Journal of the Chinese Medical Association : JCMA最新文献

{"title":"Long-term outcome after discontinuation of CGRP monoclonal antibodies therapy for migraine: A narrative review.","authors":"Tzu-Hsien Lai, Wen-Chun Liu, Cheng-Chia Yang, Ching-Mao Chang, Tsung-Wei Hou, Chia-Te Yen, Zheng-Guo Gao, Chun-Pai Yang","doi":"10.1097/JCMA.0000000000001437","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001437","url":null,"abstract":"<p><p>Migraine is a prevalent and disabling neurological disorder, particularly among patients with chronic migraine. Since the introduction of calcitonin gene-related peptide (CGRP)-targeted monoclonal antibodies (mAbs), migraine prevention has undergone a major therapeutic shift, supported by robust evidence from randomized clinical trials and real-world studies. Nevertheless, many clinical guidelines and reimbursement policies recommend treatment discontinuation after a predefined duration, despite limited data regarding long-term outcomes following cessation. This narrative review synthesizes evidence from clinical trials and real-world studies on outcomes following anti-CGRP mAb discontinuation. Within approximately three months following treatment cessation, migraine burden generally increases, frequently returning to baseline levels, although therapeutic benefits may persist in a subset of patients. Emerging data from prospective, multicenter, real-world evidence suggests that extending anti-CGRP therapy to 2- or 3-years yields progressive reductions in migraine burden compared to one year of treatment. Moreover, while the frequency of relapse decreases after the third year compared with the first, the optimal therapeutic duration to prevent long-term relapse has yet to be established. Retreatment generally restores efficacy to levels comparable to those achieved during initial therapy. These findings support individualized decisions regarding treatment duration and discontinuation and highlight the need for prospective controlled studies. Mandatory treatment interruptions imposed by reimbursement policies should therefore be reconsidered.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198704","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":"A safe and efficient analgesic approach for percutaneous transluminal angioplasty: Fentanyl plus targeted local anesthesia.","authors":"Hsuan-Chiao Huang, Chiann-Yi Hsu, Ming-Yuan Kang","doi":"10.1097/JCMA.0000000000001436","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001436","url":null,"abstract":"<p><strong>Background: </strong>Stenosis is a common complication of arteriovenous access (AV), for which percutaneous transluminal angioplasty (PTA) is a well-established intervention. Nevertheless, balloon dilation commonly induces pain. Common analgesic approaches during PTA encompass moderate intravenous sedation and analgesia, brachial plexus block, and local infiltrative anesthesia, each with its own limitations. A need currently exists for a safe, simple, and effective analgesic approach during PTA.</p><p><strong>Methods: </strong>This retrospective observational study was conducted between January 2020 and July 2022 at a single tertiary medical center. Patients with AV access dysfunction undergoing PTA were included. Patients were allocated into two groups based on the analgesia approach: one group received intraluminal fentanyl injection alone, and the other a combination of intraluminal fentanyl and local lidocaine infiltration at the stenotic site. Data regarding AV access type, lesion locations, 11-point Numerical Rating Scale (NRS) scores and procedural complications were collected. Comparative analysis between groups was conducted using appropriate statistical methods, and significance was set at p < 0.05.</p><p><strong>Results: </strong>A total of 120 patients (mean age, 62.9±11.8 years; 65% male) were included in the study: 34 in the fentanyl-only group (Group A) and 86 in the fentanyl combined with lidocaine group (Group B). Group A had a higher proportion of male patients compared to Group B (79.4% vs. 59.3%, p = 0.037). No significant differences were found in balloon size, inflation pressure, fluoroscope time, or procedural complications between groups. The primary outcome, procedural pain, was significantly lower in Group B as compared to Group A (NRS score 2.3 ± 0.9 vs. 5.1 ± 2.2, p < 0.001), and this analgesic advantage remained after adjusting for gender and age.</p><p><strong>Conclusion: </strong>Our study findings suggest that administering a combination of intraluminal fentanyl and a direct lidocaine injection in patients undergoing percutaneous transluminal angioplasty is both an efficient and safe analgesic procedure for PTA.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187195","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":"Nonselective beta-blockers and hepatic encephalopathy in liver cirrhosis:A meta-analysis of randomized controlled trials.","authors":"Tai-Hui Kuo, Yu-Jen Chen, Pei-Chang Lee, Tsung-Chieh Yang, Hsiao-Sheng Lu, Hui-Chun Huang, Jiing-Chyuan Luo, Hao-Ming Cheng, Ming-Chih Hou","doi":"10.1097/JCMA.0000000000001435","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001435","url":null,"abstract":"<p><strong>Background: </strong>Liver cirrhosis leads to portal hypertension and related complications, including ascites, esophageal varices, and hepatic encephalopathy (HE). Non-selective beta blockers (NSBBs) decrease portal pressure, but it is not yet clear whether they contribute to HE development. Therefore, we examined the association between NSBB therapy and HE in randomized controlled trials (RCTs) involving patients with cirrhosis.</p><p><strong>Methods: </strong>We systematically searched PubMed, Web of Science, ScienceDirect, and the Cochrane Library (from inception to December 31, 2024) for RCTs comparing NSBBs with a placebo, endoscopic band ligation, or injection sclerotherapy for variceal bleeding prevention in relation to HE. The risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using a random-effects model. Subgroups were defined according to the comparator, NSBB type, and hepatic function status (weighted mean Child-Pugh score ≤6 vs. >6). The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2).</p><p><strong>Results: </strong>There were 12 relevant studies, which included 775 NSBB-treated and 771 comparator patients (54 and 57 HE events). NSBB therapy was not associated with a statistically significant change in HE risk (RR 1.04, 95% CI 0.73-1.47; p = 0.84; I² = 0%). Estimates were consistent across all subgroups of hepatic function statuses (compensation, RR 1.18, 0.44-3.14; decompensation, RR 1.02, 0.70-1.48; p = 0.79), comparators (placebo, RR 1.19, 0.79-1.80; endoscopic therapy, RR 0.72, 0.38-1.39; p = 0.20), and NSBB types (propranolol/timolol, RR 1.06, 0.72-1.55; carvedilol, RR 0.95, 0.42-2.15; p = 0.82).</p><p><strong>Conclusion: </strong>Current evidence does not indicate a statistically significant association between NSBB therapy and HE development in patients with cirrhosis, regardless of disease severity.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187169","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":"Temporal and institutional differences in heart failure guideline adherence in Taiwan.","authors":"Hung-Yu Chang, Hsin-Ti Huang, Chung-Lieh Hung, Wei-Shiang Lin, Chi-Wen Cheng, Chao-Hung Wang, Chien-Yi Hsu, Chun-Chieh Wang, I-Chang Hsieh, Jin-Long Huang, Nicole Huang","doi":"10.1097/JCMA.0000000000001432","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001432","url":null,"abstract":"<p><strong>Background: </strong>Guideline-directed medical therapy (GDMT) improves outcomes in heart failure with reduced ejection fraction (HFrEF); however, variations in adherence to guidelines across hospitals and over time remain unknown. We used two Taiwanese national registries to investigate temporal and institutional differences in guideline adherence and outcomes among HFrEF patients.</p><p><strong>Methods: </strong>We looked at two Taiwanese prospective multicenter cohorts, the TSOC-HFrEF (2013-2014) and TSOC HF 2020 (2019-2022) registries. We looked at adherence to Class I recommended diagnostics and GDMT as well as 1-yr mortality rates. Measured covariates and within-hospital clustering were accounted for using multivariable-adjusted generalized estimating equation models and Cox proportional hazards models, which included marginal models.</p><p><strong>Results: </strong>The study included 3,028 patients with HFrEF from 16 medical centers and four regional hospitals. GDMT prescription and diagnostic testing rates increased significantly between the 2013 and 2020 cohorts (≥2 GDMT classes: 60.4% vs. 86.9%; three GDMT classes: 20.6% vs. 51.6%; both p < 0.001). The adjusted odds ratios for prescribing ≥2 and 3 GDMT classes in 2020 versus 2013 were 4.18 and 3.97, respectively, indicating consistent improvements across hospital types (interaction p-values = 0.721 and 0.467). Patients treated at medical centers had significantly higher prescription rates for angiotensin receptor-neprilysin inhibitors and mineralocorticoid receptor antagonists (39.1% vs. 32.2%, p = 0.011; 62.9% vs. 57.5%, p < 0.001, respectively), while prescription rates for renin-angiotensin system inhibitors were similar across hospital levels (medical center, 71.9% vs. regional hospital, 75.5%, p = 0.179). The 2020 cohort had a significantly lower 1-yr mortality rate (adjusted hazard ratio, 0.75, p = 0.012), with similar survival improvements across medical centers and regional hospitals (interaction, p = 0.106).</p><p><strong>Conclusion: </strong>Over time, HFrEF guideline adherence improved significantly at all hospital levels in Taiwan. Improved guideline adherence was associated with a 25% lower risk of all-cause mortality after 1 yr.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129638","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":"Contextual determinants of post-COVID-19 cognitive decline in dementia.","authors":"Liang-Kung Chen","doi":"10.1097/JCMA.0000000000001433","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001433","url":null,"abstract":"","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129699","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":"Serum biomarkers, modifiable risk factors, cognition, and processing speed in older adults.","authors":"Chia-Te Chen, Fong-Ping Tang, Chia-Hao Fan, Yi-Chen Wu, Liang-Kung Chen, Kuan-Yu Peng, Heng-Hsin Tung","doi":"10.1097/JCMA.0000000000001431","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001431","url":null,"abstract":"<p><strong>Background: </strong>Cognitive impairment is a major public health concern in aging populations. However, most previous studies have examined serum biomarkers and lifestyle, psychosocial, and clinical factors in isolation, and their associations with global cognition and processing speed remain unclear. The aim of this study was to investigate the associations of serum biomarkers and lifestyle, psychosocial, and clinical factors with global cognition and processing speed among community-dwelling middle-aged and older adults.</p><p><strong>Methods: </strong>This cross-sectional study analyzed data from community-dwelling adults aged ≥50 years who participated in the Gan-Dau Healthy Longevity Plan in Taiwan. Serum biomarkers were measured. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15), and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Global cognition was assessed using the Montreal Cognitive Assessment (MoCA), and processing speed was assessed using the Digit Symbol Substitution Test (DSST). Multivariable linear regression models were used to examine the associations between serum biomarkers and lifestyle, psychosocial, and clinical factors and global cognition and processing speed after covariate adjustment.</p><p><strong>Results: </strong>A total of 992 participants (mean age: 67.23 ± 7.97 years; 74.9% women) were included. Serum creatinine was negatively associated with global cognition (B = -0.27; 95% CI -0.52 to -0.02; p = 0.032) and processing speed (B = -1.61; 95% CI -2.90 to -0.33; p = 0.014) after covariate adjustment. Depressive symptoms were also independently associated with both cognitive domains, whereas diabetes was associated only with processing speed.</p><p><strong>Conclusion: </strong>Serum creatinine levels and depressive symptoms were independently associated with global cognition and processing speed. Diabetes was independently associated with processing speed only. These findings provide additional evidence regarding the associations of serum biomarkers and lifestyle, psychosocial, and clinical factors with cognitive performance. Further longitudinal studies are warranted to clarify the temporal relationships and potential clinical relevance of these associations.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129697","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":"Endometrial scratching in frozen embryo transfer: A stratified cohort study.","authors":"Tzu-Ya Wang, Yen-Hou Chang, Ling-Yu Jiang, Wei-Ting Chao, Chia-Hao Liu, Chen-Yu Huang, Chi-Hong Ho","doi":"10.1097/JCMA.0000000000001429","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001429","url":null,"abstract":"<p><strong>Background: </strong>Endometrial scratching (ES) is widely used in assisted reproduction. However, randomized trials have shown no benefits in unselected populations, and evidence specific to frozen embryo transfer (FET) is limited. Therefore, we estimated the association between ES and the clinical pregnancy rate (CPR) separately within strata defined by the embryo transfer (ET) history.</p><p><strong>Methods: </strong>In this retrospective cohort study at a tertiary center in Taiwan (January 2017-January 2021), nulliparous women aged <40 years who underwent FET were eligible. ES was performed with a Novak curette in the cycle preceding FET, and analyses were stratified by the ET history (none, 1-2, or ≥3). The primary outcome was the CPR at 6-8 weeks of gestation. Multivariate logistic regression within each stratum was adjusted for prespecified covariates. Differences between strata were not formally tested.</p><p><strong>Results: </strong>Of the 822 women who were enrolled, 176 (21.4%) underwent ES. The overall CPR did not differ between the groups (46.6% vs. 53.6%; p = 0.100). In women undergoing first FETs (n = 457), ES was associated with a lower crude CPR (39.4% vs. 58.1%; odds ratio: 0.47, 95% confidence interval [CI]: 0.27-0.80; p = 0.005) but not after adjustment (adjusted odds ratio [aOR]: 0.59, 95% CI: 0.31-1.15; p = 0.121). The CPR was numerically higher with ES in women with 1-2 previous ETs (n = 295; 50.0% vs. 46.9%; aOR: 1.29, 95% CI: 0.62-2.66; p = 0.499) and in those with ≥3 previous ETs (n = 70; 54.2% vs. 45.7%; aOR: 1.54, 95% CI: 0.19-12.40; p = 0.687); all adjusted associations were nonsignificant. Early miscarriage and ectopic pregnancy rates did not differ across the strata.</p><p><strong>Conclusion: </strong>ES was not associated with improved clinical pregnancy in this FET cohort, and its routine use in treatment-naïve patients with good prognosis was not supported. In women with previous ET failures, the estimates favored ES but were imprecise, nonsignificant, and exploratory. Therefore, adequately powered randomized controlled trials are required.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993206","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":"Claudin 18 is not a biomarker for breast mucinous tumor.","authors":"Shih-En Lin, Shih-Jheng Liou, Wan-Ching Chen, Wei-Yu Chen, Puay Hoon Tan, Jing-Yi Lai, Yi-Ming Chen, I-Tien Chiang, I-Chieh Chen, Chih-Jung Chen","doi":"10.1097/JCMA.0000000000001428","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001428","url":null,"abstract":"<p><strong>Background: </strong>Breast mucinous cystadenocarcinoma (BMCA) is an exceptionally rare malignancy that may resemble mucinous neoplasms of the pancreas, ovary, lung and colorectum. Claudin 18 (CLDN18), particularly its gastric-associated isoform CLDN18.2, is an emerging therapeutic target; however, CLDN18 immunoreactivity has not been systematically evaluated in BMCA. We investigated whether CLDN18 could distinguish BMCA from breast mucinous carcinoma (BMC) and selected extramammary mucinous mimics.</p><p><strong>Methods: </strong>Immunohistochemical (IHC) analysis for CLDN18, CK7 and CK20 was performed on 42 mucinous neoplasms comprising BMCA (n=3), BMC (n=9), pulmonary invasive mucinous adenocarcinoma (n=8), colorectal mucinous adenocarcinoma (n=10), ovarian mucinous tumors (n=6) and pancreatic mucinous cystic neoplasms (n=6). Staining intensity and percentage of positive cells were independently evaluated by two pathologists. Previously published TRPS1, organ-lineage marker and molecular findings from the same three BMCA cases were incorporated for diagnostic correlation.</p><p><strong>Results: </strong>All three BMCA and all nine BMC cases were CK7-positive, CK20-negative and lacked membranous CLDN18 staining. Mammary lineage and differentiation of the three BMCA cases were supported by previously shown TRPS1 nuclear expression. CLDN18 staining was detected in 5/6 pancreatic, 5/6 ovarian and 6/8 pulmonary mucinous tumors, while seven of ten colorectal cases were negative, two were focally positive and one was diffusely positive. CLDN18 thus provided information beyond CK7/CK20, particularly in pancreatic, ovarian and pulmonary mucinous tumors, but not in mammary mucinous tumors including BMCA.</p><p><strong>Conclusion: </strong>In this limited cohort of three BMCA, CLDN18 did not distinguish BMCA from BMC. TRPS1 provided positive support for mammary lineage, whereas CLDN18 negativity offered supplementary exclusionary evidence against selected extramammary mucinous tumors. CLDN18 should therefore be interpreted with morphology, clinical findings, CK7/CK20 and established lineage markers. Larger multicenter studies are warranted to validate its adjunctive diagnostic role in mucin-rich breast lesions.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964113","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":"Retraction: Advancing Obstetric Care: The Role of Targeted Next-Generation Sequencing in Pregnancies with Structurally Normal Fetuses.","authors":"Han-Ying Chen, Yi-Ting Wang, Jessica Kang, Yi-Yun Tai, Ti-Jia Yuan, Shin-Yu Lin, Chien-Nan Lee, Tsang-Ming Ko","doi":"10.1097/JCMA.0000000000001424","DOIUrl":"10.1097/JCMA.0000000000001424","url":null,"abstract":"","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964169","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":"2026 Taiwan guidelines for the acute pharmacologic treatment of migraine in adults.","authors":"Chi Ieong Lau, Wei-Ta Chen, Tsung-Wei Hou, Yi-Chia Liaw, Yi-Hsien Tu, Jr-Wei Wu, Chun-Pai Yang, Ping-Kun Chen, Shih-Pin Chen, Wei-Hung Chen, Yen-Yu Chen, Jong-Ling Fuh, Yung-Chu Hsu, Tzu-Chou Huang, Tzu-Hsien Lai, Jen-Feng Liang, Kang-Hsu Lin, Kao-Chang Lin, Ching-Sen Shih, Shuu-Jiun Wang, Chun Ming Yang, Fu-Chi Yang, Tu-Hsueh Yeh, Yen-Feng Wang","doi":"10.1097/JCMA.0000000000001427","DOIUrl":"https://doi.org/10.1097/JCMA.0000000000001427","url":null,"abstract":"<p><p>Since the publication of the Taiwan Headache Society's 2022 Guidelines for the Acute Treatment of Migraine Attacks, advances in headache medicine and the approval of new drugs in Taiwan have necessitated an update. To address clinical needs, the Guideline Committee of the Taiwan Headache Society reviewed evidence for pharmacological and non-pharmacological acute treatments using evidence-based principles. Drawing from the latest European, American, and international guidelines, and through expert consensus, this revision updates treatment roles, grades of recommendation, efficacy, and adverse-effect profiles. Currently, a broad range of medications is available in Taiwan for acute migraine management, categorised into \"specific\" and \"non-specific\" agents. Specific treatments include oral and intranasal triptans, and gepants, i.e., oral calcitonin gene-related peptide (CGRP) receptor antagonists. Non-specific agents include acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs: diclofenac, ibuprofen, naproxen). Injectable prochlorperazine is also strongly recommended. Ergotamine/caffeine combinations are less effective and are second-line agents, while high-dose aspirin is limited by gastrointestinal risk. Considering the potential risk of dependency, tramadol or tramadol/paracetamol combinations should be reserved until all other agents fail, and should be limited to oral forms. Other opioids, such as morphine, butorphanol, etc., lack evidence and are not recommended. Treatment should follow the principle of stratified care: oral NSAIDs for mild disability, with combination analgesics or parenteral NSAIDs as alternatives, and oral or intranasal triptans for moderate to severe disability, ideally administered early. Antiemetics may be added, and combining triptans with NSAIDs enhances efficacy. Rimegepant can be considered a first-line therapy, particularly for patients who are unresponsive or intolerant to triptans, have cardiovascular contraindications, or are at risk of developing medication overuse. In status migrainosus, parenteral corticosteroids with intravenous fluids are advised. Acetaminophen remains first-line for children and pregnant women. To prevent medication-overuse headache, acute treatments, including NSAIDs, acetaminophen, triptans, ergot derivatives, and combination analgesics, should not exceed two days per week, probably with the exception of rimegepant.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148932231","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}