Increasing evidence highlights a link between migraine, a disabling neurological disorder, and the gut microbiome. Probiotics, supplements containing colony-forming units of beneficial microbes, may influence migraine via the gut microbiome. A systematic review and meta-analysis of placebo-controlled trials was completed, and findings were synthesized narratively to evaluate probiotics for migraine prevention. Of 676 studies screened, 7 were included involving 612 participants (N = 487 females, 79.6
We examined perioperative pain assessment, medication documentation, toxicity preparedness, emergency medications and preparedness, and discharge readiness in office-based dental practices. By bringing these considerations together, the goal is to provide a practice overview of what providers should consider incorporating into their office-based dental and other similar anesthesia practices. Office- based dental anesthesia consistently delivers care to children and patients who cannot tolerate hospital treatment. Effective perioperative pain management is critically important for safe patient care in the dental office. Age-appropriate pain assessment, local-anesthetic safety, emergency preparedness, and recovery and discharge criteria are important components of office-based dental anesthesia practices. Dental offices are an important setting for patients who require sedation or general anesthesia; A practical framework may help clinicians consistently integrate safeguard elements into daily office-based care.
To review current evidence on epigenetic mechanisms in migraine, offering insights into diagnosis, disease classification, and future therapeutic management. Recent research has focused on three primary epigenetic mechanisms: DNA methylation, non-coding RNAs, and histone modifications. Altered methylation patterns have been identified in CALCA and RAMP1, both critical components of the CGRP signaling pathway. Furthermore, recent research on non-coding RNA data has enabled the development of composite risk scores to distinguish endophenotypes and support clinical diagnosis. Lastly, the therapeutic efficacy of valproic acid may be mediated via its endogenous histone deacetylase-inhibiting effect and chromatin remodeling. As our understanding of epigenetic modulation in migraine expands, these molecular insights can be integrated with genomic profiles to advance precision medicine, adding value to the interaction between genetic and environmental factors.
Diet is frequently cited among the lifestyle interventions important to managing migraine disease, but existing evidence informing dietary recommendations is hindered by limited and heterogeneous dietary study designs and results. Here, we review recent literature on migraine and diet with attention toward study designs needed to better inform dietary recommendations for migraine. Numerous recent observational studies agree that dietary intake of individuals with migraine is slightly different than their counterparts without migraine, and the disparity appears to be greater with more severe symptoms. The cross-sectional nature of the data prevents determination of causality. Meanwhile, mechanistic evidence is mounting that the relationship between dietary intake and migraine is bidirectional, yet little has been observed about the direct influence of migraine on dietary intake. Increasingly rigorous controlled dietary feeding studies demonstrate the ability of dietary modifications to impact migraine outcomes, and the strongest evidence exists for diets that diverge substantially from typical eating patterns. The implications of long-term dietary intake on migraine prognosis are also not yet known due to lack of prospective data. Multidimensional evidence supports the existence of a bidirectional relationship between diet and migraine, but data are lacking on how this interplay actually impacts dietary intake and what it means for dietary recommendations. Future research needs include: expanded study designs to better elucidate how migraine influences diet, clinical trials evaluating interventions that support healthy eating behaviors in the presence of migraine symptoms, and prospective cohorts with longitudinal assessments of migraine and dietary intake, to provide data on the reduction of risk for migraine, its exacerbation and co-morbid diet-related chronic diseases.
This review summarizes current approaches to pain assessment and pharmacologic therapy in the intensive care unit (ICU) and evaluates the expanding role of regional anesthesia (RA). Contemporary ICU analgesia emphasizes systematic pain assessment and multimodal therapy while avoiding unnecessary deep sedation. RA provides targeted, opioid-sparing analgesia for localized pain but is limited by coagulopathy, infection, altered anatomy, and practical considerations. Fascial-plane blocks may provide useful alternatives in selected patients. Thoracic epidural and paravertebral techniques remain options for selected patients but may cause hypotension and clinically significant bleeding. Ultrasound-guided techniques, including erector spinae, serratus anterior, parasternal, rectus sheath, and transversus abdominis plane blocks, expand analgesic options. Continuous catheter techniques may extend analgesia when prolonged pain is anticipated. However, evidence in heterogeneous ICU populations remains limited, and much of the current evidence is derived from perioperative or trauma populations rather than general medical ICU cohorts. Further ICU-specific comparative trials are needed to define patient selection and clinically meaningful outcomes.
