BMJ Neurology Open最新文献

{"title":"Fibrocartilaginous embolism after mountain cycling: a case report with clinical and radiological follow-up and almost complete recovery.","authors":"Sarah Sophie Hagenkötter, Faten Hammami, Beate Hagenkötter","doi":"10.1136/bmjno-2024-000690","DOIUrl":"https://doi.org/10.1136/bmjno-2024-000690","url":null,"abstract":"<p><strong>Introduction: </strong>Fibrocartilaginous embolism (FCE) is a rare spinal cord infarction due to embolism of fibrocartilaginous material with consecutive arterial infarction of the anterior spinal artery. Physical activity with increased axial pressure is the underlying mechanism of the retrograde migration of primarily nucleus pulposus material into the arterial system of the spinal cord. The initial severity of the clinical symptoms is supposed to be a prognostic predictor of recovery and so far, no specific treatment recommendation exists.</p><p><strong>Methods: </strong>We present a case of spinal cord infarction due to FCE after long and sporty mountain cycling (during 6 hours and 2500 altitude difference) with detailed clinical and radiological follow-up.</p><p><strong>Results: </strong>The clinical and radiological follow-up at month 4 showed an unexpected almost complete recovery despite the extensive initial clinical impairment.</p><p><strong>Conclusion: </strong>Mountain cycling has not yet been described as a specific trigger of FCE with spinal cord infarction. Further observation is necessary to show if the prolonged bent posture and core muscle imbalance in cycling, in addition to the Valsalva manoeuvre during physical effort, may contribute to FCE. It is unknown if prognosis of spinal cord infarction due to FCE differs from other causes of spinal ischaemia and if anticoagulation treatment presents a therapeutic option.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"6 1","pages":"e000690"},"PeriodicalIF":2.7,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11097820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of thrombocytopenia-associated cerebral venous sinus thrombosis: a population-based study.","authors":"Joshua J Mahadevan, Peter J Psaltis, Amanda G Thrift, Timothy J Kleinig","doi":"10.1136/bmjno-2023-000605","DOIUrl":"https://doi.org/10.1136/bmjno-2023-000605","url":null,"abstract":"<p><strong>Objectives: </strong>The identification of SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia (VITT) followed the recognition of a hitherto uncommon clinical syndrome frequently associated with cerebral venous sinus thrombosis (CVST), termed 'thrombosis with thrombocytopenia' syndrome (TTS). While anecdotally recognised as rare, the background incidence of TTS is unknown. We therefore aimed to investigate the background incidence of CVST with TTS in a large, well-defined population-based CVST cohort.</p><p><strong>Methods: </strong>We performed an analysis of our previously obtained retrospective population-based cohort of patients with CVST from Adelaide, Australia (2005-2011, comprising an adult population of 953 390) to identify the background incidence of CVST associated with TTS.</p><p><strong>Results: </strong>Among 105 people with CVST, the background population-based incidence of TTS-associated CVST was 1.2 per million per year (95% CI 0.5 to 2.4). A single case of a severe CVST VITT-like syndrome with multiorgan thrombosis was identified, occurring 3 weeks postrotavirus infection.</p><p><strong>Conclusions: </strong>In our population-based study, the background incidence of CVST with associated TTS was very low, and the sole clinically severe case with multiorgan thrombosis occurred following a rotaviral precipitant. Our study establishes a benchmark against which to measure future potential 'TTS' clusters and suggests that viruses other than adenovirus may trigger this syndrome.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"6 1","pages":"e000605"},"PeriodicalIF":2.7,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11097850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term cognitive recovery following isolated bilateral infarction of the fornix presenting with amnesia.","authors":"Jennifer Bradshaw, Philip Mc Choi, Scott Wrigley","doi":"10.1136/bmjno-2024-000655","DOIUrl":"10.1136/bmjno-2024-000655","url":null,"abstract":"<p><strong>Introduction: </strong>Isolated infarction of the fornix is a relatively rare stroke syndrome frequently associated with amnesia. The long-term cognitive outcome in cases of acute fornix infarction is poorly understood. This is largely due to the limited number of case studies that have documented cognitive outcomes beyond the acute recovery phase on quantifiable neuropsychological measures. We describe a patient who developed acute amnesia and was subsequently diagnosed on cerebral MRI with bilateral infarction in the anterior columns of the fornix.</p><p><strong>Method: </strong>Comprehensive neuropsychological review was undertaken prospectively at baseline, early and late phases of recovery.</p><p><strong>Results: </strong>At 9 months post-stroke, there was some reduction in the severity of memory dysfunction, but a significant anterograde amnesia persisted.</p><p><strong>Conclusion: </strong>This is one of the very few cases in the literature where neuropsychological function has been comprehensively and serially examined over the first year post-isolated bilateral fornix infarction. It is concluded that amnesia can persist well beyond 6 months in these cases, with associated functional impairment in daily life.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"6 1","pages":"e000655"},"PeriodicalIF":2.7,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11085788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive and psychopathological outcomes in acute disseminated encephalomyelitis.","authors":"Christina Kazzi, Rubina Alpitsis, Terence J O'Brien, Charles Malpas, Mastura Monif","doi":"10.1136/bmjno-2024-000640","DOIUrl":"10.1136/bmjno-2024-000640","url":null,"abstract":"<p><p>Individuals with acute disseminated encephalomyelitis (ADEM) can experience persistent cognitive deficits and psychopathology, which significantly interferes with daily functioning and quality of life. Here, we review the current literature to characterise the cognitive and psychological sequelae, suggest avenues for further research and discuss the implications for clinical practice. Research on this topic is largely limited to the paediatric population with a few case studies in the adult population. The current evidence demonstrates persistent cognitive deficits in attention and information processing speed, as well as elevated symptoms of depression and anxiety. Results are mixed for executive functions and memory, while language and visuospatial functions are relatively undisturbed. There is emerging evidence to suggest that individuals-particularly children-with ADEM experience persistent cognitive deficits and suffer from elevated symptoms of depression and anxiety. Comprehensive neuropsychological assessments are recommended to guide intervention and monitor progress. Further research is required to clarify our understanding of the cognitive and psychological outcomes following ADEM and the factors that influence them.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"6 1","pages":"e000640"},"PeriodicalIF":2.7,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11085806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140912971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Educational attainment, severity and short-term prognosis of intracerebral haemorrhage.","authors":"Nirupama Yechoor, Pamela Rist, Alena Ganbold, Christina Kourkoulis, Samantha Mora, Ernst Mayerhofer, Livia Parodi, Lindsay Rosenfeld, Christopher D Anderson, Jonathan Rosand","doi":"10.1136/bmjno-2023-000593","DOIUrl":"10.1136/bmjno-2023-000593","url":null,"abstract":"<p><strong>Background: </strong>Educational attainment is a critical social determinant of health that impacts the risk and severity of incident ischaemic stroke, but less is known of its impact on intracerebral haemorrhage (ICH). The objective of this study is to determine whether educational attainment is associated with ICH severity and short-term prognosis.</p><p><strong>Methods: </strong>Subjects were enrolled in a prospectively ascertained cohort with primary ICH from 1994 to 2020 at Massachusetts General Hospital. Educational attainment, medical history of ICH risk factors, ICH volume and ICH score were obtained on admission. The primary outcomes were ICH volume and the ICH score.</p><p><strong>Results: </strong>Of 2539 eligible patients eligible, the median age of the sample was 74 (IQR 64-82) and 2159 (85%) had high school-only education. 1655 (65%) presented with an ICH volume less than or equal to 30 mL and 1744 (69%) presented with an ICH score less than 3. In multivariable logistic regression analyses controlling for age, income, employment history and prestroke diagnoses of hypertension and coronary artery disease, patients with high school-only education were more likely to have an ICH volume greater than 30 mL compared with college diplomates (OR 1.58, 95% CI 1.24 to 2.08) and more likely to have an ICH score of 3 or greater compared with college diplomates (OR 2.37, 95% CI 1.77 to 3.19).</p><p><strong>Discussion: </strong>Prestroke educational attainment is independently associated with ICH severity and short-term prognosis, with lower educational attainment associated with larger ICH volumes and higher ICH scores. Future studies should examine how educational attainment impacts exposure to traditional clinical risk factors.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"6 1","pages":"e000593"},"PeriodicalIF":2.7,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11085696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased screen time and its association to migraine and tension-type headache: a cross-sectional investigation among Bangladeshi students.","authors":"Simanta Roy, Mohammad Azmain Iktidar, Sreshtha Chowdhury, Orindom Shing Pulock, Susmita Dey Pinky, Azaz Bin Sharif","doi":"10.1136/bmjno-2024-000656","DOIUrl":"10.1136/bmjno-2024-000656","url":null,"abstract":"<p><strong>Background: </strong>Increasing prevalence of screens among young people is a notable characteristic of the modern digital era. The study aimed to explore the prevalence and associated factors of migraine headache (MH) and tension-type headache (TTH) among Bangladeshi students continuing online education.</p><p><strong>Methods: </strong>A total of 771 students were selected conveniently and using the quota sampling method. A pretested semistructured and self-administered questionnaire containing the background information, Headache Screening Questionnaire-English Version, Patient Health Questionnaire-9, Speech, Spatial and Qualities of Hearing scale and Insomnia Severity Index was used for data collection. Multivariate logistic regression analysis was conducted to explore the relationship between different headaches and screen use.</p><p><strong>Results: </strong>The prevalence of MH, TTH and mixed headache (both MH and TTH) in the study population was 26.07%, 47.08% and 14.75%, respectively. Longer duration of online study (>12 months, adjusted ORs (AORs): 2.83, 95% CI 0 1.00 to 8.00), history of eye problem (AOR: 1.48, 95% CI 1.01 to 2.17), insomnia (AOR: 1.53, 95% CI 1.01 to 2.33) and moderate-to-severe depression (AOR: 2.35, 95% CI 1.55 to 3.56) were significantly associated with migraine headache. Conversely, longer duration of online study (>12 months, AOR: 2.87, 95% CI 1.40 to 5.86), moderate-to-severe depression (AOR=1.47, 95% CI 1.05 to 2.10) and use of multiple devices (AOR<1) for online study were significantly associated with TTH. In addition, longer duration of screen exposure (for >12 months, AOR: 4.56, 95% CI 0.99 to 20.93), moderate-to-severe depression (AOR: 2.25, 95% CI 1.37 to 3.72) and family history of headache (AOR: 2.66, 95% CI 1.65 to 4.29) were associated with mixed headache.</p><p><strong>Conclusion: </strong>Considering the current prevalence of TTH and MH among students and their relationship with screentime, providing health education on the proper use of electronic devices can be a promising strategy in mitigating the negative consequences.</p>","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"6 1","pages":"e000656"},"PeriodicalIF":2.7,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11085917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous spinal cord infarction: a systematic review","authors":"Maria Gharios, Vasilios Stenimahitis, Victor Gabriel El-Hajj, Omar Ali Mahdi, Alexander Fletcher-Sandersjöö, Pascal Jabbour, Magnus Andersson, Claes Hultling, Adrian Elmi-Terander, Erik Edström","doi":"10.1136/bmjno-2024-000754","DOIUrl":"https://doi.org/10.1136/bmjno-2024-000754","url":null,"abstract":"Background and objectives Spontaneous spinal cord infarction (SCInf) is a rare condition resulting in acute neurological impairment. Consensus on diagnostic criteria is lacking, which may present a challenge for the physician. This review aims to analyse the current literature on spontaneous SCInf, focusing on epidemiology, the diagnostic process, treatment strategies and neurological outcomes. Methods The study was performed in accordance with a previously published protocol. PubMed, Web of Science and Embase were searched using the keywords ‘spontaneous’, ‘spinal cord’, ‘infarction’ and ‘ischaemic’. The eligibility of studies was evaluated in two steps by multiple reviewers. Data from eligible studies were extracted and systematically analysed. Results 440 patients from 33 studies were included in this systematic review. Analysis of vascular risk factors showed that hypertension was present in 40%, followed by smoking in 30%, dyslipidaemia in 29% and diabetes in 16%. The severity of symptoms at admission according to the American Spinal Injury Association (ASIA) Impairment Scale was score A 19%, score B14%, score C36% and score D32%. The mean follow-up period was 34.8 (±12.2) months. ASIA score at follow-up showed score A 11%, score B 3%, score C 16%, score D 67% and score E 2%. The overall mortality during the follow-up period was 5%. When used, MRI with diffusion-weighted imaging (DWI) supported the diagnosis in 81% of cases. At follow-up, 71% of the patients were able to walk with or without walking aids. Conclusion The findings suggest a significant role for vascular risk factors in the pathophysiology of spontaneous SCInf. In the diagnostic workup, the use of DWI along with an MRI may help in confirming the diagnosis. The findings at follow-up suggest that neurological recovery is to be expected, with the majority of patients regaining ambulation. This systematic review highlights gaps in the literature and underscores the necessity for further research to establish diagnostic criteria and treatment guidelines. Data sharing not applicable as no datasets generated and/or analysed for this study.","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"7 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141167763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of the phrase ‘pyramidal weakness’ within the past 100 years","authors":"Matthew Szmidel, Henry Ma, Thanh Phan","doi":"10.1136/bmjno-2023-000580","DOIUrl":"https://doi.org/10.1136/bmjno-2023-000580","url":null,"abstract":"The concept of 'pyramidal weakness' denotes that neurological examination findings can be localised to the central nervous system (CNS), and implying a specific pattern of motor weakness involving upper limb extensors and lower limb flexors. However, other weakness patterns have been observed in CNS lesions. We aim to investigate the pattern of weakness observed in CNS lesions and explore the use of the phrase 'pyramidal weakness' over time. We searched Medline, PubMed, and Google Scholar up to January 1st, 2022, using keywords such as ‘distal weakness,’ ‘upper limb flexion,’ ‘lower limb extension,’ ‘pyramidal weakness,’ and related terms. The inclusion criteria were papers relating to brain or spinal cord lesions and terms inferring their presence or the description of a motor weakness pattern. We identified 117 studies since 1889, of which 29.9% of publications described weakness in upper limb extensors and lower limb flexors, and 26.5% reported distal weakness. We found an early reference to 'pyramidal weakness' in 1922 in the context of unilateral weakness in encephalitis with no description of the upper limb extensor and lower limb flexor pattern. Since 1988, 'pyramidal weakness' has become associated with weakness in upper limb extensors and lower limb flexors. The phrase 'pyramidal weakness', used in its current format, has been more frequent since the 1980s. Distal weakness and upper limb extensor and lower limb flexor weakness have been associated with CNS lesions.","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"51 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141167796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treating benign paroxysmal positional vertigo in acute traumatic brain injury: a prospective, randomised clinical trial assessing safety, feasibility, and efficacy","authors":"Rebecca M Smith, Caroline Burgess, Jenna Beattie, Abby Newdick, Vassilios Tahtis, Bithi Sahu, John F Golding, Jonathan Marsden, Barry M Seemungal","doi":"10.1136/bmjno-2023-000598","DOIUrl":"https://doi.org/10.1136/bmjno-2023-000598","url":null,"abstract":"Background Benign paroxysmal positional vertigo (BPPV) affects approximately half of acute, moderate-severe traumatic brain injury (TBI) patients. To date, there have been no rigorous studies of BPPV assessment or treatment in this cohort. We aimed to determine the safety, practicability, and efficacy of therapist-led BPPV management in acute TBI and the feasibility of a larger effectiveness trial. Methods This was a multi-centre, three-arm, parallel-groups, randomised, feasibility trial. Recruitment was via convenience sampling. The main inclusion criteria were age over 18 years and a confirmed, non-penetrating, acute TBI. BPPV-positive patients were randomly allocated to one of three interventions (repositioning manoeuvres, Brandt–Daroff exercises or advice) using minimisation criteria. Outcome assessors were blinded to the intervention. Results Of 2014 patients screened for inclusion, 180 were assessed for BPPV. Of those assessed, 34% (62/180) had BPPV, and 58 patients received an intervention. Therapist-led interventions were delivered safely and accurately according to intervention monitoring criteria. Resolution of BPPV was observed in 35/58 (60%) patients. The resolution rate was highest following repositioning manoeuvres (78%), followed by the advice (53%) and Brandt–Daroff interventions (42%). 10 patients experienced recurrence. This was observed more frequently in those with skull fractures and bilateral or mixed BPPV. Conclusions Overall, the results provide strong evidence for the feasibility of a future trial. Therapist-led management of BPPV in acute TBI was safe and practicable. Repositioning manoeuvres seemingly yielded a superior treatment effect. However, given the high recurrence rate of post-traumatic BPPV, the optimal time to treat according to patients’ specific recurrence risk requires further investigation. Trial registration [ISRCTN91943864][1], <https://doi.org/10.1186/ISRCTN91943864>. Data are available upon reasonable request. Data available on reasonable request. [1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN91943864","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"94 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141167858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse and serious adverse events incidence of pharmacological interventions for managing chronic and episodic migraine in adults: a systematic review","authors":"Seyran Naghdi, Martin Underwood, Anna Brown, Manjit Matharu, Callum Duncan, Natasha Davies, Aiva Aksentyte, Hema Mistry","doi":"10.1136/bmjno-2023-000616","DOIUrl":"https://doi.org/10.1136/bmjno-2023-000616","url":null,"abstract":"Background Migraine is the second most common prevalent disorder worldwide and is a top cause of disability with a substantial economic burden. Many preventive migraine medications have notable side effects that affect different body organs. Method We systematically searched for published randomised controlled trials (RCTs) using terms for migraine/headache and preventive medications. Using eligibility criteria, two reviewers independently assessed the articles. Cochrane risk-of-bias tool was applied to assess the quality of the studies. Data were classified by system organ class (SOC). Results Thirty-two RCTs with 21 780 participants met the eligibility criteria for the incidence of adverse events (AEs). Additionally, 33 RCTs with 22 615 participants were included to synthesise the incidence of serious AEs (SAEs). The percentage of attributed AEs and SAEs to each SOC for 10 preventive drugs with different dosing regimens was calculated. Amitriptyline and topiramate had a higher incidence of nervous system disorders; Topiramate was also associated with a higher incidence of psychiatric disorders. All drugs showed a certain incidence of infections and infestations, with Onabotulinumtoxin A (BTA) having the lowest rate. BTA had a higher incidence of musculoskeletal disorders than the other drugs. Calcitonin gene-related peptide (CGRP) monoclonal antibodies (MAbs) such as fremanezumab and galcanezumab were linked to more general disorders and administration site conditions than other drugs. Conclusion Notably, the observed harm to SOCs varies among these preventive drugs. We suggest conducting head-to-head RCTs to evaluate the safety profile of oral medications, BTA, and CGRP MAbs in episodic and/or chronic migraine populations. PROSPERO registration number CRD42021265993. All data relevant to the study are included in the article or uploaded as supplementary information.","PeriodicalId":52754,"journal":{"name":"BMJ Neurology Open","volume":"211 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140630887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}