OBJECTIVES/BACKGROUND:This study was undertaken to evaluate patient reasons for nonadoption of migraine-preventive medications. Despite clear recommendations and eligibility criteria for migraine-preventive treatment by the American Headache Society and the availability of these treatments, many people with migraine are not taking appropriate preventive medications. Many are not seeking medical care in the first place, but even among those who are seeking medical care and have a diagnosis of migraine, the uptake of preventive medications remains low. METHODS:The OVERCOME (Observational Survey of the Epidemiology, Treatment, and Care of Migraine) study is an observational, longitudinal web-based survey conducted in more than 60,000 adults with migraine in the United States (US). The current analysis, a secondary post hoc analysis of the 2018-2020 baseline cross-sectional surveys, evaluated medication use in participants. In particular, the analysis investigates why some participants have never taken prescription medication for migraine prevention and examines how this group differs from those who are taking preventive medication, specifically in terms of disease severity and other patient-reported outcomes. RESULTS:Our findings revealed that among OVERCOME (US) participants who met criteria for migraine (n = 59,001), only approximately half (51.3%) had sought medical care for migraine in the previous 12 months, approximately one third (36.3%) had sought care and received a migraine diagnosis, and only 10% of participants had sought care, received a diagnosis of migraine, and were currently taking prescription medications for migraine prevention. Furthermore, among those who were eligible for migraine-preventive medication based on their headache frequency and associated disability (n = 22,249), 65.3% indicated they had never taken a preventive medication for migraine. The reasons for this were mostly medication-related (25.5% stated they were concerned about side effects, 23.3% said they did not like taking prescription medication, and 20.8% stated that their other medications worked well enough); however, there were also other reasons related to stigma, access, and communication with the health care provider that were noted by participants. CONCLUSION:This study highlights an important need for patient education, especially as many of these individuals who had never taken medications to prevent migraine reported experiencing ≥15 monthly headache days (25.3%), severe interictal burden (43.3%), and severe migraine-related disability (53.1%). We believe that these results may be of interest to health care providers who see people with migraine and help them better understand and anticipate their patients' educational needs regarding migraine prevention.

To determine the reasons for non-adoption of migraine preventive medications.

Sport-related concussion remains an area of high concern for contact sport athletes and their families, as well as for the medical and scientific communities. The National Football League (NFL), along with the NFL Players Association and experts in the field, has developed protocols for the detection and management of sport-related concussions. This article reviews the NFL's most recent concussion protocol including preseason education and baseline testing for players, concussion surveillance by gameday medical teams and neurotrauma consultants and athletic trainers, gameday concussion protocol and procedures, and return to participation guidelines.

There have been no prior trials directly comparing the efficacy of different calcitonin gene-related peptide (CGRP) antagonists for migraine prevention. Reported are the results from the first head-to-head study of two CGRP antagonists, galcanezumab (monoclonal antibody) versus rimegepant (gepant), for the prevention of episodic migraine. In this 3-month, double-blind, double-dummy study, participants were randomized (1:1) to subcutaneous (SC) galcanezumab 120 mg per month (after a 240 mg loading dose) and a placebo oral disintegrating tablet (ODT) every other day (q.o.d.) or to rimegepant 75 mg ODT q.o.d. and a monthly SC placebo. The primary endpoint was the proportion of participants with a ≥ 50

Quantify the proportion of phase III galcanezumab study participants with episodic migraine (EM) and clinically meaningful improvement in the Migraine Disability Assessment (MIDAS) despite monthly migraine headache day (MHD) reduction <50%.

Background and objectives: There is increasing interest by patients and healthcare providers in using digital tools such as smartphone applications to log migraine days, potential triggers and medication use. However, there are opportunities to optimize the learnability and ease of use of these applications. In this human factors study, we evaluated the experience of individuals with migraine using the VEGA mobile application. Material and methods: For 4 weeks, individuals diagnosed with migraine used the VEGA application, which generated a migraine report containing 4 weeks of data, where migraine days were reported based on functional impact, pain severity, and medication use. Participants also responded to a survey and rated the ease of use of the application using a 6-point Likert scale, with “very easy” being the highest ranking. Results: A total of 22 participants completed this study, ranged between 22 to 57 years old, and 54% were males. Eighteen participants completed the migraine report and logged 160 total migraine days. Participants reported the functional impact of migraine as "mild," "moderate," or "severe" for respectively 2, 44, and 50 of the logged migraine days. The pain severity was scored as “mild” for 24 days, “moderate” for 65 days, and “severe” for 63 days. Moreover, 20 participants reported it was “easy” or “very easy” to learn how to use the application, and 19 participants found it “simple” or “extremely simple” to use. Conclusions: In this human factors study, the VEGA application was easy to use, providing real-time patient-reported data.

Migraine is a highly prevalent neurological disease of varying attack frequency. Headache attacks that are accompanied by a combination of impact on daily activities, photophobia and/or nausea are most commonly migraine. The headache phase of a migraine attack has attracted more research, assessment tools and treatment goals than any other feature, characteristic, or phase of migraine. However, the migraine attack may encompass up to 4 phases: the prodrome, aura, headache phase and postdrome. There is growing recognition that the burden of migraine, including symptoms associated with the headache phase of the attack, may persist between migraine attacks, sometimes referred to as the “interictal phase.” These include allodynia, hypersensitivity, photophobia, phonophobia, osmophobia, visual/vestibular disturbances and motion sickness. Subtle interictal clinical manifestations and a patient's trepidation to make plans or commitments due to the unpredictability of migraine attacks may contribute to poorer quality of life. However, there are only a few tools available to assess the interictal burden. Herein, we examine the recent advances in the recognition, description, and assessment of the interictal burden of migraine. We also highlight the value in patients feeling comfortable discussing the symptoms and overall burden of migraine when discussing migraine treatment needs with their provider.

Background:Efficacy of telemedicine for stroke was first established by the Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) trials in California and Arizona. Following these randomized controlled trials, the Stroke Telemedicine for Arizona Rural Residents (STARR) network was the first telestroke network to be established in Arizona. It consisted of a 7 spoke 1 hub telestroke system, and it was designed to serve rural, remote, or neurologically underserved communities.Objective:The objective of STARR was to establish a multicenter state-wide telestroke research network to determine the feasibility of prospective collection, recording, and regularly analysis of telestroke patient consultations and care data for the purposes of establishing quality measures, improvement, and benchmarking against other national and international telestroke programs.Methods:The STARR trial was open to enrollment for 29 months from 2008 to 2011. Mayo Clinic Hospital, Phoenix, Arizona served as the hub primary stroke center and its vascular neurologists provided emergency telestroke consultations to seven participating rural, remote, or underserved spoke community hospitals in Arizona. Eligibility criteria for activation of a telestroke alert and study enrollment were established. Consecutive patients exhibiting symptoms and signs of acute stroke within a 12 h window were enrolled, assessed, and treated by telemedicine. The state government sponsor, Arizona Department of Health Services' research grant covered the cost of acquisition, maintenance, and service of the selected telemedicine equipment as well as the professional telestroke services provided. The study deployed multiple telemedicine video cart systems, picture archive and communications systems software, and call management solutions. The STARR protocol was reviewed and approved by Mayo Clinic IRB, which served as the central IRB of record for all the participating hospitals, and the trial was registered at ClinicalTrials.gov.Results:The telestroke hotline was activated 537 times, and ultimately 443 subjects met criteria and consented to participate. The STARR successfully established a multicenter state-wide telestroke research network. The STARR developed a feasible and pragmatic approach to the prospective collection, storage, and analysis of telestroke patient consultations and care data for the purposes of establishing quality measures and tracking improvement. STARR benchmarked well against other national and international telestroke programs. STARR helped set the foundation for multiple regional and state telestroke networks and ultimately evolved into a national telestroke network.Conclusions:Multiple small and rurally located community hospitals and health systems can successfully collaborate with a more centrally located larger hospital center through telemedicine technologies to develop a coordinated approach to the assessment, diagnosis, and emergency treatment of patients manifesting symptoms and signs of an acute stroke syndrome. This model may serve well the needs of patients presenting with other time-sensitive medical emergencies.Clinical Trial Registration number: NCT00829361.

Posttraumatic headache (PTH) is the most common secondary headache disorder, accounting for approximately 4% of all headache disorders. It is the most common symptom following concussion (mild traumatic brain injury) and can be debilitating for many who have persistent symptoms. With a recent increase in public awareness regarding traumatic brain injury, there has been a corresponding increase in PTH research. The pathophysiology of PTH remains poorly understood and the underlying mechanisms are likely multifactorial. Diagnosis of PTH is dependent on a temporal relationship to a head injury. PTH often resembles common primary headache phenotypes. Treatment of PTH utilizes known treatments for these other headache phenotypes, as there is no currently approved treatment specifically for PTH. Moving forward, further studies are needed to better define and validate the definition of PTH, understand the underlying pathophysiology, and find more specific treatments.

To evaluate satisfaction with the healthcare provider report (HPR) from a migraine smartphone app (Vega), and its impact on provider confidence in decision-making in simulated patient portal communications.

While there is strong evidence supporting the importance of telemedicine in stroke, its role in other areas of neurology is not as clear. The goal of this review is to provide an overview of evidence-based data on the role of teleneurology in the care of patients with neurologic disorders other than stroke.Studies across multiple specialties report noninferiority of evaluations by telemedicine compared with traditional, in-person evaluations in terms of patient and caregiver satisfaction. Evidence reports benefits in expediting care, increasing access, reducing cost, and improving diagnostic accuracy and health outcomes. However, many studies are limited, and gaps in knowledge remain.Telemedicine use is expanding across the vast array of neurologic disorders. More studies are needed to validate and support its use.

Though studies describe postconcussive changes in eye movements, there is a need for data describing baseline eye movements. The purpose of this study was to describe baseline eye movements and visual contrast acuity using the King-Devick (KD) Eye Tracking System and KD Visual Contrast Sensitivity Chart. Fewer total saccades were noted in soccer players than basketball players (soccer, 56.9 ± 14.3; basketball, 101.1 ± 41.3; p = .0005). No significant differences were noted for the number of saccades between sexes (males, 60.4 ± 20.3; females, 84.9 ± 41.8, p = .100) or in contrast acuity between all groups (p > .05). These results suggest the presence of sport-specific trends that may invalidate the comparison of postconcussion evaluation to generic baseline athlete eye movements.