Key clinical point: Cancer risks with natalizumab and rituximab in patients with multiple sclerosis (MS) are similar to the general population, whereas there is a possible modest increase in risk with fingolimod.

Major finding: Adjusting for demography, previous cancer, and comorbidities, the risk of invasive cancer was similar or slightly lower for natalizumab (hazard ratio [HR], 1.01; 95% CI, 0.57-1.77) and rituximab (HR, 0.85; 95% CI, 0.54-1.32) compared with the general population. There was a possibly higher risk for fingolimod compared with the general population (HR, 1.53; 95% CI, 0.98-2.38) and rituximab (HR, 1.68; 95% CI, 1.00-2.84).

Study details: A Swedish register-based cohort study included 6,136 patients with MS and 37,801 non-MS individuals from the general population.

Disclosures: The study was funded through a Patient-Centered Outcomes Research Institute award. Johan Askling, Anna Fogdell-Hahn, Jan Hillert, Jan Lycke, Petra Nilsson, Magnus Vrethem, Tomas Olsson and Fredrik Piehl reported ties with one or more pharmaceutical companies. The remaining authors declared no conflicts of interest. 

Citation: Alping P et al. Ann Neurol. 2020 Feb 13. doi: 10.1002/ana.25701.

Key clinical point: Cancer risks with natalizumab and rituximab in patients with multiple sclerosis (MS) are similar to the general population, whereas there is a possible modest increase in risk with fingolimod.

Major finding: Adjusting for demography, previous cancer, and comorbidities, the risk of invasive cancer was similar or slightly lower for natalizumab (hazard ratio [HR], 1.01; 95% CI, 0.57-1.77) and rituximab (HR, 0.85; 95% CI, 0.54-1.32) compared with the general population. There was a possibly higher risk for fingolimod compared with the general population (HR, 1.53; 95% CI, 0.98-2.38) and rituximab (HR, 1.68; 95% CI, 1.00-2.84).

Study details: A Swedish register-based cohort study included 6,136 patients with MS and 37,801 non-MS individuals from the general population.

Disclosures: The study was funded through a Patient-Centered Outcomes Research Institute award. Johan Askling, Anna Fogdell-Hahn, Jan Hillert, Jan Lycke, Petra Nilsson, Magnus Vrethem, Tomas Olsson and Fredrik Piehl reported ties with one or more pharmaceutical companies. The remaining authors declared no conflicts of interest. 

Citation: Alping P et al. Ann Neurol. 2020 Feb 13. doi: 10.1002/ana.25701.

Key clinical point: Cancer risks with natalizumab and rituximab in patients with multiple sclerosis (MS) are similar to the general population, whereas there is a possible modest increase in risk with fingolimod.

Major finding: Adjusting for demography, previous cancer, and comorbidities, the risk of invasive cancer was similar or slightly lower for natalizumab (hazard ratio [HR], 1.01; 95% CI, 0.57-1.77) and rituximab (HR, 0.85; 95% CI, 0.54-1.32) compared with the general population. There was a possibly higher risk for fingolimod compared with the general population (HR, 1.53; 95% CI, 0.98-2.38) and rituximab (HR, 1.68; 95% CI, 1.00-2.84).

Study details: A Swedish register-based cohort study included 6,136 patients with MS and 37,801 non-MS individuals from the general population.

Disclosures: The study was funded through a Patient-Centered Outcomes Research Institute award. Johan Askling, Anna Fogdell-Hahn, Jan Hillert, Jan Lycke, Petra Nilsson, Magnus Vrethem, Tomas Olsson and Fredrik Piehl reported ties with one or more pharmaceutical companies. The remaining authors declared no conflicts of interest. 

Citation: Alping P et al. Ann Neurol. 2020 Feb 13. doi: 10.1002/ana.25701.

Key clinical point: Although injectables are the most frequently used disease-modifying agents (DMAs) for multiple sclerosis (MS), the utilization of oral DMAs is increasing.

Major finding: Between 2006 and 2015, DMAs were prescribed in 45% of MS visits. Although injectables remain the most commonly prescribed DMAs (78%), the use of oral DMAs has increased (from 11% in 2010-2011 to 40% in 2014-2015) and that of injectable DMAs has decreased (from 96% in 2006-2007 to 52% in 2014-2015). Visiting a neurologist was the strongest predictor of DMA use (odds ratio, 6.61; 95% CI, 3.66-11.93). 

Study details: A cross-sectional study examined the prescribing patterns and trends of DMAs in the US using the 2006-2015 National Ambulatory Medical Care Survey.

Disclosures: The study was not funded. George Hutton and Rajender Aparasu reported receiving grants from multiple pharmaceutical companies outside the submitted work. The remaining authors declared no conflicts of interest. 

Citation: Earla JR et al. Res Social Adm Pharm. 2020 Mar 11. doi: 10.1016/j.sapharm.2020.02.016. 

Key clinical point: Although injectables are the most frequently used disease-modifying agents (DMAs) for multiple sclerosis (MS), the utilization of oral DMAs is increasing.

Major finding: Between 2006 and 2015, DMAs were prescribed in 45% of MS visits. Although injectables remain the most commonly prescribed DMAs (78%), the use of oral DMAs has increased (from 11% in 2010-2011 to 40% in 2014-2015) and that of injectable DMAs has decreased (from 96% in 2006-2007 to 52% in 2014-2015). Visiting a neurologist was the strongest predictor of DMA use (odds ratio, 6.61; 95% CI, 3.66-11.93). 

Study details: A cross-sectional study examined the prescribing patterns and trends of DMAs in the US using the 2006-2015 National Ambulatory Medical Care Survey.

Disclosures: The study was not funded. George Hutton and Rajender Aparasu reported receiving grants from multiple pharmaceutical companies outside the submitted work. The remaining authors declared no conflicts of interest. 

Citation: Earla JR et al. Res Social Adm Pharm. 2020 Mar 11. doi: 10.1016/j.sapharm.2020.02.016. 

Key clinical point: Although injectables are the most frequently used disease-modifying agents (DMAs) for multiple sclerosis (MS), the utilization of oral DMAs is increasing.

Major finding: Between 2006 and 2015, DMAs were prescribed in 45% of MS visits. Although injectables remain the most commonly prescribed DMAs (78%), the use of oral DMAs has increased (from 11% in 2010-2011 to 40% in 2014-2015) and that of injectable DMAs has decreased (from 96% in 2006-2007 to 52% in 2014-2015). Visiting a neurologist was the strongest predictor of DMA use (odds ratio, 6.61; 95% CI, 3.66-11.93). 

Study details: A cross-sectional study examined the prescribing patterns and trends of DMAs in the US using the 2006-2015 National Ambulatory Medical Care Survey.

Disclosures: The study was not funded. George Hutton and Rajender Aparasu reported receiving grants from multiple pharmaceutical companies outside the submitted work. The remaining authors declared no conflicts of interest. 

Citation: Earla JR et al. Res Social Adm Pharm. 2020 Mar 11. doi: 10.1016/j.sapharm.2020.02.016. 

Key clinical point: Patients with migraine have an increased risk for comorbidities, and the risk is influenced by headache pain intensity and monthly headache days.

Major finding: Patients with migraine vs those without had an increased risk for insomnia, depression, anxiety, gastric ulcers/gastrointestinal bleeding, peripheral artery disease, angina, epilepsy, asthma, arthritis, stroke or transient ischemic attack, rheumatoid arthritis, allergies/hay fever, and vitamin D deficiency (P less than. 001). Increasing headache pain intensity was associated with an increased risk for inflammatory comorbidities, and monthly headache day frequency with risk for nearly all conditions.

Study details: The data come from the Migraine in America Symptoms and Treatment Study, which included 15,133 patients with migraine and 77,453 control individuals without migraine.

Disclosures: This study was funded and sponsored by Dr. Reddy’s Laboratories group of companies, Princeton, NJ. Sagar Munjal and Preeti Singh are employees of Dr. Reddy’s Laboratories. Richard B. Lipton, Dawn C. Buse, Michael L. Reed, Todd J. Schwedt, and David W. Dodick reported paid consultancy for Dr. Reddy’s Laboratories. The authors also reported ties with one or more pharmaceutical companies.

Citation: Buse DC et al. J Headache Pain. 2020 Mar 2. doi: 10.1186/s10194-020-1084-y.

Key clinical point: Patients with migraine have an increased risk for comorbidities, and the risk is influenced by headache pain intensity and monthly headache days.

Major finding: Patients with migraine vs those without had an increased risk for insomnia, depression, anxiety, gastric ulcers/gastrointestinal bleeding, peripheral artery disease, angina, epilepsy, asthma, arthritis, stroke or transient ischemic attack, rheumatoid arthritis, allergies/hay fever, and vitamin D deficiency (P less than. 001). Increasing headache pain intensity was associated with an increased risk for inflammatory comorbidities, and monthly headache day frequency with risk for nearly all conditions.

Study details: The data come from the Migraine in America Symptoms and Treatment Study, which included 15,133 patients with migraine and 77,453 control individuals without migraine.

Disclosures: This study was funded and sponsored by Dr. Reddy’s Laboratories group of companies, Princeton, NJ. Sagar Munjal and Preeti Singh are employees of Dr. Reddy’s Laboratories. Richard B. Lipton, Dawn C. Buse, Michael L. Reed, Todd J. Schwedt, and David W. Dodick reported paid consultancy for Dr. Reddy’s Laboratories. The authors also reported ties with one or more pharmaceutical companies.

Citation: Buse DC et al. J Headache Pain. 2020 Mar 2. doi: 10.1186/s10194-020-1084-y.

Key clinical point: Patients with migraine have an increased risk for comorbidities, and the risk is influenced by headache pain intensity and monthly headache days.

Major finding: Patients with migraine vs those without had an increased risk for insomnia, depression, anxiety, gastric ulcers/gastrointestinal bleeding, peripheral artery disease, angina, epilepsy, asthma, arthritis, stroke or transient ischemic attack, rheumatoid arthritis, allergies/hay fever, and vitamin D deficiency (P less than. 001). Increasing headache pain intensity was associated with an increased risk for inflammatory comorbidities, and monthly headache day frequency with risk for nearly all conditions.

Study details: The data come from the Migraine in America Symptoms and Treatment Study, which included 15,133 patients with migraine and 77,453 control individuals without migraine.

Disclosures: This study was funded and sponsored by Dr. Reddy’s Laboratories group of companies, Princeton, NJ. Sagar Munjal and Preeti Singh are employees of Dr. Reddy’s Laboratories. Richard B. Lipton, Dawn C. Buse, Michael L. Reed, Todd J. Schwedt, and David W. Dodick reported paid consultancy for Dr. Reddy’s Laboratories. The authors also reported ties with one or more pharmaceutical companies.

Citation: Buse DC et al. J Headache Pain. 2020 Mar 2. doi: 10.1186/s10194-020-1084-y.

Key clinical point: Topical basil essential oil at higher doses can effectively reduce the severity of pain intensity and frequency of migraine attacks.

Major Finding: The interaction between dose and time factors was significantly associated with both pain intensity and frequency of attack (P less than .001 for both). The odds of higher pain intensity and rates of higher frequency of migraine attacks in the basil essential oil vs placebo group decreased over time.

Study details: In a triple-blind study, 144 patients with migraine were randomly assigned to basil essential oil 2%, 4%, 6%, and placebo groups (1:1:1:1) by a stratified method.

Disclosures: This study was supported by the Lorestan University of Medical Sciences, Khorramabad, Iran. The authors declared no conflicts of interest. 

Citation: Ahmadifard M et al. Complement Med Res. 2020 Mar 10. doi: 10.1159/000506349. 

Key clinical point: Topical basil essential oil at higher doses can effectively reduce the severity of pain intensity and frequency of migraine attacks.

Major Finding: The interaction between dose and time factors was significantly associated with both pain intensity and frequency of attack (P less than .001 for both). The odds of higher pain intensity and rates of higher frequency of migraine attacks in the basil essential oil vs placebo group decreased over time.

Study details: In a triple-blind study, 144 patients with migraine were randomly assigned to basil essential oil 2%, 4%, 6%, and placebo groups (1:1:1:1) by a stratified method.

Disclosures: This study was supported by the Lorestan University of Medical Sciences, Khorramabad, Iran. The authors declared no conflicts of interest. 

Citation: Ahmadifard M et al. Complement Med Res. 2020 Mar 10. doi: 10.1159/000506349. 

Key clinical point: Topical basil essential oil at higher doses can effectively reduce the severity of pain intensity and frequency of migraine attacks.

Major Finding: The interaction between dose and time factors was significantly associated with both pain intensity and frequency of attack (P less than .001 for both). The odds of higher pain intensity and rates of higher frequency of migraine attacks in the basil essential oil vs placebo group decreased over time.

Study details: In a triple-blind study, 144 patients with migraine were randomly assigned to basil essential oil 2%, 4%, 6%, and placebo groups (1:1:1:1) by a stratified method.

Disclosures: This study was supported by the Lorestan University of Medical Sciences, Khorramabad, Iran. The authors declared no conflicts of interest. 

Citation: Ahmadifard M et al. Complement Med Res. 2020 Mar 10. doi: 10.1159/000506349. 

Updated April 2, 2020.

The commander of a US Navy aircraft carrier in the midst of a COVID-19 outbreak was swiftly fired by Acting Secretary of the Navy Thomas Modly following media coverage of the plight of more than 200 COVID-19 positive sailors on the USS Theodore Roosevelt.

In a statement released April 2, Modly announced the removal of Capt. Brett Crozier for writing a memo that was later leaked to the San Francisco Chronicle newspaper. According to Acting Secretary Modly, the memo was sent “outside the chain of command” and his action “made his Sailors, their families, and many in the public believe that his letter was the only reason help from our larger Navy family was forthcoming, which was hardly the case.”

On Monday, March 30, Capt. Crozier, commanding officer of the nuclear aircraft carrier USS Theodore Roosevelt, sent an urgent request for assistance to senior Navy officials: “[I]n combat we are willing to take certain risks that are not acceptable in peacetime. However, we are not at war, and therefore cannot allow a single Sailor to perish as a result of this pandemic unnecessarily. Decisive action is required now in order to comply with CDC and NAVADMIN 083/20 guidance and prevent tragic outcomes.”

Even as a number of cruise ships with ill and dying passengers were—are—waiting to be allowed to dock in Florida and elsewhere, the USS Theodore Roosevelt was also dealing with a COVID-19 outbreak onboard—and awaiting permission to let the crew of more than 4,000 on shore so they could quarantine safely.

Crozier pointed to “lessons learned” from the Diamond Princess—the only comparable situation at the time. He quoted from the abstract to an epidemiological research study: An index case on board the cruise ship was reported in late January; a month later, 619 of 3,700 passengers and crew had tested positive. Without any interventions, the abstract noted, between January 21st and February 19th an estimated 2,920 of the passengers would have been infected. Isolation and quarantine, it concluded, prevented 2,307 cases. Further, an early evacuation would have been associated with 76 infected persons.

The Diamond Princess, Crozier wrote, was able to more effectively isolate people due to a higher percentage of individual and compartmentalized accommodations. However, due to a warship’s “inherent limitations of space,” his crew could not comply with orders to practice social distancing. “With the exceptions of a handful of senior officer staterooms,” he wrote, “none of the berthing onboard a warship is appropriate for quarantine or isolation.” He also pointed to other obstacles: shared bathrooms, shared sleeping quarters, group mealtimes, and ladders and other surfaces touched and possibly contaminated as crew move around the ship.

Moreover, Crozier wrote, “The spread of the disease is ongoing and accelerating.” By Tuesday March 31st, nearly 1,300 sailors had been tested, and hundreds were testing negative, but 243 sailors had tested positive and 87 more were showing symptoms, according to the latest reports. So far, none are showing serious symptoms.

“If we do not act now, we are failing to take care of our most trusted asset—our sailors,” Capt Crozier wrote. At first, no one seemed to be listening, but after the Chronicle broke the story and it began circulating in the media—things changed. “I heard about the letter from Capt. Crozier [Tuesday] morning,” said Acting Secretary Modly in an interview with the Chronicle. “I know that our command organization has been aware of this for about 24 hours and we have been working actually the last 7 days to move those sailors off the ship and get them into accommodations in Guam. The problem is that Guam doesn’t have enough beds right now and we’re having to talk to the government there to see if we can get some hotel space, create tent-type facilities.”

He noted that the situation for the USS Theodore Roosevelt is “a little bit different and unique” in that it has aircraft and armaments on it, fire hazards, and “we have to run a nuclear power plant.” Crozier had proposed that approximately 10% of the crew remain on board to take care of the duties such as tending to the nuclear reactor.

As of April 1, the Navy plans to remove some 2,700 sailors to the hotel rooms government officials on Guam have secured for them. Secretary Modly made no mention of the care or treatment of infected sailors in his April 2nd statement, but offered this reassurance: "You can offer comfort to your fellow citizens who are struggling and fearful here at home by standing the watch, and working your way through this pandemic with courage and optimism and set the example for the nation. We have an obligation to ensure you have everything you need as fast as we can get it there, and you have my commitment that we will not let you down."

Updated April 2, 2020.

The commander of a US Navy aircraft carrier in the midst of a COVID-19 outbreak was swiftly fired by Acting Secretary of the Navy Thomas Modly following media coverage of the plight of more than 200 COVID-19 positive sailors on the USS Theodore Roosevelt.

In a statement released April 2, Modly announced the removal of Capt. Brett Crozier for writing a memo that was later leaked to the San Francisco Chronicle newspaper. According to Acting Secretary Modly, the memo was sent “outside the chain of command” and his action “made his Sailors, their families, and many in the public believe that his letter was the only reason help from our larger Navy family was forthcoming, which was hardly the case.”

On Monday, March 30, Capt. Crozier, commanding officer of the nuclear aircraft carrier USS Theodore Roosevelt, sent an urgent request for assistance to senior Navy officials: “[I]n combat we are willing to take certain risks that are not acceptable in peacetime. However, we are not at war, and therefore cannot allow a single Sailor to perish as a result of this pandemic unnecessarily. Decisive action is required now in order to comply with CDC and NAVADMIN 083/20 guidance and prevent tragic outcomes.”

Even as a number of cruise ships with ill and dying passengers were—are—waiting to be allowed to dock in Florida and elsewhere, the USS Theodore Roosevelt was also dealing with a COVID-19 outbreak onboard—and awaiting permission to let the crew of more than 4,000 on shore so they could quarantine safely.

Crozier pointed to “lessons learned” from the Diamond Princess—the only comparable situation at the time. He quoted from the abstract to an epidemiological research study: An index case on board the cruise ship was reported in late January; a month later, 619 of 3,700 passengers and crew had tested positive. Without any interventions, the abstract noted, between January 21st and February 19th an estimated 2,920 of the passengers would have been infected. Isolation and quarantine, it concluded, prevented 2,307 cases. Further, an early evacuation would have been associated with 76 infected persons.

The Diamond Princess, Crozier wrote, was able to more effectively isolate people due to a higher percentage of individual and compartmentalized accommodations. However, due to a warship’s “inherent limitations of space,” his crew could not comply with orders to practice social distancing. “With the exceptions of a handful of senior officer staterooms,” he wrote, “none of the berthing onboard a warship is appropriate for quarantine or isolation.” He also pointed to other obstacles: shared bathrooms, shared sleeping quarters, group mealtimes, and ladders and other surfaces touched and possibly contaminated as crew move around the ship.

Moreover, Crozier wrote, “The spread of the disease is ongoing and accelerating.” By Tuesday March 31st, nearly 1,300 sailors had been tested, and hundreds were testing negative, but 243 sailors had tested positive and 87 more were showing symptoms, according to the latest reports. So far, none are showing serious symptoms.

“If we do not act now, we are failing to take care of our most trusted asset—our sailors,” Capt Crozier wrote. At first, no one seemed to be listening, but after the Chronicle broke the story and it began circulating in the media—things changed. “I heard about the letter from Capt. Crozier [Tuesday] morning,” said Acting Secretary Modly in an interview with the Chronicle. “I know that our command organization has been aware of this for about 24 hours and we have been working actually the last 7 days to move those sailors off the ship and get them into accommodations in Guam. The problem is that Guam doesn’t have enough beds right now and we’re having to talk to the government there to see if we can get some hotel space, create tent-type facilities.”

He noted that the situation for the USS Theodore Roosevelt is “a little bit different and unique” in that it has aircraft and armaments on it, fire hazards, and “we have to run a nuclear power plant.” Crozier had proposed that approximately 10% of the crew remain on board to take care of the duties such as tending to the nuclear reactor.

As of April 1, the Navy plans to remove some 2,700 sailors to the hotel rooms government officials on Guam have secured for them. Secretary Modly made no mention of the care or treatment of infected sailors in his April 2nd statement, but offered this reassurance: "You can offer comfort to your fellow citizens who are struggling and fearful here at home by standing the watch, and working your way through this pandemic with courage and optimism and set the example for the nation. We have an obligation to ensure you have everything you need as fast as we can get it there, and you have my commitment that we will not let you down."

Updated April 2, 2020.

The commander of a US Navy aircraft carrier in the midst of a COVID-19 outbreak was swiftly fired by Acting Secretary of the Navy Thomas Modly following media coverage of the plight of more than 200 COVID-19 positive sailors on the USS Theodore Roosevelt.

In a statement released April 2, Modly announced the removal of Capt. Brett Crozier for writing a memo that was later leaked to the San Francisco Chronicle newspaper. According to Acting Secretary Modly, the memo was sent “outside the chain of command” and his action “made his Sailors, their families, and many in the public believe that his letter was the only reason help from our larger Navy family was forthcoming, which was hardly the case.”

On Monday, March 30, Capt. Crozier, commanding officer of the nuclear aircraft carrier USS Theodore Roosevelt, sent an urgent request for assistance to senior Navy officials: “[I]n combat we are willing to take certain risks that are not acceptable in peacetime. However, we are not at war, and therefore cannot allow a single Sailor to perish as a result of this pandemic unnecessarily. Decisive action is required now in order to comply with CDC and NAVADMIN 083/20 guidance and prevent tragic outcomes.”

Even as a number of cruise ships with ill and dying passengers were—are—waiting to be allowed to dock in Florida and elsewhere, the USS Theodore Roosevelt was also dealing with a COVID-19 outbreak onboard—and awaiting permission to let the crew of more than 4,000 on shore so they could quarantine safely.

Crozier pointed to “lessons learned” from the Diamond Princess—the only comparable situation at the time. He quoted from the abstract to an epidemiological research study: An index case on board the cruise ship was reported in late January; a month later, 619 of 3,700 passengers and crew had tested positive. Without any interventions, the abstract noted, between January 21st and February 19th an estimated 2,920 of the passengers would have been infected. Isolation and quarantine, it concluded, prevented 2,307 cases. Further, an early evacuation would have been associated with 76 infected persons.

The Diamond Princess, Crozier wrote, was able to more effectively isolate people due to a higher percentage of individual and compartmentalized accommodations. However, due to a warship’s “inherent limitations of space,” his crew could not comply with orders to practice social distancing. “With the exceptions of a handful of senior officer staterooms,” he wrote, “none of the berthing onboard a warship is appropriate for quarantine or isolation.” He also pointed to other obstacles: shared bathrooms, shared sleeping quarters, group mealtimes, and ladders and other surfaces touched and possibly contaminated as crew move around the ship.

Moreover, Crozier wrote, “The spread of the disease is ongoing and accelerating.” By Tuesday March 31st, nearly 1,300 sailors had been tested, and hundreds were testing negative, but 243 sailors had tested positive and 87 more were showing symptoms, according to the latest reports. So far, none are showing serious symptoms.

“If we do not act now, we are failing to take care of our most trusted asset—our sailors,” Capt Crozier wrote. At first, no one seemed to be listening, but after the Chronicle broke the story and it began circulating in the media—things changed. “I heard about the letter from Capt. Crozier [Tuesday] morning,” said Acting Secretary Modly in an interview with the Chronicle. “I know that our command organization has been aware of this for about 24 hours and we have been working actually the last 7 days to move those sailors off the ship and get them into accommodations in Guam. The problem is that Guam doesn’t have enough beds right now and we’re having to talk to the government there to see if we can get some hotel space, create tent-type facilities.”

He noted that the situation for the USS Theodore Roosevelt is “a little bit different and unique” in that it has aircraft and armaments on it, fire hazards, and “we have to run a nuclear power plant.” Crozier had proposed that approximately 10% of the crew remain on board to take care of the duties such as tending to the nuclear reactor.

As of April 1, the Navy plans to remove some 2,700 sailors to the hotel rooms government officials on Guam have secured for them. Secretary Modly made no mention of the care or treatment of infected sailors in his April 2nd statement, but offered this reassurance: "You can offer comfort to your fellow citizens who are struggling and fearful here at home by standing the watch, and working your way through this pandemic with courage and optimism and set the example for the nation. We have an obligation to ensure you have everything you need as fast as we can get it there, and you have my commitment that we will not let you down."

Key clinical point: Cervical noninvasive vagus nerve stimulation (nVNS) is a safe and effective technique for relieving acute pain in migraine and cluster headaches.

Major finding: The nVNS vs. sham-device treatment was effective in attaining a pain-free status within 30 minutes (P = .02), pain-relief status within 30 minutes (P = .007), pain-relief status at 60 minutes (P = .006), pain-free status in ≥50% of treated attacks (P = .005) and reduced use of abortive medication (P = .02). No significant differences were observed in decreased headache days (P = .117), adverse events (P = .81), and satisfaction (P = .07) between the nVNS and sham-device groups.

Study details: A systematic review and meta-analysis of 6 randomized controlled trials of nVNS for treating headaches (n = 983).

Disclosures: The authors declared no conflicts of interest.

Citation: Lai YH et al. Neuromodulation. 2020 Mar 12. doi: 10.1111/ner.13122. 

Key clinical point: Cervical noninvasive vagus nerve stimulation (nVNS) is a safe and effective technique for relieving acute pain in migraine and cluster headaches.

Major finding: The nVNS vs. sham-device treatment was effective in attaining a pain-free status within 30 minutes (P = .02), pain-relief status within 30 minutes (P = .007), pain-relief status at 60 minutes (P = .006), pain-free status in ≥50% of treated attacks (P = .005) and reduced use of abortive medication (P = .02). No significant differences were observed in decreased headache days (P = .117), adverse events (P = .81), and satisfaction (P = .07) between the nVNS and sham-device groups.

Study details: A systematic review and meta-analysis of 6 randomized controlled trials of nVNS for treating headaches (n = 983).

Disclosures: The authors declared no conflicts of interest.

Citation: Lai YH et al. Neuromodulation. 2020 Mar 12. doi: 10.1111/ner.13122. 

Key clinical point: Cervical noninvasive vagus nerve stimulation (nVNS) is a safe and effective technique for relieving acute pain in migraine and cluster headaches.

Major finding: The nVNS vs. sham-device treatment was effective in attaining a pain-free status within 30 minutes (P = .02), pain-relief status within 30 minutes (P = .007), pain-relief status at 60 minutes (P = .006), pain-free status in ≥50% of treated attacks (P = .005) and reduced use of abortive medication (P = .02). No significant differences were observed in decreased headache days (P = .117), adverse events (P = .81), and satisfaction (P = .07) between the nVNS and sham-device groups.

Study details: A systematic review and meta-analysis of 6 randomized controlled trials of nVNS for treating headaches (n = 983).

Disclosures: The authors declared no conflicts of interest.

Citation: Lai YH et al. Neuromodulation. 2020 Mar 12. doi: 10.1111/ner.13122. 

Key clinical point: Topiramate can reduce the number of headache days in a month and disability levels in children with migraine.

Major finding: Topiramate vs. placebo significantly reduced the number of migraine days in a month (P = .0008) and migraine-related disability in pediatric patients (P = .04), but showed no significant difference in the proportion of patients experiencing a ≥50% reduction in monthly headache days (P = .11). Topiramate was associated with higher rates of side effects, including weight loss and paresthesia (P less than .01 for both).

Study details: A meta-analysis of 5 randomized controlled trials, including 531 children with migraine aged 6-17 years.

Disclosures: The authors declared no conflicts of interest.

Citation: Wu X et al. Front Pediatr. 2020 Feb 27. doi: 10.3389/fped.2020.00028. 

Key clinical point: Topiramate can reduce the number of headache days in a month and disability levels in children with migraine.

Major finding: Topiramate vs. placebo significantly reduced the number of migraine days in a month (P = .0008) and migraine-related disability in pediatric patients (P = .04), but showed no significant difference in the proportion of patients experiencing a ≥50% reduction in monthly headache days (P = .11). Topiramate was associated with higher rates of side effects, including weight loss and paresthesia (P less than .01 for both).

Study details: A meta-analysis of 5 randomized controlled trials, including 531 children with migraine aged 6-17 years.

Disclosures: The authors declared no conflicts of interest.

Citation: Wu X et al. Front Pediatr. 2020 Feb 27. doi: 10.3389/fped.2020.00028. 

Key clinical point: Topiramate can reduce the number of headache days in a month and disability levels in children with migraine.

Major finding: Topiramate vs. placebo significantly reduced the number of migraine days in a month (P = .0008) and migraine-related disability in pediatric patients (P = .04), but showed no significant difference in the proportion of patients experiencing a ≥50% reduction in monthly headache days (P = .11). Topiramate was associated with higher rates of side effects, including weight loss and paresthesia (P less than .01 for both).

Study details: A meta-analysis of 5 randomized controlled trials, including 531 children with migraine aged 6-17 years.

Disclosures: The authors declared no conflicts of interest.

Citation: Wu X et al. Front Pediatr. 2020 Feb 27. doi: 10.3389/fped.2020.00028. 

Key clinical point: Vitamin D supplementation may improve headache characteristics and disability levels in patients with episodic migraine, especially among those with aura, possibly through attenuation of calcitonin gene-related peptide level.

Major finding: After 12 weeks, the vitamin D vs placebo group had a significant improvement in mean headache days (4.71 vs 6.43 days/month; P = .031) and mean Migraine Disability Assessment Questionnaire score (21.49 vs 31.16; P = .016).  

Study details: A post hoc analysis of a double-blind study which included patients with episodic migraine randomly assigned to receive either vitamin D 2,000 IU/day (n = 40) or placebo (n = 40). 

Disclosures: This study was supported by the Tehran University of Medical Sciences & Health Services. The authors reported no competing interests.

Citation: Ghorbani Z et al. J Headache Pain. 2020 Feb 24. doi: 10.1186/s10194-020-01090-w. 

Key clinical point: Vitamin D supplementation may improve headache characteristics and disability levels in patients with episodic migraine, especially among those with aura, possibly through attenuation of calcitonin gene-related peptide level.

Major finding: After 12 weeks, the vitamin D vs placebo group had a significant improvement in mean headache days (4.71 vs 6.43 days/month; P = .031) and mean Migraine Disability Assessment Questionnaire score (21.49 vs 31.16; P = .016).  

Study details: A post hoc analysis of a double-blind study which included patients with episodic migraine randomly assigned to receive either vitamin D 2,000 IU/day (n = 40) or placebo (n = 40). 

Disclosures: This study was supported by the Tehran University of Medical Sciences & Health Services. The authors reported no competing interests.

Citation: Ghorbani Z et al. J Headache Pain. 2020 Feb 24. doi: 10.1186/s10194-020-01090-w. 

Key clinical point: Vitamin D supplementation may improve headache characteristics and disability levels in patients with episodic migraine, especially among those with aura, possibly through attenuation of calcitonin gene-related peptide level.

Major finding: After 12 weeks, the vitamin D vs placebo group had a significant improvement in mean headache days (4.71 vs 6.43 days/month; P = .031) and mean Migraine Disability Assessment Questionnaire score (21.49 vs 31.16; P = .016).  

Study details: A post hoc analysis of a double-blind study which included patients with episodic migraine randomly assigned to receive either vitamin D 2,000 IU/day (n = 40) or placebo (n = 40). 

Disclosures: This study was supported by the Tehran University of Medical Sciences & Health Services. The authors reported no competing interests.

Citation: Ghorbani Z et al. J Headache Pain. 2020 Feb 24. doi: 10.1186/s10194-020-01090-w. 

Key clinical point: Serotonin-norepinephrine reuptake inhibitors (SNRIs) are clinically safe and effective, and non-inferior to other active drugs for the prophylaxis of migraine and vestibular migraine (VM).

Major finding: Fewer migraine days were reported with SNRIs vs placebo (standardized mean difference [SMD] -0.38; P = .04). In patients with VM, venlafaxine had a significant advantage in decreasing the vertigo severity score (weighted mean difference (MD) -1.45; P less than .0001) and emotional domain score of dizziness handicap inventory (MD -2.64; P = .03) vs other active drugs. No significant difference was noted in withdrawal rates between the groups.

Study details: Meta-analysis of six randomized controlled trials including 418 participants.

Disclosures: This study was funded by the Natural Science Foundation of Liaoning Province. The authors declared no conflicts of interests.

Citation: Wang F et al. Reg Anesth Pain Med. 2020 March. doi: 10.1136/rapm-2019-101207

Key clinical point: Serotonin-norepinephrine reuptake inhibitors (SNRIs) are clinically safe and effective, and non-inferior to other active drugs for the prophylaxis of migraine and vestibular migraine (VM).

Major finding: Fewer migraine days were reported with SNRIs vs placebo (standardized mean difference [SMD] -0.38; P = .04). In patients with VM, venlafaxine had a significant advantage in decreasing the vertigo severity score (weighted mean difference (MD) -1.45; P less than .0001) and emotional domain score of dizziness handicap inventory (MD -2.64; P = .03) vs other active drugs. No significant difference was noted in withdrawal rates between the groups.

Study details: Meta-analysis of six randomized controlled trials including 418 participants.

Disclosures: This study was funded by the Natural Science Foundation of Liaoning Province. The authors declared no conflicts of interests.

Citation: Wang F et al. Reg Anesth Pain Med. 2020 March. doi: 10.1136/rapm-2019-101207

Key clinical point: Serotonin-norepinephrine reuptake inhibitors (SNRIs) are clinically safe and effective, and non-inferior to other active drugs for the prophylaxis of migraine and vestibular migraine (VM).

Major finding: Fewer migraine days were reported with SNRIs vs placebo (standardized mean difference [SMD] -0.38; P = .04). In patients with VM, venlafaxine had a significant advantage in decreasing the vertigo severity score (weighted mean difference (MD) -1.45; P less than .0001) and emotional domain score of dizziness handicap inventory (MD -2.64; P = .03) vs other active drugs. No significant difference was noted in withdrawal rates between the groups.

Study details: Meta-analysis of six randomized controlled trials including 418 participants.

Disclosures: This study was funded by the Natural Science Foundation of Liaoning Province. The authors declared no conflicts of interests.

Citation: Wang F et al. Reg Anesth Pain Med. 2020 March. doi: 10.1136/rapm-2019-101207

Key clinical points: In episodic migraine, enhanced mindfulness-based stress reduction (MBSR+) is more effective than stress management for headache (SMH) in reducing headache and migraine days and headache related disability.

Major finding: At week 20, MBSR+ group vs. SHM group reported fewer headache days (4.6 vs. 6.0 headache days; P = .04) and had greater reduction in headache-related disability (59.6 to 54.6 vs 59.6 to 57.5; P =.02). Treatment response rate was higher in the MBSR+ group vs SMH group (52% vs. 23% reduction in headache days; P = .004). 

Study details: Patients with episodic migraine (aged, 18-65 years) were randomly assigned to receive either MBSR+ (n = 50) or SMH (n = 48).

Disclosures: This study was funded by the National Center for Complementary and Integrative Health and National Institutes of Health. The authors declared no conflicts of interest.

Citation: Seminowicz DA et al. Pain. 2020 Mar 13. doi: 10.1097/j.pain.0000000000001860.

Key clinical points: In episodic migraine, enhanced mindfulness-based stress reduction (MBSR+) is more effective than stress management for headache (SMH) in reducing headache and migraine days and headache related disability.

Major finding: At week 20, MBSR+ group vs. SHM group reported fewer headache days (4.6 vs. 6.0 headache days; P = .04) and had greater reduction in headache-related disability (59.6 to 54.6 vs 59.6 to 57.5; P =.02). Treatment response rate was higher in the MBSR+ group vs SMH group (52% vs. 23% reduction in headache days; P = .004). 

Study details: Patients with episodic migraine (aged, 18-65 years) were randomly assigned to receive either MBSR+ (n = 50) or SMH (n = 48).

Disclosures: This study was funded by the National Center for Complementary and Integrative Health and National Institutes of Health. The authors declared no conflicts of interest.

Citation: Seminowicz DA et al. Pain. 2020 Mar 13. doi: 10.1097/j.pain.0000000000001860.

Key clinical points: In episodic migraine, enhanced mindfulness-based stress reduction (MBSR+) is more effective than stress management for headache (SMH) in reducing headache and migraine days and headache related disability.

Major finding: At week 20, MBSR+ group vs. SHM group reported fewer headache days (4.6 vs. 6.0 headache days; P = .04) and had greater reduction in headache-related disability (59.6 to 54.6 vs 59.6 to 57.5; P =.02). Treatment response rate was higher in the MBSR+ group vs SMH group (52% vs. 23% reduction in headache days; P = .004). 

Study details: Patients with episodic migraine (aged, 18-65 years) were randomly assigned to receive either MBSR+ (n = 50) or SMH (n = 48).

Disclosures: This study was funded by the National Center for Complementary and Integrative Health and National Institutes of Health. The authors declared no conflicts of interest.

Citation: Seminowicz DA et al. Pain. 2020 Mar 13. doi: 10.1097/j.pain.0000000000001860.