1,721,080 research outputs found
The US Preventive Services Task Force Recommendation Statement about Screening Asymptomatic Adults for Carotid Stenosis
No full textIschemic Stroke Epidemiology during the COVID-19 Pandemic: Navigating Uncharted Waters with Changing Tides
No full textThe renin-angiotensin system: a possible contributor to migraine pathogenesis and prophylaxis
No full textMigraine and hemorrhagic stroke: a meta-analysis
No full textBackground and Purpose—Several studies have assessed the possible increased risk of hemorrhagic stroke in migraineurs,
drawing differing conclusions. No meta-analysis on the topic has been published to date.
Methods—Multiple electronic databases (MEDLINE, EMBASE, Science Citation Index, and the Cochrane Library) were
systematically searched up to March 2013 for studies dealing with migraine and hemorrhagic stroke. We selected case–
control and cohort studies with a clear definition of the diagnostic criteria for migraine and hemorrhagic stroke, using an
adjusted model or a matching procedure that could control for potential confounders, and reporting effect estimates with
95% confidence intervals (CIs) or enough data to allow calculation of those numbers. Adjusted odds ratios and hazard
ratios were used to estimate effect size.
Results—Of 11 264 records, we identified 8 studies (4 case–control and 4 cohort studies) involving a total of 1600 hemorrhagic
strokes, which were included in the meta-analysis. The overall pooled adjusted effect estimate of hemorrhagic stroke in
subjects with any migraine versus control subjects was 1.48 (95% CI, 1.16–1.88; P=0.002), with moderate statistical
heterogeneity (I2=54.7%; P value for Q test=0.031). The risk of hemorrhagic stroke in subjects with migraine with aura
(1.62; 95% CI, 0.87–3.03; P=0.129) was not significant. Compared with control subjects, the risk of hemorrhagic stroke
was greater in females with any migraine (1.55; 95% CI, 1.16–2.07; P=0.003) and in female migraineurs aged less than
45 years (1.57; 95% CI, 1.10–2.24; P=0.012).
Conclusions—Available studies suggest that subjects with migraine have an increased risk of hemorrhagic stroke. Further
studies are needed to address the hemorrhagic stroke risk according to migraine type, age, sex, and hemorrhagic stroke type
How to integrate monoclonal antibodies targeting the calcitonin gene-related peptide or its receptor in daily clinical practice
No full textBackground: Migraine is a major public health issue associated with significant morbidity, considerable negative impact on quality of life, and significant socioeconomic burden. Preventive treatments are required to reduce the occurrence and the severity of acute attacks and to minimize the use of abortive medications and the associate risk of drug-related adverse events, as well as the onset of medication-overuse headache and chronification of migraine. We performed a review of all available evidence on the safety and efficacy of monoclonal antibodies targeting the calcitonin gene-related peptide or its receptor for the preventive treatment of migraine to provide evidence-based guidance on their use in clinical practice. Abstract main body: Monoclonal antibodies targeting the calcitonin gene-related peptide or its receptor are mechanism-specific drugs for the preventive treatment of migraine. Double-blind randomized clinical trials have shown that monoclonal antibodies targeting the calcitonin gene-related peptide or its receptor are effective across all the spectrum of migraine patients who require prevention and have a good safety and tolerability profile. Nevertheless, high costs limit the affordability of those drugs at the moment. Conclusions: Specificity, long half-life, efficacy, tolerability, and ease of use make monoclonal antibodies targeting the calcitonin gene-related peptide or its receptor an appealing treatment option for migraine prevention. Optimal strategies to manage treatment over time still need to be clarified with real-life data
Cerebral vascular reactivity and the migraine-stroke relationship: A narrative review
No full textMigraine, and especially migraine with aura, is associated with an increased risk of stroke and vascular events; however, the reasons for this association are unclear. Several studies evaluated cerebral autoregulation and vasomotor reactivity in patients with migraine compared with non-migraineurs, with conflicting results. Our narrative review aimed at summarizing their results to find the most reliable evidence in the field. Studies which used visual stimuli to evoke vascular responses consistently showed an increased vascular reactivity in migraineurs compared with non-migraineurs, while studies which used systemic stimuli such as hyper- or hypocapnia showed inconsistent results. Therefore, central neural mechanisms might be more important than peripheral vascular mechanisms in determining the cerebral vascular responses of patients with migraine. However, a large body of evidence supports the existence of peripheral vascular dysfunction in patients with migraine. Further studies are needed to explain the complex interactions between central neural and peripheral vascular mechanisms in determining migraine and its vascular risk. Migraine preventive treatments, and especially the most recent ones with a peripheral action, might provide important insights in this field
Symptoms of gait and coordination impairment in a patient with COVID-19 interstitial pneumonia
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