed to suicidal thoughts and attempts in most patients admitted to our acute crisis stabilization unit over the past year. Even more concerning, removal of cell phone privileges has also contributed to suicidal thoughts and attempts in many of our patients. During the pandemic, and in the absence of meaningful interpersonal interactions, many in our pediatric population have become even more dependent on electronic devices to cope with isolation. This has created an often-devastating irony, where the very devices already associated with mental health problems in youth are now being endorsed as “necessary” by mental health professionals.

So how does electronic media use relate to isolation and the continued degradation of community, and why might electronic media use be exacerbating pediatric suicide? One way we have coped with the deterioration of our communities has been the creation of the synthetic community-substitutes found on electronic devices. Unfortunately, our electronic devices create only an illusion of community, where interpersonal interaction occurs by way of inanimate objects, and by electronic text and ideograms. These become substitutes for genuine intimacy, personal contact, and reciprocity. Instead of engaging with one another, our youth are spending hours daily in isolation engaging with a piece of plastic. The mirage generated by pixels on a plastic screen creates an illusion of connectivity, but in reality, this only increases the isolation of our youth.
 

Human evolution and connection

Intimate social connectivity, woven together in our communities, was a fundamental mechanism for human survival. Historically, for our hunter-gatherer ancestors, the community provided access to our fundamental needs, such as safety from predators and access to substantive nutrition.⁴ Community allowed our ancestors to survive and procreate, and facilitated their triumph over predation and disease.⁵ Our distinction as the dominant species on Earth has been afforded by our social connectivity. Unfortunately, in the virtual worlds of our electronic devices the intimate social connectivity of community is absent. Our children wander in isolation, left to navigate age-old evolutionary pressures in the absence of the fundamental advantage for our survival as a species.

Unlike the living, breathing bears and wolves that threatened our ancestors, in the virtual world of the electronic device children are stalked by invisible predators seeking sexual or monetary exploitation. Children are being consumed by digital advertising and social media platforms that perpetually reinforce the requirement of perfection, and they fall prey to cyberbullies who mercilessly disparage their imperfections. In their virtual worlds, where their value is predicated upon anonymous others’ opinions, they succumb to the idea that they will never be enough.⁶ Their fundamental needs of competence and relatedness go unmet, and they lose their sense of purpose, belonging, and often their will to live. More importantly, absent from their children’s virtual worlds, and preoccupied within their own, parents cannot protect their children from online predators, deflect the vicious attacks of cyberbullies, or reframe their children’s imperfections as distinctive or empowering. They are unable to provide their children with the substantive interpersonal contact necessary for resilience and that bolsters their self-worth.

Human beings are inherently social creatures, who regardless of era require community to meet their fundamental needs. As the duration of daily screen time steadily increases, our youth are spending more and more of their waking hours living in isolation in an electronic world. Without the protective social connectivity of community, they are hunted by online predators, and they are consumed by the predatory culture of perfectionism that is contradictory to the reciprocal caretaking necessary to support their healthy development. Evolutionary biology informs us that, when children are isolated, they are susceptible to predation and disease. And in the socialized isolation of their electronic worlds, they are succumbing to predation and to the depressive diseases that are exacerbating the pediatric mental health crisis.

Creating and building community amid a pandemic has been challenging at best. However, now that we have better tools to fight COVID, it is important to encourage our young patients to reduce their nonacademic screen time, and to get outside and engage with others. Their mental health depends on it.

Dr. Loper is a pediatrician and child and adolescent psychiatrist at Prisma Health–Midlands in Columbia, S.C. He is an assistant professor in the department of neuropsychiatry and behavioral science at the University of South Carolina, Columbia. Dr. Loper has no conflicts of interest. Dr. Kaminstein is an adjunct assistant professor at the graduate school of education and affiliated faculty in the organizational dynamics program, School of Arts and Sciences, at the University of Pennsylvania, Philadelphia. He is a social psychologist who has been studying groups and organizations for more than 40 years. He has no conflicts of interest.

References

1. MMWR. 2021 Jun 18;70(24):888-94.

2. Ray G. “Pediatricians, Child and Adolescent Psychiatrists and Children’s Hospitals Declare National Emergency in Children’s Mental Health.” Childrenshospitals.org. 2021 Oct 19.

3. JAMA Netw Open. 2020(8):e2011381.

4. Am J Phys Anthropol. 2018 April:165(4):777-800.

5. The influence of predation on primate and early human evolution: Impetus for cooperation, in “Origins of Altruism and Cooperation. Developments in Primatology: Progress and Prospects.” (Basingstoke, England: Springer Nature, 2011, pp. 19-40).

6. Media Psychology. 2020;23(1):52-78.

Antibiotic prescribing in pediatric primary care decreased dramatically when the COVID-19 pandemic hit, and new research indicates that drop was sustained through June of 2021.

Lauren Dutcher, MD, with the division of infectious diseases at Hospital of the University of Pennsylvania in Philadelphia, led a study of 27 pediatric primary care practices in the United States. Encounters from Jan. 1, 2018, through June 30, 2021, were included.

Researchers found a 72.7% drop in antibiotic prescriptions when they compared prepandemic April 2019 through December 2019 with the same period in 2020.

Prescriptions remained at the lower levels, primarily driven by reductions in respiratory tract infection (RTI) encounters, and began to rise only in April of 2021, the authors write.

Findings were published online Jan. 11 in Pediatrics.

Researchers report there were 69,327 antibiotic prescriptions from April through December in 2019 and 18,935 antibiotic prescriptions during the same months in 2020.

“The reduction in prescriptions at visits for respiratory tract infection (RTI) accounted for 87.3% of this decrease,” the authors write.

Both prescribing and acute non–COVID-19 respiratory tract infection diagnoses decreased.

Researchers conclude reductions in viral RTI transmission likely played a large role in reduced RTI pediatric visits and antibiotic prescriptions.

Dr. Dutcher told this publication the reduction was likely caused by a combination of less viral transmission of respiratory infections, helped in part by masking and distancing, but also avoidance of health care in the pandemic.

She said the data reinforce the need for appropriate prescribing.

“Antibiotic prescribing is really heavily driven by respiratory infections so this should continue to clue providers in on how frequently that can be unnecessary,“ she said.

Dr. Dutcher said there was probably a reduction in secondary bacterial infections as well as the viral infections.

The research is more comprehensive than some other previous studies, the authors write.

“Although other studies demonstrated early reductions in RTIs and antibiotic prescribing during the COVID-19 pandemic, to our knowledge, this is the first study to demonstrate a sustained decrease in antibiotic prescribing in pediatric primary care throughout 2020 and early 2021,” they write.

The findings also suggest benefits of preventive measures during the pandemic, the authors say.

“Our data suggest that reducing community viral RTI transmission through social distancing and masking corresponds with a reduction in antibiotic prescribing,” they write.

Kao-Ping Chua, MD, a pediatrician and an assistant professor of pediatrics at the University of Michigan in Ann Arbor, said the reductions indicate one of two things is happening: either children aren’t getting sick as often during the pandemic or they are getting sick, but not coming in.

University of Michigan

This article was updated 1/11/22.

Antibiotic prescribing in pediatric primary care decreased dramatically when the COVID-19 pandemic hit, and new research indicates that drop was sustained through June of 2021.

Lauren Dutcher, MD, with the division of infectious diseases at Hospital of the University of Pennsylvania in Philadelphia, led a study of 27 pediatric primary care practices in the United States. Encounters from Jan. 1, 2018, through June 30, 2021, were included.

Researchers found a 72.7% drop in antibiotic prescriptions when they compared prepandemic April 2019 through December 2019 with the same period in 2020.

Prescriptions remained at the lower levels, primarily driven by reductions in respiratory tract infection (RTI) encounters, and began to rise only in April of 2021, the authors write.

Findings were published online Jan. 11 in Pediatrics.

Researchers report there were 69,327 antibiotic prescriptions from April through December in 2019 and 18,935 antibiotic prescriptions during the same months in 2020.

“The reduction in prescriptions at visits for respiratory tract infection (RTI) accounted for 87.3% of this decrease,” the authors write.

Both prescribing and acute non–COVID-19 respiratory tract infection diagnoses decreased.

Researchers conclude reductions in viral RTI transmission likely played a large role in reduced RTI pediatric visits and antibiotic prescriptions.

Dr. Dutcher told this publication the reduction was likely caused by a combination of less viral transmission of respiratory infections, helped in part by masking and distancing, but also avoidance of health care in the pandemic.

She said the data reinforce the need for appropriate prescribing.

“Antibiotic prescribing is really heavily driven by respiratory infections so this should continue to clue providers in on how frequently that can be unnecessary,“ she said.

Dr. Dutcher said there was probably a reduction in secondary bacterial infections as well as the viral infections.

The research is more comprehensive than some other previous studies, the authors write.

“Although other studies demonstrated early reductions in RTIs and antibiotic prescribing during the COVID-19 pandemic, to our knowledge, this is the first study to demonstrate a sustained decrease in antibiotic prescribing in pediatric primary care throughout 2020 and early 2021,” they write.

The findings also suggest benefits of preventive measures during the pandemic, the authors say.

“Our data suggest that reducing community viral RTI transmission through social distancing and masking corresponds with a reduction in antibiotic prescribing,” they write.

Kao-Ping Chua, MD, a pediatrician and an assistant professor of pediatrics at the University of Michigan in Ann Arbor, said the reductions indicate one of two things is happening: either children aren’t getting sick as often during the pandemic or they are getting sick, but not coming in.

University of Michigan

This article was updated 1/11/22.

Antibiotic prescribing in pediatric primary care decreased dramatically when the COVID-19 pandemic hit, and new research indicates that drop was sustained through June of 2021.

Lauren Dutcher, MD, with the division of infectious diseases at Hospital of the University of Pennsylvania in Philadelphia, led a study of 27 pediatric primary care practices in the United States. Encounters from Jan. 1, 2018, through June 30, 2021, were included.

Researchers found a 72.7% drop in antibiotic prescriptions when they compared prepandemic April 2019 through December 2019 with the same period in 2020.

Prescriptions remained at the lower levels, primarily driven by reductions in respiratory tract infection (RTI) encounters, and began to rise only in April of 2021, the authors write.

Findings were published online Jan. 11 in Pediatrics.

Researchers report there were 69,327 antibiotic prescriptions from April through December in 2019 and 18,935 antibiotic prescriptions during the same months in 2020.

“The reduction in prescriptions at visits for respiratory tract infection (RTI) accounted for 87.3% of this decrease,” the authors write.

Both prescribing and acute non–COVID-19 respiratory tract infection diagnoses decreased.

Researchers conclude reductions in viral RTI transmission likely played a large role in reduced RTI pediatric visits and antibiotic prescriptions.

Dr. Dutcher told this publication the reduction was likely caused by a combination of less viral transmission of respiratory infections, helped in part by masking and distancing, but also avoidance of health care in the pandemic.

She said the data reinforce the need for appropriate prescribing.

“Antibiotic prescribing is really heavily driven by respiratory infections so this should continue to clue providers in on how frequently that can be unnecessary,“ she said.

Dr. Dutcher said there was probably a reduction in secondary bacterial infections as well as the viral infections.

The research is more comprehensive than some other previous studies, the authors write.

“Although other studies demonstrated early reductions in RTIs and antibiotic prescribing during the COVID-19 pandemic, to our knowledge, this is the first study to demonstrate a sustained decrease in antibiotic prescribing in pediatric primary care throughout 2020 and early 2021,” they write.

The findings also suggest benefits of preventive measures during the pandemic, the authors say.

“Our data suggest that reducing community viral RTI transmission through social distancing and masking corresponds with a reduction in antibiotic prescribing,” they write.

Kao-Ping Chua, MD, a pediatrician and an assistant professor of pediatrics at the University of Michigan in Ann Arbor, said the reductions indicate one of two things is happening: either children aren’t getting sick as often during the pandemic or they are getting sick, but not coming in.

University of Michigan

This article was updated 1/11/22.

Key clinical point: Ubrogepant was effective and safe in patients with migraine, regardless of prior or concomitant preventive medication use.

Major finding: Ubrogepant vs. placebo was associated with significantly higher responder rates for pain freedom (P £ .005), absence of most bothersome symptom (50 mg ubrogepant vs. placebo; P £ .001), and pain relief (P £ .011) at 2 hours, with the responder rates not being significantly different among patients with vs. without preventive medication use (all P > .05). No serious or treatment-related adverse events were reported.

Study details: Findings are from a pooled analysis of ACHIEVE I and ACHIEVE II phase 3 trials (n = 2,247) and the long-term safety extension trial (n = 813) including patients with migraine with or without a history of preventive medication use.

Disclosures: This study was funded by Allergan (before its acquisition by AbbVie). Some investigators, including the lead author, reported advising or consulting for; being a speaker, on the board of directors, or a contributing author for; receiving grants, research support, and honoraria from; holding stocks or patents with; or employment with various sources including Allergan and AbbVie.

Source: Blumenfeld AM et al. Add Ther. 2021 (Dec 7). Doi: 10.1007/s12325-021-01923-3.

Key clinical point: Ubrogepant was effective and safe in patients with migraine, regardless of prior or concomitant preventive medication use.

Major finding: Ubrogepant vs. placebo was associated with significantly higher responder rates for pain freedom (P £ .005), absence of most bothersome symptom (50 mg ubrogepant vs. placebo; P £ .001), and pain relief (P £ .011) at 2 hours, with the responder rates not being significantly different among patients with vs. without preventive medication use (all P > .05). No serious or treatment-related adverse events were reported.

Study details: Findings are from a pooled analysis of ACHIEVE I and ACHIEVE II phase 3 trials (n = 2,247) and the long-term safety extension trial (n = 813) including patients with migraine with or without a history of preventive medication use.

Disclosures: This study was funded by Allergan (before its acquisition by AbbVie). Some investigators, including the lead author, reported advising or consulting for; being a speaker, on the board of directors, or a contributing author for; receiving grants, research support, and honoraria from; holding stocks or patents with; or employment with various sources including Allergan and AbbVie.

Source: Blumenfeld AM et al. Add Ther. 2021 (Dec 7). Doi: 10.1007/s12325-021-01923-3.

Key clinical point: Ubrogepant was effective and safe in patients with migraine, regardless of prior or concomitant preventive medication use.

Major finding: Ubrogepant vs. placebo was associated with significantly higher responder rates for pain freedom (P £ .005), absence of most bothersome symptom (50 mg ubrogepant vs. placebo; P £ .001), and pain relief (P £ .011) at 2 hours, with the responder rates not being significantly different among patients with vs. without preventive medication use (all P > .05). No serious or treatment-related adverse events were reported.

Study details: Findings are from a pooled analysis of ACHIEVE I and ACHIEVE II phase 3 trials (n = 2,247) and the long-term safety extension trial (n = 813) including patients with migraine with or without a history of preventive medication use.

Disclosures: This study was funded by Allergan (before its acquisition by AbbVie). Some investigators, including the lead author, reported advising or consulting for; being a speaker, on the board of directors, or a contributing author for; receiving grants, research support, and honoraria from; holding stocks or patents with; or employment with various sources including Allergan and AbbVie.

Source: Blumenfeld AM et al. Add Ther. 2021 (Dec 7). Doi: 10.1007/s12325-021-01923-3.

Key clinical point: Fremanezumab was effective and well tolerated over 12 weeks in older patients with chronic or episodic migraine.

Major finding: Quarterly and monthly fremanezumab vs. placebo showed greater reduction in monthly average migraine days (least-squares mean change from baseline [D] −4.3 and −4.6 vs. −2.3), headache days of at least moderate severity (D −3.9 and −4.2 vs. −2.1), and acute medication use (D −3.7 and −4.0 vs. −1.3) over 12 weeks (all P < .05). Adverse events were similar across groups.

Study details: Findings are pooled subgroup analysis of 3 phase 3 studies (HALO CM, HALO EM, and FOCUS) including 246 participants aged ≥60 years with chronic or episodic migraine with an inadequate response to 2-4 prior migraine preventives. They were randomly assigned to quarterly fremanezumab, monthly fremanezumab, or matched monthly placebo.

Disclosures: This study was funded by Teva Pharmaceuticals Ltd. Some investigators, including the lead author, reported participating in clinical trials and receiving honoraria, research support, and legal or personal fees from and being former or current employees of various sources, including Teva Pharmaceuticals.

Source: Nahas SJ et al. J Headache Pain. 2021;22:141 (Nov 24). Doi: 10.1186/s10194-021-01351-2.

Key clinical point: Fremanezumab was effective and well tolerated over 12 weeks in older patients with chronic or episodic migraine.

Major finding: Quarterly and monthly fremanezumab vs. placebo showed greater reduction in monthly average migraine days (least-squares mean change from baseline [D] −4.3 and −4.6 vs. −2.3), headache days of at least moderate severity (D −3.9 and −4.2 vs. −2.1), and acute medication use (D −3.7 and −4.0 vs. −1.3) over 12 weeks (all P < .05). Adverse events were similar across groups.

Study details: Findings are pooled subgroup analysis of 3 phase 3 studies (HALO CM, HALO EM, and FOCUS) including 246 participants aged ≥60 years with chronic or episodic migraine with an inadequate response to 2-4 prior migraine preventives. They were randomly assigned to quarterly fremanezumab, monthly fremanezumab, or matched monthly placebo.

Disclosures: This study was funded by Teva Pharmaceuticals Ltd. Some investigators, including the lead author, reported participating in clinical trials and receiving honoraria, research support, and legal or personal fees from and being former or current employees of various sources, including Teva Pharmaceuticals.

Source: Nahas SJ et al. J Headache Pain. 2021;22:141 (Nov 24). Doi: 10.1186/s10194-021-01351-2.

Key clinical point: Fremanezumab was effective and well tolerated over 12 weeks in older patients with chronic or episodic migraine.

Major finding: Quarterly and monthly fremanezumab vs. placebo showed greater reduction in monthly average migraine days (least-squares mean change from baseline [D] −4.3 and −4.6 vs. −2.3), headache days of at least moderate severity (D −3.9 and −4.2 vs. −2.1), and acute medication use (D −3.7 and −4.0 vs. −1.3) over 12 weeks (all P < .05). Adverse events were similar across groups.

Study details: Findings are pooled subgroup analysis of 3 phase 3 studies (HALO CM, HALO EM, and FOCUS) including 246 participants aged ≥60 years with chronic or episodic migraine with an inadequate response to 2-4 prior migraine preventives. They were randomly assigned to quarterly fremanezumab, monthly fremanezumab, or matched monthly placebo.

Disclosures: This study was funded by Teva Pharmaceuticals Ltd. Some investigators, including the lead author, reported participating in clinical trials and receiving honoraria, research support, and legal or personal fees from and being former or current employees of various sources, including Teva Pharmaceuticals.

Source: Nahas SJ et al. J Headache Pain. 2021;22:141 (Nov 24). Doi: 10.1186/s10194-021-01351-2.

Key clinical point: Patients with migraine are more likely to suffer from dry eye than patients without migraine.

Major finding: The prevalence of dry eye was significantly higher in patients with vs. without migraine (odds ratio, 1.55; P < .001).

Study details: Findings are from a meta-analysis of 7 case-control or cross-sectional studies including a total population of 1,033,288 individuals with or without migraine.

Disclosures: This study was supported by the National Natural Science Foundation of China and Fundamental Research Funds of the State Key Laboratory of Ophthalmology. The authors declared no conflict of interests.

Source: Chen H et al. Cornea. 2021 (Nov 6). Doi: 10.1097/ICO.0000000000002851.

Key clinical point: Patients with migraine are more likely to suffer from dry eye than patients without migraine.

Major finding: The prevalence of dry eye was significantly higher in patients with vs. without migraine (odds ratio, 1.55; P < .001).

Study details: Findings are from a meta-analysis of 7 case-control or cross-sectional studies including a total population of 1,033,288 individuals with or without migraine.

Disclosures: This study was supported by the National Natural Science Foundation of China and Fundamental Research Funds of the State Key Laboratory of Ophthalmology. The authors declared no conflict of interests.

Source: Chen H et al. Cornea. 2021 (Nov 6). Doi: 10.1097/ICO.0000000000002851.

Key clinical point: Patients with migraine are more likely to suffer from dry eye than patients without migraine.

Major finding: The prevalence of dry eye was significantly higher in patients with vs. without migraine (odds ratio, 1.55; P < .001).

Study details: Findings are from a meta-analysis of 7 case-control or cross-sectional studies including a total population of 1,033,288 individuals with or without migraine.

Disclosures: This study was supported by the National Natural Science Foundation of China and Fundamental Research Funds of the State Key Laboratory of Ophthalmology. The authors declared no conflict of interests.

Source: Chen H et al. Cornea. 2021 (Nov 6). Doi: 10.1097/ICO.0000000000002851.

Key clinical point: Prevalence of migraine was higher in patients with celiac disease (CD) vs. healthy controls, with patients with CD and migraine showing worse gastrointestinal symptoms compared with those without migraine.

Major finding: The prevalence of migraine was higher in patients with vs. without CD (20.7% vs. 11.9%; P < .001). Patients with CD with vs. without migraine headache had a higher prevalence of abdominal pain (80.1% vs. 71.8%; P = .025), constipation (47.8% vs. 35.5%; P = .011), and diarrhea (60.8% vs. 45.9%; P = .002).

Study details: This case-control cross-sectional study included 1,000 adult patients with CD and 1,000 healthy controls.

Disclosures: No funding was received for this study. The authors declared no conflict of interests.

Source: Fanaeian MM et al. PLoS One. 2021;16(11):e0259502 (Nov 17). Doi:  10.1371/journal.pone.0259502.

Key clinical point: Prevalence of migraine was higher in patients with celiac disease (CD) vs. healthy controls, with patients with CD and migraine showing worse gastrointestinal symptoms compared with those without migraine.

Major finding: The prevalence of migraine was higher in patients with vs. without CD (20.7% vs. 11.9%; P < .001). Patients with CD with vs. without migraine headache had a higher prevalence of abdominal pain (80.1% vs. 71.8%; P = .025), constipation (47.8% vs. 35.5%; P = .011), and diarrhea (60.8% vs. 45.9%; P = .002).

Study details: This case-control cross-sectional study included 1,000 adult patients with CD and 1,000 healthy controls.

Disclosures: No funding was received for this study. The authors declared no conflict of interests.

Source: Fanaeian MM et al. PLoS One. 2021;16(11):e0259502 (Nov 17). Doi:  10.1371/journal.pone.0259502.

Key clinical point: Prevalence of migraine was higher in patients with celiac disease (CD) vs. healthy controls, with patients with CD and migraine showing worse gastrointestinal symptoms compared with those without migraine.

Major finding: The prevalence of migraine was higher in patients with vs. without CD (20.7% vs. 11.9%; P < .001). Patients with CD with vs. without migraine headache had a higher prevalence of abdominal pain (80.1% vs. 71.8%; P = .025), constipation (47.8% vs. 35.5%; P = .011), and diarrhea (60.8% vs. 45.9%; P = .002).

Study details: This case-control cross-sectional study included 1,000 adult patients with CD and 1,000 healthy controls.

Disclosures: No funding was received for this study. The authors declared no conflict of interests.

Source: Fanaeian MM et al. PLoS One. 2021;16(11):e0259502 (Nov 17). Doi:  10.1371/journal.pone.0259502.

Key clinical point: The frequency of occipital bending (OB) was 2-fold higher in patients with migraine with visual aura than those without visual aura.

Major finding: Overall, the prevalence of OB was 33.3% and was significantly higher in patients with migraine with vs. without visual aura (57.1% vs. 25.4%; odds ratio 3.9; P = .015).

Study details: Findings are from a retrospective analysis of 84 patients with migraine with (n = 21) or without visual aura (n = 63).

Disclosures: No source of funding was identified. The authors declared no conflict of interests.

Source: Özkan E et al. Headache. 2021 (Nov 28). Doi: 10.1111/head.14240.

Key clinical point: The frequency of occipital bending (OB) was 2-fold higher in patients with migraine with visual aura than those without visual aura.

Major finding: Overall, the prevalence of OB was 33.3% and was significantly higher in patients with migraine with vs. without visual aura (57.1% vs. 25.4%; odds ratio 3.9; P = .015).

Study details: Findings are from a retrospective analysis of 84 patients with migraine with (n = 21) or without visual aura (n = 63).

Disclosures: No source of funding was identified. The authors declared no conflict of interests.

Source: Özkan E et al. Headache. 2021 (Nov 28). Doi: 10.1111/head.14240.

Key clinical point: The frequency of occipital bending (OB) was 2-fold higher in patients with migraine with visual aura than those without visual aura.

Major finding: Overall, the prevalence of OB was 33.3% and was significantly higher in patients with migraine with vs. without visual aura (57.1% vs. 25.4%; odds ratio 3.9; P = .015).

Study details: Findings are from a retrospective analysis of 84 patients with migraine with (n = 21) or without visual aura (n = 63).

Disclosures: No source of funding was identified. The authors declared no conflict of interests.

Source: Özkan E et al. Headache. 2021 (Nov 28). Doi: 10.1111/head.14240.

Key clinical point: Unilateral pain, fewer failed preventives, good response to triptans, and medication overuse at baseline were associated with a persistent positive response to galcanezumab during the first 3 months of therapy in patients with chronic migraine.

Major finding: Overall, 41.7% of patients had a persistent 3-month 50% responder rate in headache days of at least moderate intensity. Responders vs. nonresponders had lower number of failed preventives (odds ratio [OR] 0.733; P = .041), frequent unilateral pain (OR 3.686; P = .041), medication overuse at baseline (OR 4.575; P = .012), and good response to triptans (OR 3.248; P = .028).

Study details: This observational study included 156 adult patients with chronic migraine from the GARLIT study who had a galcanezumab prescription.

Disclosures: This study was funded by Campus Bio-Medico University. Some investigators including the lead author received grants, travel expenses, and honoraria for advisory boards, speaker panels, or clinical investigation studies from various pharmaceutical companies.

Source: Vernieri F et al. Eur J Neurol. 2021 (Nov 26). Doi: 10.1111/ene.15197.

Key clinical point: Unilateral pain, fewer failed preventives, good response to triptans, and medication overuse at baseline were associated with a persistent positive response to galcanezumab during the first 3 months of therapy in patients with chronic migraine.

Major finding: Overall, 41.7% of patients had a persistent 3-month 50% responder rate in headache days of at least moderate intensity. Responders vs. nonresponders had lower number of failed preventives (odds ratio [OR] 0.733; P = .041), frequent unilateral pain (OR 3.686; P = .041), medication overuse at baseline (OR 4.575; P = .012), and good response to triptans (OR 3.248; P = .028).

Study details: This observational study included 156 adult patients with chronic migraine from the GARLIT study who had a galcanezumab prescription.

Disclosures: This study was funded by Campus Bio-Medico University. Some investigators including the lead author received grants, travel expenses, and honoraria for advisory boards, speaker panels, or clinical investigation studies from various pharmaceutical companies.

Source: Vernieri F et al. Eur J Neurol. 2021 (Nov 26). Doi: 10.1111/ene.15197.

Key clinical point: Unilateral pain, fewer failed preventives, good response to triptans, and medication overuse at baseline were associated with a persistent positive response to galcanezumab during the first 3 months of therapy in patients with chronic migraine.

Major finding: Overall, 41.7% of patients had a persistent 3-month 50% responder rate in headache days of at least moderate intensity. Responders vs. nonresponders had lower number of failed preventives (odds ratio [OR] 0.733; P = .041), frequent unilateral pain (OR 3.686; P = .041), medication overuse at baseline (OR 4.575; P = .012), and good response to triptans (OR 3.248; P = .028).

Study details: This observational study included 156 adult patients with chronic migraine from the GARLIT study who had a galcanezumab prescription.

Disclosures: This study was funded by Campus Bio-Medico University. Some investigators including the lead author received grants, travel expenses, and honoraria for advisory boards, speaker panels, or clinical investigation studies from various pharmaceutical companies.

Source: Vernieri F et al. Eur J Neurol. 2021 (Nov 26). Doi: 10.1111/ene.15197.

Key clinical point: Lasmiditan was associated with mild-to-moderate central nervous system (CNS)-related adverse events (AE), mostly transient in duration.

Major finding: Treatment-emergent serious AEs occurred in 0.4%, 0.2%, and 0.4% of patients treated with placebo, 100 mg lasmiditan, and 200 mg lasmiditan, respectively. The most common treatment-emergent AEs with lasmiditan were dizziness, nausea, paresthesia, fatigue, somnolence, and vertigo, with mostly mild-to-moderate severity. No deaths were reported.

Study details: Findings are from safety analysis of the phase 3 CENTURION trial that assessed 4,494 attacks across 1,471 patients with migraine with and without aura who were randomly assigned to either 200 mg lasmiditan or 100 mg lasmiditan for 4 attacks or placebo for 3 attacks and 50 mg lasmiditan for the third/fourth attack.

Disclosures: This study was sponsored by Eli Lilly and Company. Some investigators, including the lead author, reported receiving research grants, institutional payments, or fees for advisory boards and scientific lecturing; being an employee of; owning shares in; or consulting for various sources, including Eli Lilly and Company.

Source: Tassorelli C et al. J Headache Pain. 2021;22:132 (Nov 6). Doi: 10.1186/s10194-021-01343-2.

Key clinical point: Lasmiditan was associated with mild-to-moderate central nervous system (CNS)-related adverse events (AE), mostly transient in duration.

Major finding: Treatment-emergent serious AEs occurred in 0.4%, 0.2%, and 0.4% of patients treated with placebo, 100 mg lasmiditan, and 200 mg lasmiditan, respectively. The most common treatment-emergent AEs with lasmiditan were dizziness, nausea, paresthesia, fatigue, somnolence, and vertigo, with mostly mild-to-moderate severity. No deaths were reported.

Study details: Findings are from safety analysis of the phase 3 CENTURION trial that assessed 4,494 attacks across 1,471 patients with migraine with and without aura who were randomly assigned to either 200 mg lasmiditan or 100 mg lasmiditan for 4 attacks or placebo for 3 attacks and 50 mg lasmiditan for the third/fourth attack.

Disclosures: This study was sponsored by Eli Lilly and Company. Some investigators, including the lead author, reported receiving research grants, institutional payments, or fees for advisory boards and scientific lecturing; being an employee of; owning shares in; or consulting for various sources, including Eli Lilly and Company.

Source: Tassorelli C et al. J Headache Pain. 2021;22:132 (Nov 6). Doi: 10.1186/s10194-021-01343-2.

Key clinical point: Lasmiditan was associated with mild-to-moderate central nervous system (CNS)-related adverse events (AE), mostly transient in duration.

Major finding: Treatment-emergent serious AEs occurred in 0.4%, 0.2%, and 0.4% of patients treated with placebo, 100 mg lasmiditan, and 200 mg lasmiditan, respectively. The most common treatment-emergent AEs with lasmiditan were dizziness, nausea, paresthesia, fatigue, somnolence, and vertigo, with mostly mild-to-moderate severity. No deaths were reported.

Study details: Findings are from safety analysis of the phase 3 CENTURION trial that assessed 4,494 attacks across 1,471 patients with migraine with and without aura who were randomly assigned to either 200 mg lasmiditan or 100 mg lasmiditan for 4 attacks or placebo for 3 attacks and 50 mg lasmiditan for the third/fourth attack.

Disclosures: This study was sponsored by Eli Lilly and Company. Some investigators, including the lead author, reported receiving research grants, institutional payments, or fees for advisory boards and scientific lecturing; being an employee of; owning shares in; or consulting for various sources, including Eli Lilly and Company.

Source: Tassorelli C et al. J Headache Pain. 2021;22:132 (Nov 6). Doi: 10.1186/s10194-021-01343-2.

Key clinical point: Greater occipital nerve (GON) blockade with local anesthetics reduced the severity and duration of headaches in patients with episodic migraine without aura, with the headache frequency reducing significantly among patients receiving lidocaine alone or in combination with triamcinolone.

Major finding: GON block with triamcinolone, lidocaine, lidocaine+triamcinolone, or only normal saline significantly reduced the severity (P < .001) and duration (P = .001) of headaches, with no injection being superior to placebo. Headache frequency reduced in patients who received lidocaine (5.81 attacks per month; 95% CI of the difference −2.52 to −9.09) and lidocaine+triamcinolone (5.69 attacks per month; 95% CI of the difference −1.11 to −10.27).

Study details: This placebo-controlled clinical trial randomly assigned 55 adult patients with episodic migraine without aura to triamcinolone (n = 10), lidocaine (n = 16), lidocaine+triamcinolone (n = 13), or normal saline only (n = 16) groups.

Disclosures: This work was supported by the Iranian Center of Neurological Research in affiliation with Tehran University of Medical Sciences. The authors declared no conflict of interests.

Source: Malekian N et al. Cephalalgia. 2021 (Nov 17). Doi: 10.1177/03331024211058182.

Key clinical point: Greater occipital nerve (GON) blockade with local anesthetics reduced the severity and duration of headaches in patients with episodic migraine without aura, with the headache frequency reducing significantly among patients receiving lidocaine alone or in combination with triamcinolone.

Major finding: GON block with triamcinolone, lidocaine, lidocaine+triamcinolone, or only normal saline significantly reduced the severity (P < .001) and duration (P = .001) of headaches, with no injection being superior to placebo. Headache frequency reduced in patients who received lidocaine (5.81 attacks per month; 95% CI of the difference −2.52 to −9.09) and lidocaine+triamcinolone (5.69 attacks per month; 95% CI of the difference −1.11 to −10.27).

Study details: This placebo-controlled clinical trial randomly assigned 55 adult patients with episodic migraine without aura to triamcinolone (n = 10), lidocaine (n = 16), lidocaine+triamcinolone (n = 13), or normal saline only (n = 16) groups.

Disclosures: This work was supported by the Iranian Center of Neurological Research in affiliation with Tehran University of Medical Sciences. The authors declared no conflict of interests.

Source: Malekian N et al. Cephalalgia. 2021 (Nov 17). Doi: 10.1177/03331024211058182.

Key clinical point: Greater occipital nerve (GON) blockade with local anesthetics reduced the severity and duration of headaches in patients with episodic migraine without aura, with the headache frequency reducing significantly among patients receiving lidocaine alone or in combination with triamcinolone.

Major finding: GON block with triamcinolone, lidocaine, lidocaine+triamcinolone, or only normal saline significantly reduced the severity (P < .001) and duration (P = .001) of headaches, with no injection being superior to placebo. Headache frequency reduced in patients who received lidocaine (5.81 attacks per month; 95% CI of the difference −2.52 to −9.09) and lidocaine+triamcinolone (5.69 attacks per month; 95% CI of the difference −1.11 to −10.27).

Study details: This placebo-controlled clinical trial randomly assigned 55 adult patients with episodic migraine without aura to triamcinolone (n = 10), lidocaine (n = 16), lidocaine+triamcinolone (n = 13), or normal saline only (n = 16) groups.

Disclosures: This work was supported by the Iranian Center of Neurological Research in affiliation with Tehran University of Medical Sciences. The authors declared no conflict of interests.

Source: Malekian N et al. Cephalalgia. 2021 (Nov 17). Doi: 10.1177/03331024211058182.