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Our latest post is: Intermittent Fasting - 5 Things You Need to Know.

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Triptans (eletriptan, rizatriptan, sumatriptan, and zolmitriptan) were found to be most effective in a systemic review and meta-analysis comparing the efficacy and tolerability of 17 oral medications for acute migraine management.

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Comparative effects of drug interventions for the acute management of migraine episodes in adults: systematic review and network meta-analysis. BMJ. 2024 Sep 18;386:e080107. doi: 10.1136/bmj-2024-080107. PMID: 39293828

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For patients with TIA or stroke due to severe (70-99%) symptomatic intracranial atherosclerotic stenosis (sICAS) of the major intracranial arteries, submaximal balloon angioplasty may become a first-line therapy option based on the BASIS trial. Current first-line therapy will remain medical management, with catheter-based interventions such as submaximal balloon angioplasty and intracranial artery stenting reserved for patients with stroke recurrence on maximal medical therapy until a larger multinational study can be completed.

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Balloon Angioplasty vs Medical Management for Intracranial Artery Stenosis: The BASIS Randomized Clinical Trial. JAMA. 2024 Oct 1;332(13):1059-1069. doi: 10.1001/jama.2024.12829. PMID: 39235816; PMCID: PMC11378071.

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Cavernous sinus thrombosis (CST) is a rare but serious thrombophlebitic disease that can be easy to miss in the emergency department setting. This article provides an overview of CST as well as some pearls for clinching this diagnosis for emergency medicine physicians.

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High risk and low prevalence diseases: Cavernous sinus thrombosis. Am J Emerg Med. 2024;83:47-53. doi:10.1016/j.ajem.2024.06.024.
PMID: 38959601.

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ACEP released a clinical policy that addresses the choice of a second-line agent for adults with refractory seizures after adequate dosing of benzodiazepines.

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Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Seizures: Approved by the ACEP Board of Directors, April 17, 2024. Ann Emerg Med. 2024 Jul;84(1):e1-e12. doi: 10.1016/j.annemergmed.2024.02.018. PMID: 38906639.

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This systematic review snapshot found that when the HINTS exam is used by properly trained clinicians, it shows high sensitivity and moderate specificity to identify central causes of acute vestibular syndrome (AVS).

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Are the HINTS and HINTS Plus Examinations Accurate for Identifying a Central Cause of Acute Vestibular Syndrome? Ann Emerg Med. 2024 Jul;84(1):60-62. doi: 10.1016/j.annemergmed.2024.01.027. Epub 2024 Feb 22. PMID: 38385911.

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Maintaining a high suspicion for botulism is crucial in making a prompt diagnosis and in reducing morbidity and mortality. This review highlights pearls and pitfalls of diagnosis and management.

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High risk and low prevalence diseases: Botulism. Am J Emerg Med. 2024 Aug;82:174-182. doi: 10.1016/j.ajem.2024.06.018. Epub 2024 Jun 20. PMID: 38925095.

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The SWITCH trial found that decompressive craniectomy plus best medical treatment may improve outcomes in patients with severe intracerebral hemorrhage involving the basal ganglia or thalamus.

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Decompressive craniectomy plus best medical treatment versus best medical treatment alone for spontaneous severe deep supratentorial intracerebral haemorrhage: a randomised controlled clinical trial. Lancet. 2024 Jun 1;403(10442):2395-2404. doi: 10.1016/S0140-6736(24)00702-5. Epub 2024 May 15. PMID: 38761811.

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Diagnosing patients with a posterior circulation TIA who are experiencing  isolated episodic dizziness can be challenging, especially when considering the difficulty in assessing individual symptoms and the small absolute number of these patients. The authors lay out a pragmatic approach for assessment and diagnosis, but the data to support a reliable clinical decision-making tool is weak.

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Recognizing Posterior Circulation Transient Ischemic Attacks Presenting as Episodic Isolated Dizziness. Ann Emerg Med. 2024 May 23:S0196-0644(24)00214-2. doi: 10.1016/j.annemergmed.2024.04.006. Epub ahead of print. PMID: 38795083.

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This new review summarizes the current evidence regarding diagnosis and management of mild TBI in children.

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Contemporary diagnosis and management of mild TBI (concussions): What you need to know. J Trauma Acute Care Surg. 2024 Jun 1;96(6):865-869. doi: 10.1097/TA.0000000000004297. Epub 2024 May 2. PMID: 38696496.

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This retrospective cohort study of Kaiser NorCal EDs found increasing use of CT cerebral angiography for spontaneous subarachnoid hemorrhage diagnosis to be associated with fewer lumbar punctures and higher detection of unruptured intracranial aneurysms, with no significant change in the miss rate for SAH or bacterial meningitis.

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Shifts in Diagnostic Testing for Headache in the Emergency Department, 2015 to 2021. JAMA Netw Open. 2024 Apr 1;7(4):e247373. doi: 10.1001/jamanetworkopen.2024.7373. PMID: 38639937; PMCID: PMC11031686.