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Background: Nurtec, a versatile migraine medication, has gained popularity. However, the awareness of migraine surgery remains uncertain. Methods: Following a descriptive approach, this cross-sectional study used Google Trends data as of December 1, 2023, to analyze internet search patterns. Approval from Vanderbilt University's institutional review board and adherence to Strengthening the Reporting of Observational Studies in Epidemiology guidelines were confirmed. Monthly relative search volume (RSV) data for "migraine surgery," "Nurtec," and "Rimegepant" were collected from January 1, 2004, to November 11, 2023, within the United States. Statistical analysis involved determining mean monthly RSV values and percentage changes for critical periods. Results: For "Nurtec," a significant surge in RSV occurred from March 2020 to April 2020 (344%). Additional peaks were observed from June 2020 to July 2020 (66%), October 2020 to December 2020 (169%), May 2021 to June 2021 (33%), and May 2023 to June 2023 (14%). "Migraine surgery" exhibited a notable 400% increase in RSV, from March 2005 to May 2005. However, post-2006, RSV for "migraine surgery" consistently remained low without noticeable peaks. Conclusions: The analysis of RSV trends for "Nurtec" and "migraine surgery" from 2004 to 2023 reveals the impact of pivotal events and marketing strategies on public interest. The distinct peaks in "Nurtec" RSV align with Food & Drug Administration approvals and marketing campaigns, highlighting the medication's accessibility. Conversely, the consistently low RSV for "migraine surgery" indicates limited awareness, emphasizing the need for enhanced promotion and education regarding surgical interventions.
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Due to multiple factors, transgender and gender diverse (TGD) individuals are more likely to experience suicidal ideation, engage in intentional injury, and attempt suicide than cisgender individuals. Lack of access to healthcare among TGD individuals may contribute to adverse physical and mental health outcomes. Few institutions of higher education include gender-affirming care in their student health insurance plans, neglecting to provide equitable care for their entire student body and further ostracizing TGD people. By including all-encompassing, gender-affirming student health insurance, institutions of higher learning have the opportunity to preserve TGD individuals' physical and mental health and promote student well-being.
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Migraine surgeons have identified six "trigger sites" where cranial nerve compression may trigger a migraine. This study investigates the change in headache severity and frequency following nerve block of the occipital trigger site. This PRISMA-compliant systematic review of five databases searched from database inception through May 2020 is registered under the PROSPERO ID: CRD42020199369. Only randomized controlled trials utilizing injection treatments for headaches with pain or tenderness in the occipital scalp were included. Pain severity was scored from 0 to 10. Headache frequency was reported as days per week. Included were 12 RCTs treating 586 patients of mean ages ranging from 33.7 to 55.8 years. Meta-analyses of pain severity comparing nerve blocks to baseline showed statistically significant reductions of 2.88 points at 5 to 20 min, 3.74 points at 1 to 6 weeks, and 1.07 points at 12 to 24 weeks. Meta-analyses of pain severity of nerve blocks compared with treatment groups of neurolysis, pulsed radiofrequency, and botulinum toxin type A showed similar headache pain severity at 1 to 2 weeks, and inferior improvements compared with the treatment groups after 2 weeks. Meta-analyses of headache frequency showed statistically significant reductions at 1 to 6-week follow-ups as compared with baseline and at 1 to 6 weeks as compared with inactive control injections. The severity and frequency of occipital headaches are reduced following occipital nerve blocks. This improvement is used to predict the success of migraine surgery. Future research should investigate spinous process injections with longer follow-up.
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Background: Improved techniques for lymphedema detection and monitoring of disease progression are needed. This study aims to use the noninvasive MyotonPRO Device to detect differences in biomechanical skin characteristics in patients with breast cancer-related lymphedema (BCRL). Methods: The handheld Myoton device was used to measure skin parameters including dynamic skin stiffness, oscillation frequency (tone), mechanical stress relaxation time, and creep in 11 women diagnosed with BCRL. Seven anatomical sites were measured bilaterally for each participant. The average values in the affected arms were compared with those in the contralateral unaffected arms. Results: Among the 11 female participants with unilateral BCRL Stages 0 to II, the combined averages for dynamic skin stiffness and frequency measurements were decreased in the affected arms when compared with those for the contralateral control arms (ratio < 1). The median ratio of stiffness (affected to unaffected control arm) was 0.91 (interquartile range [IQR] 0.78-1.03) while frequency was 0.94 (IQR 0.89-1.0). Skin relaxation time and creep averages were increased in the affected arms. The relaxation time median ratio (affected to unaffected control arm) was 1.07 (IQR 1.02-1.14) and the median ratio of creep was 1.06 (IQR 1.03-1.16). Conclusions: This study suggests the Myoton can detect differences in skin biomechanical parameters of the affected and unaffected arms in patients with BCRL. Larger studies are needed to draw strong conclusions.
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Background: Individuals with an extremity amputation are predisposed to persistent pain that reduces their quality of life. Residual limb pain is defined as pain that is felt in the limb after amputation. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review of 5 databases from inception to June 2020 was performed and is registered under the PROSPERO ID: CRD42020199297. Included studies were clinical trials with residual limb pain assessed at a minimum follow-up of 1 week. Meta-analyses of residual limb pain prevalence and severity were performed with subgroups of extremity and amputation etiology. Results: Twenty clinical trials met criteria and reported on a total of 1347 patients. Mean patient ages ranged from 38 to 77. Residual limb pain prevalence at 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years, respectively, was 50%, 11%, 23%, 27%, 22%, and 24%. Mean residual limb pain severity at the 6 months or longer follow-up was 4.19 out of 10 for cancer amputations, 2.70 for traumatic amputations, 0.47 for vasculopathy amputations, 1.01 for lower extremity amputations, and 3.56 for upper extremity amputations. Conclusions: Residual limb pain severity varies according to the etiology of amputation and is more common after upper extremity amputation than lower extremity amputations. The most severe pain is reported by patients undergoing amputations due to cancer, followed by traumatic amputations, while vascular amputation patients report lower pain severity. Promising methods of reducing long-term pain are preoperative pain control, nerve or epidural blocks, use of memantine, calcitonin-containing blocks, and prophylactic nerve coaptations.
Contexte: Les personnes subissant une amputation d'un membre sont prédisposées à des douleurs persistantes réduisant leur qualité de vie. La douleur du membre résiduel est définie comme étant la douleur ressentie dans le membre après l'amputation. Méthodes: Une revue systématique conforme à PRISMA de 5 bases de données depuis leur création jusqu'en juin 2020 a été effectuée et enregistrée sous l'ID PROSPERO: CRD42020199297. Les études incluses étaient des essais cliniques avec douleur du membre résiduel évaluée à un suivi minimum de 1 semaine. Des méta-analyses sur la prévalence et la sévérité de la douleur du membre résiduel ont été réalisées avec des sous-groupes en fonction du membre et de la cause de l'amputation. Résultats: 20 essais cliniques satisfaisaient les critères et portaient sur un total de 1347 patients. Les âges moyens des patients étaient compris entre 38 et 77 ans. La prévalence de la douleur du membre résiduel à 1 semaine, 1 mois, 3 mois, 6 mois, 1 an et 2 ans était, respectivement, de 50%, 11%, 23%, 27%, 22%, et 24%. La sévérité moyenne de la douleur du membre résiduel aux suivis de 6 mois ou plus a été de 4,19 sur 10 pour les amputations pour cancer, 2,70 pour les amputations post traumatisme, 0,47 pour les amputations liées à une vasculopathie, 1,01 pour les amputations du membre inférieur et 3,56 pour les amputations du membre supérieur. Conclusions: La sévérité de la douleur du membre résiduel varie en fonction du motif de l'amputation, et elle est plus fréquente après une amputation du membre supérieur qu'après des amputations du membre inférieur. La douleur la plus sévère a été décrite par des patients subissant une amputation à cause d'un cancer, suivie des amputations traumatiques, alors que les patients ayant subi une amputation pour cause vasculaire signalent une sévérité plus faible. Des méthodes prometteuses de réduction de la douleur à long terme sont le contrôle préopératoire de la douleur, les blocs nerveux et épiduraux, l'utilisation de la mémantine, de blocs contenant de la calcitonine et la coaptation prophylactique des nerfs.