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Robblee J, Hakim SM, Reynolds JM, Monteith TS, Zhang N, Barad M. Nonspecific oral medications versus anti-calcitonin gene-related peptide monoclonal antibodies for migraine: A systematic review and meta-analysis of randomized controlled trials. Headache 2024. [PMID: 38634515 DOI: 10.1111/head.14693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To compare calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) versus nonspecific oral migraine preventives (NOEPs). BACKGROUND Insurers mandate step therapy with NOEPs before approving CGRP mAbs. METHODS Databases were searched for class I or II randomized controlled trials (RCTs) comparing CGRP mAbs or NOEPs versus placebo for migraine prevention in adults. The primary outcome measure was monthly migraine days (MMD) or moderate to severe headache days. RESULTS Twelve RCTs for CGRP mAbs, 5 RCTs for topiramate, and 3 RCTs for divalproex were included in the meta-analysis. There was high certainty that CGRP mAbs are more effective than placebo, with weighted mean difference (WMD; 95% confidence interval) of -1.64 (-1.99 to -1.28) MMD, which is compatible with small effect size (Cohen's d -0.25 [-0.34 to -0.16]). Certainty of evidence that topiramate or divalproex is more effective than placebo was very low and low, respectively (WMD -1.45 [-1.52 to -1.38] and -1.65 [-2.30 to -1.00], respectively; Cohen's d -1.25 [-2.47 to -0.03] and -0.48 [-0.67 to -0.29], respectively). Trial sequential analysis showed that information size was adequate and that CGRP mAbs had clear benefit versus placebo. Network meta-analysis showed no statistically significant difference between CGRP mAbs and topiramate (WMD -0.19 [-0.56 to 0.17]) or divalproex (0.01 [-0.73 to 0.75]). No significant difference was seen between topiramate or divalproex (0.21 [-0.45 to 0.86]). CONCLUSIONS There is high certainty that CGRP mAbs are more effective than placebo, but the effect size is small. When feasible, CGRP mAbs may be prescribed as first-line preventives; topiramate or divalproex could be as effective but are less well tolerated. The findings of this study support the recently published 2024 position of the American Headache Society on the use of CGRP mAbs as the first-line treatment.
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Affiliation(s)
- Jennifer Robblee
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Sameh M Hakim
- Department of Anesthesiology, Intensive Care, and Pain Management, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - John M Reynolds
- The Louis Calder Memorial Library, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Teshamae S Monteith
- Division of Headache, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Niushen Zhang
- Department of Neurology & Neurological Sciences, Stanford Health Care, Stanford, California, USA
| | - Meredith Barad
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Health Care, Stanford, California, USA
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Monteith TS, Stark-Inbar A, Shmuely S, Harris D, Garas S, Ironi A, Kalika P, Irwin SL. Remote electrical neuromodulation (REN) wearable device for adolescents with migraine: a real-world study of high-frequency abortive treatment suggests preventive effects. Front Pain Res (Lausanne) 2023; 4:1247313. [PMID: 38028429 PMCID: PMC10657883 DOI: 10.3389/fpain.2023.1247313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Migraine is a chronic neurological disease manifesting as attacks of disabling head pain and associated symptoms. Remote electrical neuromodulation (REN) is a non-pharmacological, prescribed, wearable device (Nerivio®). This device has been certified by the FDA for the acute and/or preventive treatment of migraine with or without aura in patients 12 years of age or older. The device is affixed to the user's arm during 45-min treatment sessions and is operated using a smartphone app. This study (NCT05769322) aims to evaluate whether frequent use of REN for the acute treatment of migraine in adolescents resulted in a reduction in monthly migraine treatment days (MMTD), as previously demonstrated in adults through a dedicated prevention clinical trial (NCT04828707). Methods The study included real-world prospective data from adolescent patients who used REN on at least 10 days every 28-day month, following the REN migraine prevention guideline of an every-other-day pattern. Additional requirements were at least three REN treatment days in each of the two subsequent months. The number of MMTD was used as a proxy measure for the number of monthly migraine days (MMD). The change in MMTD from the first month, taken as a "baseline," to each of the following months was used to evaluate the presence and size of potential migraine preventive benefits of REN in adolescents. Results A total of 83 adolescents were eligible for analysis. The users were 15.9 ± 1.3 years of age (mean ± SD), and 89% of them were female. The results demonstrated a substantial month-to-month reduction in the mean (±SD) number of REN treatment days from 12.6 (±3.2) MMTD in the first month to 9.0 (±4.8) MMTD in the second month (p < 0.001), and a further decrease to 7.4 (±4.2) MMTD in the third month (p < 0.001). This indicates an accumulative reduction of 5.2 (±4.8) mean REN MMTD from the first month to the third month of consecutive REN treatment. The users also reported consistent 2-h acute pain responses in at least 50% of their treated attacks, with 61.9% of the users reported experiencing pain relief, 24.5% reported pain freedom, 67.4% indicated relief in functional disability, and 41.3% reported complete freedom from functional disability. Conclusion The frequent use of REN among adolescents as an acute treatment for migraine attacks resulted in a decrease in the mean number of monthly treatment days in the subsequent months, suggesting that REN may have potential preventive benefits for migraine in this subpopulation.
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Affiliation(s)
| | | | - Sharon Shmuely
- Clinical Development Department, Theranica, Netanya, Israel
| | - Dagan Harris
- Clinical Development Department, Theranica, Netanya, Israel
| | - Sandy Garas
- Clinical Development Department, Theranica, Netanya, Israel
| | - Alon Ironi
- Clinical Development Department, Theranica, Netanya, Israel
| | - Paige Kalika
- Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Samantha L. Irwin
- Department of Neurology, UCSF Benioff Children’s Hospitals, San Francisco, CA, United States
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Ruiz M, Cocores A, Tosti A, Goadsby PJ, Monteith TS. Alopecia as an emerging adverse event to CGRP monoclonal antibodies: Cases Series, evaluation of FAERS, and literature review. Cephalalgia 2023; 43:3331024221143538. [PMID: 36739513 DOI: 10.1177/03331024221143538] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Alopecia is associated with erenumab post-marketing, but no cases have been described. METHODS We describe two patients that reported temporary hair loss and review the FDA Adverse Event Reporting System (FAERS). RESULTS The first patient experienced alopecia within three months of starting erenumab, which did not improve with ongoing use or transition to fremanezumab. The second patient reported alopecia within two weeks of starting erenumab, which continued after transition to galcanezumab; months later, there was also recurrent hair loss within one month of starting fremanzeumab. According to FAERS (last accessed 18 August 2022), alopecia was reported most with erenumab (1158), followed by galcanezumab (554), fremanezumab (175), eptinezumab (23), rimegepant (26), ubrogepant (4), and atogepant (3). CONCLUSION Most events were reported in women and non-serious. The potential mechanism of alopecia with drugs targeting calcitonin gene-related peptide or its receptor possibly includes disruptions in the microvascular circulation and other homeostatic mechanisms.
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Affiliation(s)
- Miguel Ruiz
- Department of Biological Sciences, Florida International University, Miami, Florida, USA
| | - Alexandra Cocores
- Department of Neurology, Division of Headache, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Peter J Goadsby
- Institute of Psychiatry, Psychology, And Neuroscience, King's College, London, UK
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Teshamae S Monteith
- Department of Neurology, Division of Headache, University of Miami Miller School of Medicine, Miami, Florida, USA
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Cocores AN, Goadsby PJ, Monteith TS. Post-vaccination headache reporting: Trends according to the Vaccine Adverse Events Reporting System. Headache 2023; 63:275-282. [PMID: 36651626 DOI: 10.1111/head.14458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess the characteristics and associated disability of headache as an adverse event following vaccination. BACKGROUND According to clinical trials and post-licensure surveillance, headache is a common symptom of vaccines, yet systematic investigations of post-licensure reports of this adverse event are lacking. METHODS This was a retrospective database analysis study. We searched the Vaccine Adverse Events Reporting System (VAERS) database completed from July 1990 to June 2020 (a 30-year period prior to the start of COVID-19 pandemic) to identify reports of headache. We evaluated epidemiological features, including event characteristics, patient demographics, and vaccine type. RESULTS In those aged 3 years or older, headache was the fifth most reported adverse symptom, present in 8.1% (43,218/536,120) of all reports. Of headache reports, 96.3% (41,635/43,218) included the code "headache" not further specified. Migraine was coded in 1973 cases, although almost one-third (12,467/41,808; 29.8%) of headache reports without a migraine code mention nausea or vomiting. The onset of symptoms was within 1 day of vaccination in over two-thirds of cases. The majority of reports were classified as not serious; about one-third involved emergency room or office visits. Of the 43,218 total headache reports, only a minority involved hospitalizations (2624; 6.1%) or permanent disability (1091; 2.5%), females accounted for 68.9% (29,771) and males for 29.5% (12,725), patients aged 6 to 59 years represented 67.3% (29,112), and over one-third of cases were reported after herpes zoster (8665; 20.1%) and influenza (6748; 15.6%) vaccinations. CONCLUSION In a national surveillance system, headache was a commonly reported post-vaccination adverse event; a small subset of reports was considered serious. The development of standardized vaccine-related case definitions could be useful for better evaluating headache as an adverse event during vaccine development, and may reduce vaccine hesitancy especially in headache-prone individuals.
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Affiliation(s)
- Alexandra N Cocores
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Peter J Goadsby
- NIHR King's Clinical Research Facility & Headache Group-Wolfson CARD, King's College London, London, UK.,Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | - Teshamae S Monteith
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Monteith TS. Advocacy for Migraine Relief: Strategic Planning to Eliminate the Burden. Curr Pain Headache Rep 2022; 26:567-574. [PMID: 35716274 PMCID: PMC9206221 DOI: 10.1007/s11916-022-01059-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 11/29/2022]
Abstract
Purpose of Review The goal of this article is to describe migraine advocacy as an essential means to advance the field of headache medicine. Special attention is spent outlining advocacy initiatives and priorities. Recent Findings There is little written about “migraine advocacy” in the literature. However, organizational and expert priorities include advocating for policies that improve systems of care, telemedicine, education, research, and public initiatives that reduce health disparities and the stigma of migraine. Summary This summary includes the latest advocacy efforts to support policies that may improve migraine care, strengthen the field of headache medicine, and eliminate the burden of migraine.
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Mukhtarzada MG, Monteith TS. Equity and Disparities in Diagnosis, Management, and Research of Post-Traumatic Headache. Curr Pain Headache Rep 2022; 26:555-566. [PMID: 35567660 DOI: 10.1007/s11916-022-01058-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW There are notable health disparities and inequities in individuals with traumatic brain injury (TBI) and concussion by race, ethnicity, gender, socioeconomic status, and geography. This review will evaluate these disparities and inequities and assess the social determinants of health that drive outcomes for post-traumatic headache. Interventions for achieving this are also discussed. RECENT FINDINGS Significant disparities and inequities exist in TBI and concussion among people of different races, socioeconomic status, and geographic locations. Migraine is a common symptom post-concussion, for which disparities and social determinants of health are also discussed. Overall, multi-level interventions to reduce these disparities and inequities are reviewed for post-traumatic headache but require further investigation. Interventions are needed to reduce disparities and inequities including public health initiatives, improvements in clinical care, diversity/inclusion training, and research efforts. As literature expands, we can form guidance to identify solutions for eliminating disparities in care of diverse populations.
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Affiliation(s)
- Mejgan G Mukhtarzada
- Department of Neurology-Headache Division, University of Miami, Miller School of Medicine, 1120 NW 14 Street #13th floor, Miami, FL, 33136, USA
| | - Teshamae S Monteith
- Department of Neurology-Headache Division, University of Miami, Miller School of Medicine, 1120 NW 14 Street #13th floor, Miami, FL, 33136, USA.
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Cocores AN, Monteith TS. Headache as a Neurologic Manifestation of Systemic Disease. Curr Treat Options Neurol 2022; 24:17-40. [PMID: 35317303 PMCID: PMC8931180 DOI: 10.1007/s11940-022-00704-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 11/26/2022]
Abstract
Purpose of Review Recent Findings Summary
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Affiliation(s)
- Alexandra N. Cocores
- Division of Headache, Department of Neurology, Miller School of Medicine, University of Miami, 1120 NW 14 Street, Florida, Miami 33132 USA
| | - Teshamae S. Monteith
- Division of Headache, Department of Neurology, Miller School of Medicine, University of Miami, 1120 NW 14 Street, Florida, Miami 33132 USA
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8
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Garces KN, Cocores AN, Goadsby PJ, Monteith TS. Headache After Vaccination: An Update on Recent Clinical Trials and Real-World Reporting. Curr Pain Headache Rep 2022; 26:895-918. [PMID: 36418848 PMCID: PMC9685066 DOI: 10.1007/s11916-022-01094-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to characterize headache as a vaccine adverse event (VAE) in clinical trials. RECENT FINDINGS Of the recent phase III vaccine RCTs (non-COVID-19), 53 studies reported on headache (13 infectious agents). The median rate (interquartile range) of headache was 15.6% (IQR: 9.6-37.6%). Of these, 24.5% of the RCTs reported headache greater in the vaccine group compared to the placebo/control group. In the herpes zoster vaccination trials, headache was more common in all active groups: median rate 33.9% (IQR: 29.7-40.5%) as compared to placebo: median rate 17.7% (IQR: 15.4-23.8%). Influenza and HPV vaccination trials were the 2nd and 3rd most common to have headache as a VAE. Of the 6 widely distributed COVID-19 vaccinations, median rate of post-vaccination headache was 39% (IQR: 28-50%). Headache is a common VAE in vaccine trials. Standardized grading methods, predictors of persistence, and treatment regimens are warranted.
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Affiliation(s)
- Kimberly N. Garces
- Division of Headache, Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL USA
| | - Alexandra N. Cocores
- Division of Headache, Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL USA
| | - Peter J. Goadsby
- NIHR King’s Clinical Research Facility & Headache Group-Wolfson CARD, King’s College London, London, UK ,Department of Neurology, University of California, Los Angeles, Los Angeles, CA USA
| | - Teshamae S. Monteith
- Division of Headache, Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL USA
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Deer RR, Rock MA, Vasilevsky N, Carmody L, Rando H, Anzalone AJ, Basson MD, Bennett TD, Bergquist T, Boudreau EA, Bramante CT, Byrd JB, Callahan TJ, Chan LE, Chu H, Chute CG, Coleman BD, Davis HE, Gagnier J, Greene CS, Hillegass WB, Kavuluru R, Kimble WD, Koraishy FM, Köhler S, Liang C, Liu F, Liu H, Madhira V, Madlock-Brown CR, Matentzoglu N, Mazzotti DR, McMurry JA, McNair DS, Moffitt RA, Monteith TS, Parker AM, Perry MA, Pfaff E, Reese JT, Saltz J, Schuff RA, Solomonides AE, Solway J, Spratt H, Stein GS, Sule AA, Topaloglu U, Vavougios GD, Wang L, Haendel MA, Robinson PN. Characterizing Long COVID: Deep Phenotype of a Complex Condition. EBioMedicine 2021; 74:103722. [PMID: 34839263 PMCID: PMC8613500 DOI: 10.1016/j.ebiom.2021.103722] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/22/2021] [Accepted: 11/15/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Numerous publications describe the clinical manifestations of post-acute sequelae of SARS-CoV-2 (PASC or "long COVID"), but they are difficult to integrate because of heterogeneous methods and the lack of a standard for denoting the many phenotypic manifestations. Patient-led studies are of particular importance for understanding the natural history of COVID-19, but integration is hampered because they often use different terms to describe the same symptom or condition. This significant disparity in patient versus clinical characterization motivated the proposed ontological approach to specifying manifestations, which will improve capture and integration of future long COVID studies. METHODS The Human Phenotype Ontology (HPO) is a widely used standard for exchange and analysis of phenotypic abnormalities in human disease but has not yet been applied to the analysis of COVID-19. FUNDING We identified 303 articles published before April 29, 2021, curated 59 relevant manuscripts that described clinical manifestations in 81 cohorts three weeks or more following acute COVID-19, and mapped 287 unique clinical findings to HPO terms. We present layperson synonyms and definitions that can be used to link patient self-report questionnaires to standard medical terminology. Long COVID clinical manifestations are not assessed consistently across studies, and most manifestations have been reported with a wide range of synonyms by different authors. Across at least 10 cohorts, authors reported 31 unique clinical features corresponding to HPO terms; the most commonly reported feature was Fatigue (median 45.1%) and the least commonly reported was Nausea (median 3.9%), but the reported percentages varied widely between studies. INTERPRETATION Translating long COVID manifestations into computable HPO terms will improve analysis, data capture, and classification of long COVID patients. If researchers, clinicians, and patients share a common language, then studies can be compared/pooled more effectively. Furthermore, mapping lay terminology to HPO will help patients assist clinicians and researchers in creating phenotypic characterizations that are computationally accessible, thereby improving the stratification, diagnosis, and treatment of long COVID. FUNDING U24TR002306; UL1TR001439; P30AG024832; GBMF4552; R01HG010067; UL1TR002535; K23HL128909; UL1TR002389; K99GM145411.
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Affiliation(s)
- Rachel R Deer
- University of Texas Medical Branch, Galveston, TX, USA.
| | | | - Nicole Vasilevsky
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Monarch Initiative
| | - Leigh Carmody
- Monarch Initiative; The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Halie Rando
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alfred J Anzalone
- Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Marc D Basson
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences
| | - Tellen D Bennett
- Section of Informatics and Data Science, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Eilis A Boudreau
- Department of Neurology; Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR 97239
| | - Carolyn T Bramante
- Departments of Internal Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455
| | - James Brian Byrd
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109
| | - Tiffany J Callahan
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lauren E Chan
- Monarch Initiative; College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Haitao Chu
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN USA
| | - Christopher G Chute
- Johns Hopkins University, Schools of Medicine, Public Health, and Nursing, Baltimore, MD, USA
| | - Ben D Coleman
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA; Institute for Systems Genomics, University of Connecticut, Farmington, CT 06032, USA
| | | | - Joel Gagnier
- Departments of Orthopaedic Surgery & Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Casey S Greene
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - William B Hillegass
- University of Mississippi Medical Center, University of Mississippi Medical Center, Jackson, MS, USA; Departments of Data Science and Medicine
| | | | - Wesley D Kimble
- West Virginia Clinical and Translational Science Institute, West Virginia University, Morgantown, WV, USA
| | | | | | - Chen Liang
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Feifan Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Hongfang Liu
- Department of Artificial Intelligence and Informatics, Mayo Clinic, MN, USA
| | | | - Charisse R Madlock-Brown
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, 920 Madison Ave. Suite 518N, Memphis TN 38613
| | - Nicolas Matentzoglu
- Monarch Initiative; Semanticly Ltd; European Bioinformatics Institute (EMBL-EBI)
| | - Diego R Mazzotti
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center
| | - Julie A McMurry
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Monarch Initiative
| | - Douglas S McNair
- Quantitative Sciences, Global Health Div., Gates Foundation, Seattle, WA 98109, USA
| | | | | | - Ann M Parker
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Schools of Medicine, Baltimore, MD, USA
| | - Mallory A Perry
- Children's Hospital of Philadelphia Research Institute, Philadelphia, PA, USA
| | | | - Justin T Reese
- Monarch Initiative; Lawrence Berkeley National Laboratory
| | - Joel Saltz
- Stony Brook University; Biomedical Informatics
| | | | - Anthony E Solomonides
- Outcomes Research Network, Research Institute, NorthShore University HealthSystem, Evanston, IL 60201, USA; Institute for Translational Medicine, University of Chicago, Chicago, IL, USA
| | - Julian Solway
- Institute for Translational Medicine, University of Chicago, Chicago, IL, USA
| | - Heidi Spratt
- University of Texas Medical Branch, Galveston, TX, USA
| | - Gary S Stein
- University of Vermont Larner College of Medicine, Departments of Biochemistry and Surgery, Burlington, Vermont 05405
| | | | | | - George D Vavougios
- Department of Computer Science and Telecommunications, University of Thessaly, Papasiopoulou 2 - 4, P.C.; 131 - Galaneika, Lamia, Greece; Department of Neurology, Athens Naval Hospital 70 Deinokratous Street, P.C. 115 21 Athens, Greece; Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Biopolis, P.C. 41500 Larissa, Greece
| | - Liwei Wang
- Department of Artificial Intelligence and Informatics, Mayo Clinic, MN, USA
| | - Melissa A Haendel
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Monarch Initiative.
| | - Peter N Robinson
- Monarch Initiative; The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA; Institute for Systems Genomics, University of Connecticut, Farmington, CT 06032, USA.
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Gordon Perue GL, Fox-Rosellini SE, Sur NB, Marulanda-Londono E, Margolesky J, Tornes L, Bure A, Kalika PM, Chileuitt AA, Allespach H, Uthman BM, Alkhachroum A, Sacco RL, Monteith TS. Development of an Equity, Diversity, Inclusion, and Anti-racism Pledge as the Foundation for Action in an Academic Department of Neurology. Neurology 2021; 97:729-736. [PMID: 34408073 DOI: 10.1212/wnl.0000000000012674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 07/27/2021] [Indexed: 11/15/2022] Open
Abstract
Recent racial inequities as illustrated by the health disparities in COVID-19 infections and deaths, the recent killings of Black men and women by law enforcement, and the widening socioeconomic inequality and have brought systemic racism into a national conversation. These unprecedented times may have deleterious consequences, increasing stress, and trauma for many members of the neurology workforce. The Equity, Diversity, Inclusion and Anti-Racism Committee within our Department of Neurology provides infrastructure and guidance to foster a culture of belonging and addresses the well-being of faculty, staff, and trainees. Here, we present the creation and implementation of our Equity, Diversity, Inclusion, and Anti-Racism (EDIA) Pledge, which was central to our committee's response to these unprecedented times. We outline the process of developing this unique EDIA Pledge and provide a roadmap for approaching these important topics through a Continuing Medical Education Neurology Grand Rounds aimed at fostering a diverse, inclusive, equitable, and antiracist work environment. Through the lived experiences of 4 faculty members, we identify the impact of bias and microaggressions and encourage allyship and personal development for cultural intelligence. We hope that these efforts will inspire neurology departments and other academic institutions across the globe to make a similar pledge.
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Affiliation(s)
- Gillian L Gordon Perue
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL.
| | - Susan E Fox-Rosellini
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Nicole B Sur
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Erika Marulanda-Londono
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Jason Margolesky
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Leticia Tornes
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Annelly Bure
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Paige M Kalika
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Abraham Andres Chileuitt
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Heidi Allespach
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Basim M Uthman
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Ayham Alkhachroum
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Ralph L Sacco
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
| | - Teshamae S Monteith
- From the Department of Neurology (G.L.G.P., S.E.F.-R., N.B.S., E.M.-L., J.M., L.T., A.B., P.M.K., A.A.C., H.A., B.M.U., A.A., R.L.S., T.S.M.), University of Miami-Miller School of Medicine; and Miami Veterans Affairs Hospital (B.M.U.), FL
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Kiarashi J, VanderPluym J, Szperka CL, Turner S, Minen MT, Broner S, Ross AC, Wagstaff AE, Anto M, Marzouk M, Monteith TS, Rosen N, Manrriquez SL, Seng E, Finkel A, Charleston L. Factors Associated With, and Mitigation Strategies for, Health Care Disparities Faced by Patients With Headache Disorders. Neurology 2021; 97:280-289. [PMID: 34108270 PMCID: PMC8424498 DOI: 10.1212/wnl.0000000000012261] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 04/19/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To review contemporary issues of health care disparities in headache medicine with regard to race/ethnicity, socioeconomic status (SES), and geography and propose solutions for addressing these disparities. METHODS An Internet and PubMed search was performed and literature was reviewed for key concepts underpinning disparities in headache medicine. Content was refined to areas most salient to our goal of informing the provision of equitable care in headache treatment through discussions with a group of 16 experts from a range of headache subspecialties. RESULTS Taken together, a multitude of factors, including racism, SES, insurance status, and geographical disparities, contribute to the inequities that exist within the health care system when treating headache disorders. Interventions such as improving public education, advocacy, optimizing telemedicine, engaging in community outreach to educate primary care providers, training providers in cultural sensitivity and competence and implicit bias, addressing health literacy, and developing recruitment strategies to increase representation of underserved groups within headache research are proposed as solutions to ameliorate disparities. CONCLUSION Neurologists have a responsibility to provide and deliver equitable care to all. It is important that disparities in the management of headache disorders are identified and addressed.
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Affiliation(s)
- Jessica Kiarashi
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing.
| | - Juliana VanderPluym
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Christina L Szperka
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Scott Turner
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Mia T Minen
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Susan Broner
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Alexandra C Ross
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Amanda E Wagstaff
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Marissa Anto
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Maya Marzouk
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Teshamae S Monteith
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Noah Rosen
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Salvador L Manrriquez
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Elizabeth Seng
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Alan Finkel
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Larry Charleston
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
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Abstract
Introduction: Cluster headache [CH] is a severely disabling trigeminal autonomic cephalalgia [TAC]. Approximately 1 in 1,000 adults are affected by CH. Calcitonin gene-related peptide [CGRP] is an important mediator in the pathophysiology of CH. Galcanezumab is a monoclonal antibody with an affinity for the CGRP peptide, FDA approved for the prevention of episodic CH. Areas covered: Search words queried were 'cluster headache,' 'cluster headache, and CGRP,' 'cluster headache, and galcanezumab.' Over 99 articles in Pubmed and prescribing information for galcanezumab were reviewed. Some of the data pertaining to CH trials with fremanezumab were reviewed using clinical trials.org. Expert opinion: Galcanezumab has shown benefit in decreasing the weekly frequency of CH attacks across week 1 through week 3 in patients with CH; 8.7 attacks in the galcanezumab group, as compared with 5.2 in the placebo group (95% confidence interval, 0.2 to 6.7; P = 0.04). It has a favorable risk-benefit ratio. The prevention of CH with CGRP inhibition represents a novel advance for a condition with a significant unmet need. The negative trial results of galcanezumab for chronic cluster headache [CCH] may be due to the refractory nature and sheds light on the critical need to investigate the underlying biology and therapeutic options.
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Affiliation(s)
- Dharani Mudugal
- Department of Neurology, Creighton University Medical Center , Omaha, NE, USA
| | - Teshamae S Monteith
- Department of Neurology, University of Miami, Miami School of Medicine , Miami, FL, USA
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McMurry HS, Tsang DC, Lin N, Symes SN, Dong C, Monteith TS. Head injury and neuropsychiatric sequelae in asylum seekers. Neurology 2020; 95:e2605-e2609. [PMID: 33004606 DOI: 10.1212/wnl.0000000000010929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 07/14/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Asylum seekers experience a high burden of physical and psychological trauma, yet there is a scarcity of literature regarding the epidemiology and sequelae of head injury (HI) in asylum seekers. We examined HI prevalence and association with neuropsychiatric comorbidities in asylum seekers. METHODS A retrospective cross-sectional study was performed through review of 139 medical affidavits from an affidavit database. Affidavits written from 2010 to 2018 were included. Demographic and case-related data were collected and classified based on the presence of HI. For neuropsychiatric sequelae, the primary study outcome was headache and the secondary outcomes were depression, posttraumatic stress disorder, and anxiety. Multivariable logistic regression was performed to examine the association between HI and neuropsychiatric sequelae, adjusted for demographic and clinical characteristics. RESULTS A total of 139 medical affidavits of asylum seekers were included. The mean age was 27.4 ± 12.1 years, 56.8% were female, and 38.8% were <19 years. Almost half (42.5%) explicitly self-reported history of HI. Compared to clients who did not report HI, clients with HI were older and more likely to report a history of headache, physical abuse, physical trauma, concussion, and loss of consciousness. After adjustment for demographic and clinical characteristics, clients with HI had greater odds for neuropsychological sequelae such as headache (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.0-8.7) and depression (OR 2.5, 95% CI 1.1-5.7). CONCLUSIONS We observed a high prevalence of HI in asylum seekers. Comprehensive screening for HI and neuropsychiatric comorbidities is encouraged when evaluating asylum seekers.
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Affiliation(s)
- Hannah S McMurry
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL
| | - Darren C Tsang
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL
| | - Nicole Lin
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL
| | - Stephen N Symes
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL
| | - Chuanhui Dong
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL
| | - Teshamae S Monteith
- From the Division of Infectious Diseases and Immunology/Allergy (S.N.S.) and Clinical Translational Research Division (C.D.) and Headache Division (T.S.M.), Department of Neurology, University of Miami Miller School of Medicine (H.S.M., D.C.T., N.L., S.N.S., C.D., T.S.M.), FL.
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Loder E, Starling A, Borrero‐Mejias C, Burch R, Armand C, Begasse de Dhaem O, Broner S, Buse DC, Candee MS, Chehrenama M, Dougherty C, Duvall JR, Gautreaux J, Geweke LO, Gokani T, Halker Singh R, Issa S, Jion YI, Krel R, Kriegler J, Kuruvilla D, Leroux E, Metzler A, Minen M, Monteith TS, Nahas S, Nye B, O’Brien HL, Orlova Y, Pace A, Padilla JM, Pham A, Rastogi RG, Rayhill M, Robblee J, Schusse C, Simms G, Vgontzas A, Vollbracht SE, Werely JC, Goldberg SW. Ten (No, Make that 11) Ways the Migraine Mavens Have Changed the Conversation About Sexism in Medicine. Headache 2020. [DOI: 10.1111/head.13840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Rebecca Burch
- Neurology Brigham and Women's Hospital Boston MA USA
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Borrero‐Mejias C, Starling AJ, Burch R, Loder E, Armand C, Begasse de Dhaem O, Broner S, Buse DC, Candee MS, Chehrenama M, Dougherty C, Duvall JR, Gautreaux J, Gokani T, Singh RH, Issa S, Jion YI, Krel R, Kriegler J, Kuruvilla D, Leroux E, Metzler A, Minen M, Monteith TS, Nahas S, Nye B, O'Brien HL, Orlova Y, Pace A, Padilla JM, Pham A, Rastogi RG, Rayhill M, Robblee J, Schusse C, Simms G, Vgontzas A, Vollbracht SE, Werely JC, Wrobel Goldberg S. Ten Eleven Things Not to Say to Your Female Colleagues. Headache 2019; 59:1846-1854. [DOI: 10.1111/head.13647] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Clarimar Borrero‐Mejias
- Department of Neurology Barrow Neurological Institute at Phoenix Children's Hospital Phoenix AZ USA
| | | | - Rebecca Burch
- Department of Neurology Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - Elizabeth Loder
- Division of Headache Department of Neurology Brigham and Women's Hospital Harvard Medical School Boston MA USA
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Charleston L, Royce J, Monteith TS, Broner SW, O'Brien HL, Manrriquez SL, Robbins MS. Migraine Care Challenges and Strategies in US Uninsured and Underinsured Adults: A Narrative Review, Part 2. Headache 2019; 58:633-647. [PMID: 29878343 DOI: 10.1111/head.13321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review the challenges and potential solutions in treatment options for quality migraine care in adult patients who are under or uninsured. BACKGROUND The Affordable Care Act has improved access to health care for many; however, those who are underserved continue to face treatment disparities and have inadequate access to appropriate migraine management. METHODS This manuscript is the second of a 2-part narrative review which was performed after a series of discussions within the Underserved Populations in Headache Medicine Special Interest Section meetings of the American Headache Society. Literature was reviewed for key concepts underpinning conceptual boundaries and a broad overview of the subject matter. Published guidelines, state-specific Medicaid websites, headache quality measurement sets, literature review, and expert opinion were used to tailor suggested treatment options and therapeutic strategies. In this second part of our narrative review, we explored migraine care strategies and considerations for underserved and vulnerable adult populations with migraine. RESULTS Although common, migraine remains untreated, particularly among those of low socioeconomic status. Low socioeconomic status may play an important role in the disease progression, prescription of hazardous medications such as opioids, outcomes, and quality of life of patients with migraine and other headache disorders. There are some evidence-based and guideline supported treatment options available at low cost that include prescription medications and supplements, though approved devices are costly. Resources available online and simple nonpharmacological strategies may be particularly useful in the underserved migraine population. CONCLUSIONS We identified and discussed migraine treatment barriers that affect underserved populations in the US and summarized practical, cost-effective strategies to surmount them. However, more research is needed to identify the best cost-effective measures for migraine management in underserved and vulnerable patients who are uninsured or underinsured.
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Affiliation(s)
- Larry Charleston
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey Royce
- Neuro and Headache Center, SwedishAmerican Hospital, Rockford, IL, USA
| | - Teshamae S Monteith
- Department of Neurology-Headache Division, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Susan W Broner
- Weill Cornell Medicine Headache Program, Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - Hope L O'Brien
- Division of Neurology, Cincinnati Children's Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Salvador L Manrriquez
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Matthew S Robbins
- Department of Neurology, Albert Einstein College of Medicine, Montefiore Headache Center, Bronx, NY, USA
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Charleston L, Royce J, Monteith TS, Broner SW, O'Brien HL, Manrriquez SL, Robbins MS. Migraine Care Challenges and Strategies in US Uninsured and Underinsured Adults: A Narrative Review, Part 1. Headache 2018. [DOI: 10.1111/head.13286] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Larry Charleston
- Department of Neurology; University of Michigan; Ann Arbor MI USA
| | - Jeffrey Royce
- Neuro and Headache Center, SwedishAmerican Hospital; Rockford IL USA
| | - Teshamae S. Monteith
- Headache Division, Department of Neurology; University of Miami, Miller School of Medicine; Miami FL USA
| | - Susan W. Broner
- Weill Cornell Medicine Headache Program, Department of Neurology, Weill Cornell Medical College; New York NY USA
| | - Hope L. O'Brien
- Division of Neurology; Cincinnati Children's Medical Center, University of Cincinnati College of Medicine; Cincinnati OH USA
| | - Salvador L. Manrriquez
- Herman Ostrow School of Dentistry; University of Southern California; Los Angeles CA USA
| | - Matthew S. Robbins
- Department of Neurology, Albert Einstein College of Medicine; Montefiore Headache Center; Bronx NY USA
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Monteith TS. Migraine reliefAbout migraine. Neurology 2017; 88:e128-e131. [DOI: 10.1212/wnl.0000000000003785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Monteith TS, Kralik SF, Dillon WP, Hawkins RA, Goadsby PJ. The utility of radioisotope cisternography in low CSF/volume syndromes compared to myelography. Cephalalgia 2016; 36:1291-1295. [DOI: 10.1177/0333102416628467] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The objective of this report is to compare computed tomography (CT) and magnetic resonance (MR) myelography with radioisotope cisternography (RC) for detection of spinal cerebrospinal (CSF) leaks. Methods We retrospectively reviewed 12 spontaneous intracranial hypotension (SIH) patients; CT and RC were performed simultaneously. Three patients had MR myelography. Results CT and/or MR myelography identified CSF leaks in four of 12 patients. RC detected spinal leaks in all three patients confirmed by CT myelography; RC identified the CSF leak location in two of three cases, and these were due to osteophytic spicules and/or discs. RC showed only enlarged perineural activity. Only intrathecal gadolinium MR myelography clearly identified a slow leak from a perineural cyst. In eight remaining cases, the leak site was unknown; however, two of these showed indirect signs of CSF leak on RC. CSF slow leaks from perineural cysts were the most common presumed etiology; and the cysts were best visualized on myelography. Conclusion RC is comparable to CT myelography but has spatial limitations and should be limited to atypical cases.
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Affiliation(s)
- Teshamae S Monteith
- Headache Division, Department of Neurology, University of Miami, Miller School of Medicine, USA
| | - Stephen F Kralik
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, USA
| | - William P Dillon
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Randall A Hawkins
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Peter J Goadsby
- Headache Group, Department of Neurology, University of California, San Francisco, USA
- NIHR-Wellcome Trust Clinical Research Facility, King's College London, UK
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Abstract
OBJECTIVE To examine the association between migraine and stroke/vascular outcomes in a racially/ethnically diverse, older cohort. METHODS Participants from the Northern Manhattan Study, a population-based cohort study of stroke incidence, were assessed for migraine symptoms using a self-report questionnaire based on criteria from the International Classification of Headache Disorders, second edition. We estimated the association between migraine and combined vascular events including stroke and stroke only over a mean follow-up of 11 years, using Cox models adjusted for sociodemographic and vascular risk factors. RESULTS Of 1,292 participants (mean age 68 ± 9 years) with migraine data followed prospectively for vascular events, 262 patients (20%) had migraine and 75 (6%) had migraine with aura. No association was found between migraine (with or without aura) and risk of either stroke or combined cardiovascular events. There was an interaction between migraine and current smoking (p = 0.02 in relation to stroke and p = 0.03 for combined vascular events), such that those with migraine and smoking were at an increased risk. The hazard ratio of stroke for migraine among current smokers was 3.17 (95% confidence interval [CI] 1.13-8.85) and among current nonsmokers was 0.77 (95% CI 0.44-1.35). In relation to combined vascular events, the hazard ratio for migraine vs no migraine among current smokers was 1.83 (95% CI 0.89-3.75) and among current nonsmokers was 0.63 (95% CI 0.43-0.94). CONCLUSION In our racially/ethnically diverse population-based cohort, migraine was associated with an increased risk of stroke among active smokers but not among nonsmokers.
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Affiliation(s)
- Teshamae S Monteith
- From the Department of Neurology (T.S.M., H.G., T.R., R.L.S.), University of Miami School of Medicine, FL; and Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
| | - Hannah Gardener
- From the Department of Neurology (T.S.M., H.G., T.R., R.L.S.), University of Miami School of Medicine, FL; and Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Tatjana Rundek
- From the Department of Neurology (T.S.M., H.G., T.R., R.L.S.), University of Miami School of Medicine, FL; and Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Mitchell S V Elkind
- From the Department of Neurology (T.S.M., H.G., T.R., R.L.S.), University of Miami School of Medicine, FL; and Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Ralph L Sacco
- From the Department of Neurology (T.S.M., H.G., T.R., R.L.S.), University of Miami School of Medicine, FL; and Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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Abstract
INTRODUCTION People with migraine often report being osmophobic, both during and between acute migraine attacks. It is not clear, however, whether such reports are associated with changes in olfaction such as hyperosmia, as measured by psychophysical testing. In this case-control study we quantitatively assessed olfactory identification ability, which correlates with threshold tests of olfactory acuity, in patients with migraine at baseline (no headache), during migraine episodes, and after a treated attack and compared the test scores to those of matched control subjects. METHODS Fifty episodic migraine subjects and 50 and sex- and age-matched controls without headache were tested. All completed the University of Pennsylvania Smell Identification Test (UPSIT), a standardized and well-validated olfactory test. RESULTS At baseline, the UPSIT scores did not differ significantly between the migraine and control study groups (median paired score difference: -1, p = 0.18). During migraine attacks, a minority of migraine subjects (eight of 42) developed microsmia (i.e. lower test scores by at least four points), suggesting that, as compared to their matched controls, olfactory acuity was somewhat impaired during migraine attacks (p = 0.02). This difference was less pronounced and not statistically significant after a successfully treated attack (p = 0.15). DISCUSSION People with episodic migraine were found to have similar olfactory function as age- and sex-matched controls, but a minority exhibit microsmia or hyposmia during acute attacks. The cause of this dysfunction is unknown, but could relate to autonomic symptoms, limbic system activation, or disorders of higher order sensory processing.
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Affiliation(s)
- Michael J Marmura
- Department of Neurology, Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Waseem Anjum
- Department of Neurology, Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Richard L Doty
- Smell & Taste Center, Department of Otorhinolaryngology, Perelman School of Medicine, University of Pennsylvania, PA, USA
| | - Sarah E Hegarty
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Scott W Keith
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
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Scher AI, Monteith TS. Epidemiology and classification of post-traumatic headache: what do we know and how do we move forward? Comment on Lucas et al., "Prevalence and characterization of headache following mild TBI". Cephalalgia 2013; 34:83-5. [PMID: 23928363 DOI: 10.1177/0333102413499644] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ann I Scher
- Preventive Medicine and Biometrics, Uniformed Services University, MD, USA
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Abstract
OPINION STATEMENT The conceptual shift of our understanding of migraine from a vascular disorder to a brain disorder has dramatically altered the approach to the development of new medicines in the field. Current pharmacologic treatments of acute migraine consist of nonspecific and relatively specific agents. Migraine-specific drugs comprise two classes, the ergot alkaloid derivatives and the triptans, serotonin 5-HT(1B/1D) receptor agonists. The ergots, consisting of ergotamine and dihydroergotamine (DHE), are the oldest specific antimigraine drugs available and are considered relatively safe and effective. Ergotamine has been used less extensively because of its adverse effects; DHE is better tolerated. The triptan era, beginning in the 1990s, was a period of considerable change, although these medicines retained vasoconstrictor actions. New methods of delivering older drugs include orally inhaled DHE and the transdermal formulation of sumatriptan, both currently under study. Novel medicines being developed are targeted at neural sites of action. Serotonin 5-HT(1F) receptor agonists have proven effective in phase II studies and have no vascular actions. Calcitonin gene-related peptide (CGRP) receptor antagonists are another promising nonvasoconstrictor approach to treating acute migraine. Olcegepant (BIBN4096BS) and telcagepant (MK-0974) have been shown to be safe and effective in phase I, II, and (for telcagepant) phase III clinical trials. Other targets under investigation include glutamate (AMPA/kainate), TRPV1, prostanoid EP4, and nitric oxide synthase. With new neural targets and the potential for therapeutic advances, the next era of antimigraine medications is near.
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Affiliation(s)
- Teshamae S. Monteith
- Department of Neurology, UCSF Headache Center, 1701 Divisadero Street, Suite 480, San Francisco, CA 94115 USA
| | - Peter J. Goadsby
- Department of Neurology, UCSF Headache Center, 1701 Divisadero Street, Suite 480, San Francisco, CA 94115 USA
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Kister I, Caminero AB, Monteith TS, Soliman A, Bacon TE, Bacon JH, Kalina JT, Inglese M, Herbert J, Lipton RB. Migraine is comorbid with multiple sclerosis and associated with a more symptomatic MS course. J Headache Pain 2010; 11:417-25. [PMID: 20625916 PMCID: PMC3452278 DOI: 10.1007/s10194-010-0237-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 06/21/2010] [Indexed: 01/13/2023] Open
Abstract
The objectives of this study were: (1) to assess relative frequency of migraine in multiple sclerosis (MS) patients using the validated self-administered diagnostic questionnaire, and to compare the migraine rates in MS outpatients to age- and gender-matched historical population controls; (2) to compare clinical and radiographic characteristics in MS patients with migraine and headache-free MS patients. We conducted a cross-sectional study to assess the demographic profiles, headache features and clinical characteristics of MS patients attending a MS clinic using a questionnaire based on the American Migraine Prevalence and Prevention (AMPP) study. We compared the relative frequency of migraine in MS clinic patients and AMPP cohort. We also compared clinical and radiographic features in MS patients with migraine to an MS control group without headache. Among 204 MS patients, the relative frequency of migraine was threefold higher than in population controls both for women [55.7 vs. 17.1%; prevalence ratio (PR) =3.26, p<0.001] and men (18.4 vs. 5.6%; PR=3.29, p<0.001). In a series of logistic regression models that controlled for age, gender, disease duration, β-interferon use, and depression, migraine in MS patients was significantly associated (p<0.01) with trigeminal and occipital neuralgia, facial pain, Lhermitte's sign, temporomandibular joint pain, non-headache pain and a past history of depression. Migraine status was not significantly associated with disability on patient-derived disability steps scale or T2 lesion burden on brain MRI. Migraine is three-times more common in MS clinic patients than in general population. MS-migraine group was more symptomatic than the MS-no headache group.
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Affiliation(s)
- Ilya Kister
- Department of Neurology, NYU-MS Care Center, NYU School of Medicine, 301 E 17th St., New York, NY 10003, USA.
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Abstract
Tension-type headache (TTH) is the most prevalent primary headache disorder. An important factor in the long-term prognosis of TTH is the overuse of acute medications used to treat headache. There are many reasons why patients with TTH overuse acute medications, including biobehavioral influences, dependency, and a lack of patient education. Chronic daily headache occurs in 4.1% of the general population, and chronic tension-type headache and medication overuse headache (MOH) occur in approximately 2.2% and 1.5%, respectively. A proper diagnosis is essential for the treatment of these patients. Treatment should include pathological considerations concerning TTH and MOH, which include peripheral and central mechanisms. Because TTH with MOH carries the worst prognosis, more clinical studies focusing on the complex interaction and treatments of TTH and MOH are needed.
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Affiliation(s)
- Teshamae S Monteith
- Department of Neurology, UCSF Headache Group, 1635 Divisadero Street, Suite 520-530, San Francisco, CA 94115, USA.
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Raymond GV, Seidman R, Monteith TS, Kolodny E, Sathe S, Mahmood A, Powers JM. Head trauma can initiate the onset of adreno-leukodystrophy. J Neurol Sci 2009; 290:70-4. [PMID: 19945717 DOI: 10.1016/j.jns.2009.11.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 10/14/2009] [Accepted: 11/10/2009] [Indexed: 11/17/2022]
Abstract
X-linked adreno-leukodystrophy and its adult variant, adrenomyeloneuropathy, are caused by mutations in ABCD1 that encodes a peroxisomal membrane protein of unknown physiological significance. In spite of identical mutations, they can have markedly divergent neurological and neuropathologic characteristics. Adreno-leukodystrophy classically presents in normal boys with mild neuropsychiatric features, which progress to frank neurological signs, the vegetative state and death in approximately three years. Adrenomyeloneuropathy typically affects young men with spastic paraparesis and sensory ataxia that can progress over decades. The neuropathologic correlate for adreno-leukodystrophy is severe inflammatory demyelination of posterior cerebral white matter, while a chronic distal axonopathy of spinal cord and peripheral nerve occurs in adrenomyeloneuropathy. Consequently, both modifier genes and environmental factors have been implicated in their pathogeneses. We report five cases of adreno-leukodystrophy whose onsets were initiated by moderate to severe head trauma, two of whom were conversions from adrenomyeloneuropathy. Their clinical courses were rapidly incapacitating, short (i.e., weeks to a few years) and fatal due to marked cerebral inflammatory demyelination. These cases, in concert with several previous reports, indicate that head trauma is one environmental factor that can have a profoundly deleterious effect on those genetically at risk for, or with milder clinical phenotypes of, this disease. Avoidance of potential head trauma and a rapid response to episodes of moderate to severe head trauma in this patient population seem prudent.
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