Stanford (Calif.) University’s human performance lab sits next to its physical therapy clinic, so orthopedic surgeons often stop by to request biomechanical analyses for their patients, such as athletes with repeat injuries.

“It would take us days to analyze the data, so we would only do it a handful of times per year,” said Scott Uhlrich, PhD, director of research at the lab.

Now an app can do the job in less than 10 minutes.

The motion-capture app, created by Dr. Uhlrich and fellow bioengineers at Stanford, could help clinicians design better interventions to ward off mobility problems and speed recovery. It could also help researchers fill huge knowledge gaps about human mobility.

Known as OpenCap, the app uses smartphone videos, artificial intelligence, and computational biomechanical modeling to quantify movement. It’s currently available free for research and educational use. Model Health, a startup affiliated with the Stanford researchers, provides licenses for commercial use and clinical practice.

Here’s how it works. Footage of human movement, recorded by two smartphones, gets uploaded to the cloud, where an algorithm identifies a set of points on the body. The app relies on computer vision algorithms, a form of AI that trains computers to “understand” visual data – in this case, a person’s pose.

Next, the app quantifies how the body is moving through three-dimensional space. Musculoskeletal system models reveal insights into that movement, such as the angle of a joint, the stretch in a tendon, or the force being transferred through the joints.

“These are the quantities that relate to injuries and disease,” said Dr. Uhlrich, co-author of a study introducing the app. “We need to get to those quantities to be able to inform medical research and eventually clinical practice.”

The conventional approach to getting this kind of analysis requires special expertise and costs $150,000. By contrast, the app is free and easy to use.

It “democratizes” human movement analysis, said senior study author Scott Delp, PhD, professor of bioengineering and mechanical engineering at Stanford. The researchers hope this will “improve outcomes for patients across the world.” 

‘Endless opportunities’

A lot about human mobility remains mysterious.

In aging adults, researchers can’t say when balance starts to degrade or by how much every year. They’re also still unraveling how sports injuries occur and how degenerative joint diseases like arthritis progress.

“We don’t really understand the onset of a lot of things, because we’ve just never measured it,” Dr. Uhlrich said.

OpenCap could help change that in a big way. Although biomechanics studies tend to be small – just 14 participants, on average – the app could allow for much larger studies, thanks to its lower cost and ease of use. In the study, the app collected movement data on 100 participants in less than 10 hours and computed results in 31 hours – an effort that would otherwise have taken a year.

“Studies of hundreds will be common, and thousands will be feasible, especially if assessments are integrated into clinic visits,” Dr. Uhlrich said.

About 2,600 researchers around the world are already using the app, according to Dr. Uhlrich. Many had never created a dynamic simulation before.

“The opportunities here are endless,” said Eni Halilaj, PhD, an assistant professor of mechanical engineering at Carnegie Mellon, Pittsburgh, who was not involved in creating the app. That’s especially true for “highly heterogeneous conditions that we have not been able to fully characterize through traditional studies with limited patients.”

In one case, researcher Reed Gurchiek, a former Stanford postdoc and current professor at Clemson (S.C.) University, used the app to study hamstring strain injuries during sprinting and found that these muscles lengthen faster during acceleration, compared with running at a constant speed.

“This aligns with the higher observed injury rates when athletes are accelerating,” Dr. Uhlrich explained. “Varied-speed sprinting studies are not possible in the lab, so this was really enabled by OpenCap’s portability.”
 

Movement as a biomarker

The researchers are already using the app to build new tools, including metrics to identify risk for anterior cruciate ligament injury in young athletes and to measure balance. 

Someday, the technology could augment annual physicals, establishing movement as a biomarker. By having patients perform a few movements, like walking or standing up, clinicians could assess their disease risk and progression or their risk of falling. 

Excessive loading in the knee joint puts patients at higher risk of developing osteoarthritis, for instance, but clinicians can’t easily access this information. The disease is typically diagnosed after symptoms appear, even though intervention could happen much earlier. 

“Prevention is still not as embraced as it should be,” said Pamela Toto, PhD, professor of occupational therapy at the University of Pittsburgh, who also was not involved in making the app. “If we could tie the technology to intervention down the road, that could be valuable.”

A version of this article first appeared on Medscape.com.

Stanford (Calif.) University’s human performance lab sits next to its physical therapy clinic, so orthopedic surgeons often stop by to request biomechanical analyses for their patients, such as athletes with repeat injuries.

“It would take us days to analyze the data, so we would only do it a handful of times per year,” said Scott Uhlrich, PhD, director of research at the lab.

Now an app can do the job in less than 10 minutes.

The motion-capture app, created by Dr. Uhlrich and fellow bioengineers at Stanford, could help clinicians design better interventions to ward off mobility problems and speed recovery. It could also help researchers fill huge knowledge gaps about human mobility.

Known as OpenCap, the app uses smartphone videos, artificial intelligence, and computational biomechanical modeling to quantify movement. It’s currently available free for research and educational use. Model Health, a startup affiliated with the Stanford researchers, provides licenses for commercial use and clinical practice.

Here’s how it works. Footage of human movement, recorded by two smartphones, gets uploaded to the cloud, where an algorithm identifies a set of points on the body. The app relies on computer vision algorithms, a form of AI that trains computers to “understand” visual data – in this case, a person’s pose.

Next, the app quantifies how the body is moving through three-dimensional space. Musculoskeletal system models reveal insights into that movement, such as the angle of a joint, the stretch in a tendon, or the force being transferred through the joints.

“These are the quantities that relate to injuries and disease,” said Dr. Uhlrich, co-author of a study introducing the app. “We need to get to those quantities to be able to inform medical research and eventually clinical practice.”

The conventional approach to getting this kind of analysis requires special expertise and costs $150,000. By contrast, the app is free and easy to use.

It “democratizes” human movement analysis, said senior study author Scott Delp, PhD, professor of bioengineering and mechanical engineering at Stanford. The researchers hope this will “improve outcomes for patients across the world.” 

‘Endless opportunities’

A lot about human mobility remains mysterious.

In aging adults, researchers can’t say when balance starts to degrade or by how much every year. They’re also still unraveling how sports injuries occur and how degenerative joint diseases like arthritis progress.

“We don’t really understand the onset of a lot of things, because we’ve just never measured it,” Dr. Uhlrich said.

OpenCap could help change that in a big way. Although biomechanics studies tend to be small – just 14 participants, on average – the app could allow for much larger studies, thanks to its lower cost and ease of use. In the study, the app collected movement data on 100 participants in less than 10 hours and computed results in 31 hours – an effort that would otherwise have taken a year.

“Studies of hundreds will be common, and thousands will be feasible, especially if assessments are integrated into clinic visits,” Dr. Uhlrich said.

About 2,600 researchers around the world are already using the app, according to Dr. Uhlrich. Many had never created a dynamic simulation before.

“The opportunities here are endless,” said Eni Halilaj, PhD, an assistant professor of mechanical engineering at Carnegie Mellon, Pittsburgh, who was not involved in creating the app. That’s especially true for “highly heterogeneous conditions that we have not been able to fully characterize through traditional studies with limited patients.”

In one case, researcher Reed Gurchiek, a former Stanford postdoc and current professor at Clemson (S.C.) University, used the app to study hamstring strain injuries during sprinting and found that these muscles lengthen faster during acceleration, compared with running at a constant speed.

“This aligns with the higher observed injury rates when athletes are accelerating,” Dr. Uhlrich explained. “Varied-speed sprinting studies are not possible in the lab, so this was really enabled by OpenCap’s portability.”
 

Movement as a biomarker

The researchers are already using the app to build new tools, including metrics to identify risk for anterior cruciate ligament injury in young athletes and to measure balance. 

Someday, the technology could augment annual physicals, establishing movement as a biomarker. By having patients perform a few movements, like walking or standing up, clinicians could assess their disease risk and progression or their risk of falling. 

Excessive loading in the knee joint puts patients at higher risk of developing osteoarthritis, for instance, but clinicians can’t easily access this information. The disease is typically diagnosed after symptoms appear, even though intervention could happen much earlier. 

“Prevention is still not as embraced as it should be,” said Pamela Toto, PhD, professor of occupational therapy at the University of Pittsburgh, who also was not involved in making the app. “If we could tie the technology to intervention down the road, that could be valuable.”

A version of this article first appeared on Medscape.com.

Stanford (Calif.) University’s human performance lab sits next to its physical therapy clinic, so orthopedic surgeons often stop by to request biomechanical analyses for their patients, such as athletes with repeat injuries.

“It would take us days to analyze the data, so we would only do it a handful of times per year,” said Scott Uhlrich, PhD, director of research at the lab.

Now an app can do the job in less than 10 minutes.

The motion-capture app, created by Dr. Uhlrich and fellow bioengineers at Stanford, could help clinicians design better interventions to ward off mobility problems and speed recovery. It could also help researchers fill huge knowledge gaps about human mobility.

Known as OpenCap, the app uses smartphone videos, artificial intelligence, and computational biomechanical modeling to quantify movement. It’s currently available free for research and educational use. Model Health, a startup affiliated with the Stanford researchers, provides licenses for commercial use and clinical practice.

Here’s how it works. Footage of human movement, recorded by two smartphones, gets uploaded to the cloud, where an algorithm identifies a set of points on the body. The app relies on computer vision algorithms, a form of AI that trains computers to “understand” visual data – in this case, a person’s pose.

Next, the app quantifies how the body is moving through three-dimensional space. Musculoskeletal system models reveal insights into that movement, such as the angle of a joint, the stretch in a tendon, or the force being transferred through the joints.

“These are the quantities that relate to injuries and disease,” said Dr. Uhlrich, co-author of a study introducing the app. “We need to get to those quantities to be able to inform medical research and eventually clinical practice.”

The conventional approach to getting this kind of analysis requires special expertise and costs $150,000. By contrast, the app is free and easy to use.

It “democratizes” human movement analysis, said senior study author Scott Delp, PhD, professor of bioengineering and mechanical engineering at Stanford. The researchers hope this will “improve outcomes for patients across the world.” 

‘Endless opportunities’

A lot about human mobility remains mysterious.

In aging adults, researchers can’t say when balance starts to degrade or by how much every year. They’re also still unraveling how sports injuries occur and how degenerative joint diseases like arthritis progress.

“We don’t really understand the onset of a lot of things, because we’ve just never measured it,” Dr. Uhlrich said.

OpenCap could help change that in a big way. Although biomechanics studies tend to be small – just 14 participants, on average – the app could allow for much larger studies, thanks to its lower cost and ease of use. In the study, the app collected movement data on 100 participants in less than 10 hours and computed results in 31 hours – an effort that would otherwise have taken a year.

“Studies of hundreds will be common, and thousands will be feasible, especially if assessments are integrated into clinic visits,” Dr. Uhlrich said.

About 2,600 researchers around the world are already using the app, according to Dr. Uhlrich. Many had never created a dynamic simulation before.

“The opportunities here are endless,” said Eni Halilaj, PhD, an assistant professor of mechanical engineering at Carnegie Mellon, Pittsburgh, who was not involved in creating the app. That’s especially true for “highly heterogeneous conditions that we have not been able to fully characterize through traditional studies with limited patients.”

In one case, researcher Reed Gurchiek, a former Stanford postdoc and current professor at Clemson (S.C.) University, used the app to study hamstring strain injuries during sprinting and found that these muscles lengthen faster during acceleration, compared with running at a constant speed.

“This aligns with the higher observed injury rates when athletes are accelerating,” Dr. Uhlrich explained. “Varied-speed sprinting studies are not possible in the lab, so this was really enabled by OpenCap’s portability.”
 

Movement as a biomarker

The researchers are already using the app to build new tools, including metrics to identify risk for anterior cruciate ligament injury in young athletes and to measure balance. 

Someday, the technology could augment annual physicals, establishing movement as a biomarker. By having patients perform a few movements, like walking or standing up, clinicians could assess their disease risk and progression or their risk of falling. 

Excessive loading in the knee joint puts patients at higher risk of developing osteoarthritis, for instance, but clinicians can’t easily access this information. The disease is typically diagnosed after symptoms appear, even though intervention could happen much earlier. 

“Prevention is still not as embraced as it should be,” said Pamela Toto, PhD, professor of occupational therapy at the University of Pittsburgh, who also was not involved in making the app. “If we could tie the technology to intervention down the road, that could be valuable.”

A version of this article first appeared on Medscape.com.

TOPLINE:

Strength training at any point in life is associated with a lower risk of knee pain and osteoarthritis, contrary to persistent assumptions of adverse effects.

METHODOLOGY:

• Researchers reviewed data on strength training and knee pain from 2,607 adults. They used the Historical Physical Activity Survey Instrument to assess the impact of strength training during four periods (ages 12-18 years, 19-34 years, 35-49 years, and 50 years and older).
• The participants were enrolled in the Osteoarthritis Initiative, a multicenter, prospective, longitudinal study; 44% were male, the average age was 64.3 years, and the mean body mass index was 28.5 kg/m².
• Strength training was defined as those exposed and not exposed, as well as divided into low, medium, and high tertiles for those exposed. A total of 818 individuals were exposed to strength training, and 1,789 were not exposed to strength training.
• The primary outcomes were frequent knee pain, radiographic OA (ROA), and symptomatic radiographic OA (SOA).

TAKEAWAY:

• The study is the first to examine the effect of strength training on knee health in a community population sample not selected for a history of elite weight lifting.
• Overall, strength training at any point in life was associated with lower incidence of frequent knee pain, ROA, and SOA, compared with no strength training (odds ratios, 0.82, 0.83, and 0.77, respectively).
• When separated by tertiles, only the high-exposure group had significantly reduced odds of frequent knee pain, ROA, and SOA, with odds ratios of 0.74, 0.70, and 0.69, respectively. A dose-response relationship appeared for all three conditions, with the lowest odds ratios in the highest strength training exposure groups.
• Findings were similar for different age ranges, but the association between strength training and less frequent knee pain, less ROA, and less SOA was strongest in the older age groups.

IN PRACTICE:

“Our findings support the idea that the medical community should proactively encourage more people to participate in strength training to help reduce their risk of osteoarthritis and other chronic conditions,” the researchers write.

SOURCE:

The study, with first author Grace H. Lo, MD, of Baylor College of Medicine, Houston, and colleagues, was published in Arthritis and Rheumatology.

LIMITATIONS:

The observational design and self-selected study population of strength training participants might bias the results, including participants’ recall of their activity level levels and changes in exercise trends over time. More research is needed to explore associations between strength training and knee OA among those who started strength training at a younger age.

DISCLOSURES:

The study was funded in part by the VA Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety at the Michael E. DeBakey VA Medical Center, Houston, and by donations to the Tupper Research Fund at Tufts Medical Center. The Osteoarthritis Initiative is supported by the National Institutes of Health; private funding partners include Merck Research Laboratories, Novartis, GlaxoSmithKline, and Pfizer. Three authors report having financial relationships with multiple pharmaceutical companies.

A version of this article first appeared on Medscape.com.

TOPLINE:

Strength training at any point in life is associated with a lower risk of knee pain and osteoarthritis, contrary to persistent assumptions of adverse effects.

METHODOLOGY:

• Researchers reviewed data on strength training and knee pain from 2,607 adults. They used the Historical Physical Activity Survey Instrument to assess the impact of strength training during four periods (ages 12-18 years, 19-34 years, 35-49 years, and 50 years and older).
• The participants were enrolled in the Osteoarthritis Initiative, a multicenter, prospective, longitudinal study; 44% were male, the average age was 64.3 years, and the mean body mass index was 28.5 kg/m².
• Strength training was defined as those exposed and not exposed, as well as divided into low, medium, and high tertiles for those exposed. A total of 818 individuals were exposed to strength training, and 1,789 were not exposed to strength training.
• The primary outcomes were frequent knee pain, radiographic OA (ROA), and symptomatic radiographic OA (SOA).

TAKEAWAY:

• The study is the first to examine the effect of strength training on knee health in a community population sample not selected for a history of elite weight lifting.
• Overall, strength training at any point in life was associated with lower incidence of frequent knee pain, ROA, and SOA, compared with no strength training (odds ratios, 0.82, 0.83, and 0.77, respectively).
• When separated by tertiles, only the high-exposure group had significantly reduced odds of frequent knee pain, ROA, and SOA, with odds ratios of 0.74, 0.70, and 0.69, respectively. A dose-response relationship appeared for all three conditions, with the lowest odds ratios in the highest strength training exposure groups.
• Findings were similar for different age ranges, but the association between strength training and less frequent knee pain, less ROA, and less SOA was strongest in the older age groups.

IN PRACTICE:

“Our findings support the idea that the medical community should proactively encourage more people to participate in strength training to help reduce their risk of osteoarthritis and other chronic conditions,” the researchers write.

SOURCE:

The study, with first author Grace H. Lo, MD, of Baylor College of Medicine, Houston, and colleagues, was published in Arthritis and Rheumatology.

LIMITATIONS:

The observational design and self-selected study population of strength training participants might bias the results, including participants’ recall of their activity level levels and changes in exercise trends over time. More research is needed to explore associations between strength training and knee OA among those who started strength training at a younger age.

DISCLOSURES:

The study was funded in part by the VA Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety at the Michael E. DeBakey VA Medical Center, Houston, and by donations to the Tupper Research Fund at Tufts Medical Center. The Osteoarthritis Initiative is supported by the National Institutes of Health; private funding partners include Merck Research Laboratories, Novartis, GlaxoSmithKline, and Pfizer. Three authors report having financial relationships with multiple pharmaceutical companies.

A version of this article first appeared on Medscape.com.

TOPLINE:

Strength training at any point in life is associated with a lower risk of knee pain and osteoarthritis, contrary to persistent assumptions of adverse effects.

METHODOLOGY:

• Researchers reviewed data on strength training and knee pain from 2,607 adults. They used the Historical Physical Activity Survey Instrument to assess the impact of strength training during four periods (ages 12-18 years, 19-34 years, 35-49 years, and 50 years and older).
• The participants were enrolled in the Osteoarthritis Initiative, a multicenter, prospective, longitudinal study; 44% were male, the average age was 64.3 years, and the mean body mass index was 28.5 kg/m².
• Strength training was defined as those exposed and not exposed, as well as divided into low, medium, and high tertiles for those exposed. A total of 818 individuals were exposed to strength training, and 1,789 were not exposed to strength training.
• The primary outcomes were frequent knee pain, radiographic OA (ROA), and symptomatic radiographic OA (SOA).

TAKEAWAY:

• The study is the first to examine the effect of strength training on knee health in a community population sample not selected for a history of elite weight lifting.
• Overall, strength training at any point in life was associated with lower incidence of frequent knee pain, ROA, and SOA, compared with no strength training (odds ratios, 0.82, 0.83, and 0.77, respectively).
• When separated by tertiles, only the high-exposure group had significantly reduced odds of frequent knee pain, ROA, and SOA, with odds ratios of 0.74, 0.70, and 0.69, respectively. A dose-response relationship appeared for all three conditions, with the lowest odds ratios in the highest strength training exposure groups.
• Findings were similar for different age ranges, but the association between strength training and less frequent knee pain, less ROA, and less SOA was strongest in the older age groups.

IN PRACTICE:

“Our findings support the idea that the medical community should proactively encourage more people to participate in strength training to help reduce their risk of osteoarthritis and other chronic conditions,” the researchers write.

SOURCE:

The study, with first author Grace H. Lo, MD, of Baylor College of Medicine, Houston, and colleagues, was published in Arthritis and Rheumatology.

LIMITATIONS:

The observational design and self-selected study population of strength training participants might bias the results, including participants’ recall of their activity level levels and changes in exercise trends over time. More research is needed to explore associations between strength training and knee OA among those who started strength training at a younger age.

DISCLOSURES:

The study was funded in part by the VA Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety at the Michael E. DeBakey VA Medical Center, Houston, and by donations to the Tupper Research Fund at Tufts Medical Center. The Osteoarthritis Initiative is supported by the National Institutes of Health; private funding partners include Merck Research Laboratories, Novartis, GlaxoSmithKline, and Pfizer. Three authors report having financial relationships with multiple pharmaceutical companies.

A version of this article first appeared on Medscape.com.

Key clinical point: Attention-deficit hyperactivity disorder (ADHD) symptoms and impulsive personality traits appeared to be more prevalent in patients with episodic migraine than in control individuals.

Major finding: Patients with episodic migraine vs control individuals had higher mean scores for inattention (5.0 vs 2.7; P < .00001), hyperactivity (4.0 vs 2.5; P = .000621), and impulsivity (2.0 vs 1.1; P = .000407) on the ADHD scale. A higher percentage of patients vs control participants (35.5% vs 8.6%) scored ‘often’ or ‘very often’ in ≥1 items of the impulsivity subscale (P < .05).

Study details: This observational cohort study included 100 patients with episodic migraine and 150 control participants without migraine.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Gonzalez-Hernandez A et al. Attention deficit hyperactivity disorder in adults with migraine. J Atten Disord. 2023 (Sep 27). doi: 10.1177/10870547231199256

Key clinical point: Attention-deficit hyperactivity disorder (ADHD) symptoms and impulsive personality traits appeared to be more prevalent in patients with episodic migraine than in control individuals.

Major finding: Patients with episodic migraine vs control individuals had higher mean scores for inattention (5.0 vs 2.7; P < .00001), hyperactivity (4.0 vs 2.5; P = .000621), and impulsivity (2.0 vs 1.1; P = .000407) on the ADHD scale. A higher percentage of patients vs control participants (35.5% vs 8.6%) scored ‘often’ or ‘very often’ in ≥1 items of the impulsivity subscale (P < .05).

Study details: This observational cohort study included 100 patients with episodic migraine and 150 control participants without migraine.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Gonzalez-Hernandez A et al. Attention deficit hyperactivity disorder in adults with migraine. J Atten Disord. 2023 (Sep 27). doi: 10.1177/10870547231199256

Key clinical point: Attention-deficit hyperactivity disorder (ADHD) symptoms and impulsive personality traits appeared to be more prevalent in patients with episodic migraine than in control individuals.

Major finding: Patients with episodic migraine vs control individuals had higher mean scores for inattention (5.0 vs 2.7; P < .00001), hyperactivity (4.0 vs 2.5; P = .000621), and impulsivity (2.0 vs 1.1; P = .000407) on the ADHD scale. A higher percentage of patients vs control participants (35.5% vs 8.6%) scored ‘often’ or ‘very often’ in ≥1 items of the impulsivity subscale (P < .05).

Study details: This observational cohort study included 100 patients with episodic migraine and 150 control participants without migraine.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Gonzalez-Hernandez A et al. Attention deficit hyperactivity disorder in adults with migraine. J Atten Disord. 2023 (Sep 27). doi: 10.1177/10870547231199256

Key clinical point: In patients with migraine, an increase in monthly headache days (MHD) adversely impacts health-related quality of life (HRQoL) measured by the Migraine-Specific Quality-of-Life Questionnaire (MSQ), with the impact being partially mediated by depression, allodynia, and anxiety.

Major finding: For every 1-day increase in the MHD, the scores for MSQ’s Role Function-Restrictive, Role Function-Preventive, and Emotional Function parameters worsened by 0.92, 0.60, and 1.23 points, respectively (all P < .001). Depression, allodynia, and anxiety mediated 15.2%-24.3%, 9.6%-16.1%, and 2.3%-6.0%, respectively, of the total observed effects of MHD on the HRQoL.

Study details: Findings are from a post hoc analysis of the CaMEO study including 12,715 patients with migraine who completed the Core and Comorbidities/Endophenotypes modules.

Disclosures: This study was funded by Allergan (prior to its acquisition by AbbVie). B Dabruzzo declared being an employee of AbbVie and may own its stocks. The other authors declared ties with various sources, including AbbVie.

Source: Lipton RB et al. Impact of monthly headache days on migraine-related quality of life: Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study. Headache. 2023 (Oct 5). doi: 10.1111/head.14629

Key clinical point: In patients with migraine, an increase in monthly headache days (MHD) adversely impacts health-related quality of life (HRQoL) measured by the Migraine-Specific Quality-of-Life Questionnaire (MSQ), with the impact being partially mediated by depression, allodynia, and anxiety.

Major finding: For every 1-day increase in the MHD, the scores for MSQ’s Role Function-Restrictive, Role Function-Preventive, and Emotional Function parameters worsened by 0.92, 0.60, and 1.23 points, respectively (all P < .001). Depression, allodynia, and anxiety mediated 15.2%-24.3%, 9.6%-16.1%, and 2.3%-6.0%, respectively, of the total observed effects of MHD on the HRQoL.

Study details: Findings are from a post hoc analysis of the CaMEO study including 12,715 patients with migraine who completed the Core and Comorbidities/Endophenotypes modules.

Disclosures: This study was funded by Allergan (prior to its acquisition by AbbVie). B Dabruzzo declared being an employee of AbbVie and may own its stocks. The other authors declared ties with various sources, including AbbVie.

Source: Lipton RB et al. Impact of monthly headache days on migraine-related quality of life: Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study. Headache. 2023 (Oct 5). doi: 10.1111/head.14629

Key clinical point: In patients with migraine, an increase in monthly headache days (MHD) adversely impacts health-related quality of life (HRQoL) measured by the Migraine-Specific Quality-of-Life Questionnaire (MSQ), with the impact being partially mediated by depression, allodynia, and anxiety.

Major finding: For every 1-day increase in the MHD, the scores for MSQ’s Role Function-Restrictive, Role Function-Preventive, and Emotional Function parameters worsened by 0.92, 0.60, and 1.23 points, respectively (all P < .001). Depression, allodynia, and anxiety mediated 15.2%-24.3%, 9.6%-16.1%, and 2.3%-6.0%, respectively, of the total observed effects of MHD on the HRQoL.

Study details: Findings are from a post hoc analysis of the CaMEO study including 12,715 patients with migraine who completed the Core and Comorbidities/Endophenotypes modules.

Disclosures: This study was funded by Allergan (prior to its acquisition by AbbVie). B Dabruzzo declared being an employee of AbbVie and may own its stocks. The other authors declared ties with various sources, including AbbVie.

Source: Lipton RB et al. Impact of monthly headache days on migraine-related quality of life: Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study. Headache. 2023 (Oct 5). doi: 10.1111/head.14629

Key clinical point: Valproic acid, propranolol, and venlafaxine significantly improved vestibular migraine frequency but had no significant differences in terms of vestibular migraine severity, dropout rates, and safety profiles compared with placebo.

Major finding: Compared with placebo, valproic acid (standardized mean difference [SMD] −1.61; 95% CI −2.69 to −0.54), propranolol (SMD −1.36; 95% CI −2.55 to −0.17), and venlafaxine (SMD −1.25; 95% CI −2.32 to −0.18) led to better improvement in vestibular migraine frequency. However, vestibular migraine severity, dropout rates, and safety profiles did not differ significantly between the treatment groups.

Study details: This network meta-analysis of seven randomized controlled trials included 828 patients with vestibular migraine.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Chen J-J et al. Network meta-analysis of different treatments for vestibular migraine. CNS Drugs. 2023;37(9):837-847 (Sep 7). doi: 10.1007/s40263-023-01037-0

Key clinical point: Valproic acid, propranolol, and venlafaxine significantly improved vestibular migraine frequency but had no significant differences in terms of vestibular migraine severity, dropout rates, and safety profiles compared with placebo.

Major finding: Compared with placebo, valproic acid (standardized mean difference [SMD] −1.61; 95% CI −2.69 to −0.54), propranolol (SMD −1.36; 95% CI −2.55 to −0.17), and venlafaxine (SMD −1.25; 95% CI −2.32 to −0.18) led to better improvement in vestibular migraine frequency. However, vestibular migraine severity, dropout rates, and safety profiles did not differ significantly between the treatment groups.

Study details: This network meta-analysis of seven randomized controlled trials included 828 patients with vestibular migraine.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Chen J-J et al. Network meta-analysis of different treatments for vestibular migraine. CNS Drugs. 2023;37(9):837-847 (Sep 7). doi: 10.1007/s40263-023-01037-0

Key clinical point: Valproic acid, propranolol, and venlafaxine significantly improved vestibular migraine frequency but had no significant differences in terms of vestibular migraine severity, dropout rates, and safety profiles compared with placebo.

Major finding: Compared with placebo, valproic acid (standardized mean difference [SMD] −1.61; 95% CI −2.69 to −0.54), propranolol (SMD −1.36; 95% CI −2.55 to −0.17), and venlafaxine (SMD −1.25; 95% CI −2.32 to −0.18) led to better improvement in vestibular migraine frequency. However, vestibular migraine severity, dropout rates, and safety profiles did not differ significantly between the treatment groups.

Study details: This network meta-analysis of seven randomized controlled trials included 828 patients with vestibular migraine.

Disclosures: This study did not receive any specific funding. The authors declared no conflicts of interest.

Source: Chen J-J et al. Network meta-analysis of different treatments for vestibular migraine. CNS Drugs. 2023;37(9):837-847 (Sep 7). doi: 10.1007/s40263-023-01037-0

Key clinical point: High dietary potassium intake is associated with a decreased risk for migraine, with an L-shaped correlation between dietary potassium intake and migraine highlighting an inflection at ~1,439.3 mg/day.

Major finding: Participants in the second quartile (potassium intake 1771-2476 mg/day) vs first quartile (potassium intake ≤ 1771 mg/day) showed a lower risk for migraine (adjusted odds ratio 0.84; P = .021), which suggested an L-shaped (non-linear) association between dietary potassium intake and migraine (P = .016), with an inflection at ~1439.3 mg/day.

Study details: This cross-sectional study included 10,254 participants age ≥ 20 years, of whom 2065 (20.1%) had migraine.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Xu L et al. Association between dietary potassium intake and severe headache or migraine in US adults: A population-based analysis. Front Nutr. 2023;10:1255468 (Sep 15). doi:  10.3389/fnut.2023.1255468

Key clinical point: High dietary potassium intake is associated with a decreased risk for migraine, with an L-shaped correlation between dietary potassium intake and migraine highlighting an inflection at ~1,439.3 mg/day.

Major finding: Participants in the second quartile (potassium intake 1771-2476 mg/day) vs first quartile (potassium intake ≤ 1771 mg/day) showed a lower risk for migraine (adjusted odds ratio 0.84; P = .021), which suggested an L-shaped (non-linear) association between dietary potassium intake and migraine (P = .016), with an inflection at ~1439.3 mg/day.

Study details: This cross-sectional study included 10,254 participants age ≥ 20 years, of whom 2065 (20.1%) had migraine.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Xu L et al. Association between dietary potassium intake and severe headache or migraine in US adults: A population-based analysis. Front Nutr. 2023;10:1255468 (Sep 15). doi:  10.3389/fnut.2023.1255468

Key clinical point: High dietary potassium intake is associated with a decreased risk for migraine, with an L-shaped correlation between dietary potassium intake and migraine highlighting an inflection at ~1,439.3 mg/day.

Major finding: Participants in the second quartile (potassium intake 1771-2476 mg/day) vs first quartile (potassium intake ≤ 1771 mg/day) showed a lower risk for migraine (adjusted odds ratio 0.84; P = .021), which suggested an L-shaped (non-linear) association between dietary potassium intake and migraine (P = .016), with an inflection at ~1439.3 mg/day.

Study details: This cross-sectional study included 10,254 participants age ≥ 20 years, of whom 2065 (20.1%) had migraine.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Xu L et al. Association between dietary potassium intake and severe headache or migraine in US adults: A population-based analysis. Front Nutr. 2023;10:1255468 (Sep 15). doi:  10.3389/fnut.2023.1255468

TOPLINE: 

A new study shows that piperacillin-tazobactam and cefepime are equally safe for acute kidney injury (AKI) in acute infection, with cefepime linked to more neurological issues.

METHODOLOGY:

The coadministration of piperacillin-tazobactam and vancomycin may raise the risk for AKI, according to a warning from the Food and Drug Administration.

The ACORN trial included 2,511 adults presenting to emergency department or intensive care unit with suspected infection.

Within 12 hours of presentation, these individuals were prescribed either cefepime (n = 1,214) or piperacillin-tazobactam (n = 1,297).

The primary outcome was the risk for the highest stage of AKI or death within 14 days of randomization.
 

TAKEAWAY:

The highest stage of AKI or death within 14 days did not differ significantly between the cefepime and piperacillin-tazobactam groups (odds ratio, 0.95; P = .56).

The incidence of major adverse kidney events by day 14 was not significantly different between the two groups (absolute risk difference, 1.4%; 95% confidence interval, −1.0% to 3.8%).

Patients in the cefepime versus piperacillin-tazobactam group had fewer days alive and free of delirium and coma within 14 days (OR, 0.79; 95% CI, 0.65-0.95).
 

IN PRACTICE:

In an accompanying editorial, Steven Y. C. Tong, department of infectious diseases, University of Melbourne, and colleagues wrote: “Because institutions must make decisions about which antibiotics to position on medical wards for rapid administration in patients meeting sepsis criteria, these data should offer solace that if the choice is made to use piperacillin-tazobactam, there is not an increased risk of AKI.”

SOURCE:

The study was led by Edward T. Qian, MD, of Vanderbilt University Medical Center, Nashville, Tenn. It was published online in JAMA with an accompanying editorial.

LIMITATIONS:

The study was conducted at a single academic center, which may limit the generalizability of findings.

Both patients and clinicians were not blinded to group assignment, which may have influenced clinical assessments like Richmond Agitation-Sedation Scale and CAM-ICU or the frequency of laboratory measurements like creatinine.
 

DISCLOSURES:

The project was supported by the Vanderbilt Institute for Clinical and Translational Research and several other sources, including grants from the National Center for Advancing Translational Sciences. Some authors declared receiving travel grant, personal fees, honoraria, and unrelated research support from various sources.

A version of this article appeared on Medscape.com.

TOPLINE: 

A new study shows that piperacillin-tazobactam and cefepime are equally safe for acute kidney injury (AKI) in acute infection, with cefepime linked to more neurological issues.

METHODOLOGY:

The coadministration of piperacillin-tazobactam and vancomycin may raise the risk for AKI, according to a warning from the Food and Drug Administration.

The ACORN trial included 2,511 adults presenting to emergency department or intensive care unit with suspected infection.

Within 12 hours of presentation, these individuals were prescribed either cefepime (n = 1,214) or piperacillin-tazobactam (n = 1,297).

The primary outcome was the risk for the highest stage of AKI or death within 14 days of randomization.
 

TAKEAWAY:

The highest stage of AKI or death within 14 days did not differ significantly between the cefepime and piperacillin-tazobactam groups (odds ratio, 0.95; P = .56).

The incidence of major adverse kidney events by day 14 was not significantly different between the two groups (absolute risk difference, 1.4%; 95% confidence interval, −1.0% to 3.8%).

Patients in the cefepime versus piperacillin-tazobactam group had fewer days alive and free of delirium and coma within 14 days (OR, 0.79; 95% CI, 0.65-0.95).
 

IN PRACTICE:

In an accompanying editorial, Steven Y. C. Tong, department of infectious diseases, University of Melbourne, and colleagues wrote: “Because institutions must make decisions about which antibiotics to position on medical wards for rapid administration in patients meeting sepsis criteria, these data should offer solace that if the choice is made to use piperacillin-tazobactam, there is not an increased risk of AKI.”

SOURCE:

The study was led by Edward T. Qian, MD, of Vanderbilt University Medical Center, Nashville, Tenn. It was published online in JAMA with an accompanying editorial.

LIMITATIONS:

The study was conducted at a single academic center, which may limit the generalizability of findings.

Both patients and clinicians were not blinded to group assignment, which may have influenced clinical assessments like Richmond Agitation-Sedation Scale and CAM-ICU or the frequency of laboratory measurements like creatinine.
 

DISCLOSURES:

The project was supported by the Vanderbilt Institute for Clinical and Translational Research and several other sources, including grants from the National Center for Advancing Translational Sciences. Some authors declared receiving travel grant, personal fees, honoraria, and unrelated research support from various sources.

A version of this article appeared on Medscape.com.

TOPLINE: 

A new study shows that piperacillin-tazobactam and cefepime are equally safe for acute kidney injury (AKI) in acute infection, with cefepime linked to more neurological issues.

METHODOLOGY:

The coadministration of piperacillin-tazobactam and vancomycin may raise the risk for AKI, according to a warning from the Food and Drug Administration.

The ACORN trial included 2,511 adults presenting to emergency department or intensive care unit with suspected infection.

Within 12 hours of presentation, these individuals were prescribed either cefepime (n = 1,214) or piperacillin-tazobactam (n = 1,297).

The primary outcome was the risk for the highest stage of AKI or death within 14 days of randomization.
 

TAKEAWAY:

The highest stage of AKI or death within 14 days did not differ significantly between the cefepime and piperacillin-tazobactam groups (odds ratio, 0.95; P = .56).

The incidence of major adverse kidney events by day 14 was not significantly different between the two groups (absolute risk difference, 1.4%; 95% confidence interval, −1.0% to 3.8%).

Patients in the cefepime versus piperacillin-tazobactam group had fewer days alive and free of delirium and coma within 14 days (OR, 0.79; 95% CI, 0.65-0.95).
 

IN PRACTICE:

In an accompanying editorial, Steven Y. C. Tong, department of infectious diseases, University of Melbourne, and colleagues wrote: “Because institutions must make decisions about which antibiotics to position on medical wards for rapid administration in patients meeting sepsis criteria, these data should offer solace that if the choice is made to use piperacillin-tazobactam, there is not an increased risk of AKI.”

SOURCE:

The study was led by Edward T. Qian, MD, of Vanderbilt University Medical Center, Nashville, Tenn. It was published online in JAMA with an accompanying editorial.

LIMITATIONS:

The study was conducted at a single academic center, which may limit the generalizability of findings.

Both patients and clinicians were not blinded to group assignment, which may have influenced clinical assessments like Richmond Agitation-Sedation Scale and CAM-ICU or the frequency of laboratory measurements like creatinine.
 

DISCLOSURES:

The project was supported by the Vanderbilt Institute for Clinical and Translational Research and several other sources, including grants from the National Center for Advancing Translational Sciences. Some authors declared receiving travel grant, personal fees, honoraria, and unrelated research support from various sources.

A version of this article appeared on Medscape.com.

Key clinical point: Poor sleep could be a significant risk factor for an ensuing migraine attack, and an intensely painful migraine attack may lead to a subsequent increase in sleep duration, thus highlighting that sleep hygiene is an inherent part of migraine management.

Major finding: The odds of having a migraine attack increased by 6.1% and 17.4% with every deviation from mean sleep and every sleep interruption, respectively, during the previous day, whereas the overall sleep duration had no effect on attack occurrences. An intensely painful attack (M = 0.13; 95% high density interval 0.06-0.20) positively predicted increased sleep duration during the same evening.

Study details: This retrospective cross-sectional study included 724 patients (ages, 18-81 years) with a mean monthly migraine attack frequency of 9.94.

Disclosures: This study was supported by a UK Medical Research Council PhD studentship. Two authors declared being employees of Healint Pte. Ltd, and some authors declared ties with various sources.

Source: Stanyer EC et al. Investigating the relationship between sleep and migraine in a global sample: A Bayesian cross-sectional approach. J Headache Pain. 2023;24:123 (Sep 8). doi: 10.1186/s10194-023-01638-6

Key clinical point: Poor sleep could be a significant risk factor for an ensuing migraine attack, and an intensely painful migraine attack may lead to a subsequent increase in sleep duration, thus highlighting that sleep hygiene is an inherent part of migraine management.

Major finding: The odds of having a migraine attack increased by 6.1% and 17.4% with every deviation from mean sleep and every sleep interruption, respectively, during the previous day, whereas the overall sleep duration had no effect on attack occurrences. An intensely painful attack (M = 0.13; 95% high density interval 0.06-0.20) positively predicted increased sleep duration during the same evening.

Study details: This retrospective cross-sectional study included 724 patients (ages, 18-81 years) with a mean monthly migraine attack frequency of 9.94.

Disclosures: This study was supported by a UK Medical Research Council PhD studentship. Two authors declared being employees of Healint Pte. Ltd, and some authors declared ties with various sources.

Source: Stanyer EC et al. Investigating the relationship between sleep and migraine in a global sample: A Bayesian cross-sectional approach. J Headache Pain. 2023;24:123 (Sep 8). doi: 10.1186/s10194-023-01638-6

Key clinical point: Poor sleep could be a significant risk factor for an ensuing migraine attack, and an intensely painful migraine attack may lead to a subsequent increase in sleep duration, thus highlighting that sleep hygiene is an inherent part of migraine management.

Major finding: The odds of having a migraine attack increased by 6.1% and 17.4% with every deviation from mean sleep and every sleep interruption, respectively, during the previous day, whereas the overall sleep duration had no effect on attack occurrences. An intensely painful attack (M = 0.13; 95% high density interval 0.06-0.20) positively predicted increased sleep duration during the same evening.

Study details: This retrospective cross-sectional study included 724 patients (ages, 18-81 years) with a mean monthly migraine attack frequency of 9.94.

Disclosures: This study was supported by a UK Medical Research Council PhD studentship. Two authors declared being employees of Healint Pte. Ltd, and some authors declared ties with various sources.

Source: Stanyer EC et al. Investigating the relationship between sleep and migraine in a global sample: A Bayesian cross-sectional approach. J Headache Pain. 2023;24:123 (Sep 8). doi: 10.1186/s10194-023-01638-6

Key clinical point: In this real-world study of patients with migraine, galcanezumab showed higher response rates than those reported in clinical trials, with chronic migraine (CM) and multiple failures to previous preventive medication being significant predictors of a poor response to galcanezumab.

Major finding: At 3 months of galcanezumab treatment, 55.7% of patients showed a 50% response to galcanezumab. CM (odds ratio [OR] 0.09; P = .047) and the number of previous nonresponse to preventive medication classes (OR 0.55; P = .022) were significantly associated with a poor response to galcanezumab.

Study details: This real-world study involved a prospective follow-up of 104 patients with migraine who received monthly galcanezumab.

Disclosures: This study was supported by the New Faculty Startup Fund from Seoul National University and a National Research Foundation of Korea grant. The authors declared no conflicts of interest.

Source: Kim SA et al. Predictors of galcanezumab response in a real-world study of Korean patients with migraine. Sci Rep. 2023;13:14825 (Sep 8). doi: 10.1038/s41598-023-42110-4

Key clinical point: In this real-world study of patients with migraine, galcanezumab showed higher response rates than those reported in clinical trials, with chronic migraine (CM) and multiple failures to previous preventive medication being significant predictors of a poor response to galcanezumab.

Major finding: At 3 months of galcanezumab treatment, 55.7% of patients showed a 50% response to galcanezumab. CM (odds ratio [OR] 0.09; P = .047) and the number of previous nonresponse to preventive medication classes (OR 0.55; P = .022) were significantly associated with a poor response to galcanezumab.

Study details: This real-world study involved a prospective follow-up of 104 patients with migraine who received monthly galcanezumab.

Disclosures: This study was supported by the New Faculty Startup Fund from Seoul National University and a National Research Foundation of Korea grant. The authors declared no conflicts of interest.

Source: Kim SA et al. Predictors of galcanezumab response in a real-world study of Korean patients with migraine. Sci Rep. 2023;13:14825 (Sep 8). doi: 10.1038/s41598-023-42110-4

Key clinical point: In this real-world study of patients with migraine, galcanezumab showed higher response rates than those reported in clinical trials, with chronic migraine (CM) and multiple failures to previous preventive medication being significant predictors of a poor response to galcanezumab.

Major finding: At 3 months of galcanezumab treatment, 55.7% of patients showed a 50% response to galcanezumab. CM (odds ratio [OR] 0.09; P = .047) and the number of previous nonresponse to preventive medication classes (OR 0.55; P = .022) were significantly associated with a poor response to galcanezumab.

Study details: This real-world study involved a prospective follow-up of 104 patients with migraine who received monthly galcanezumab.

Disclosures: This study was supported by the New Faculty Startup Fund from Seoul National University and a National Research Foundation of Korea grant. The authors declared no conflicts of interest.

Source: Kim SA et al. Predictors of galcanezumab response in a real-world study of Korean patients with migraine. Sci Rep. 2023;13:14825 (Sep 8). doi: 10.1038/s41598-023-42110-4

Key clinical point: A significant proportion of patients with migraine do not respond to ≥1 triptans, and this lack of response is associated with increased migraine severity and disability.

Major finding: Overall, 42.5%, 13.1%, 3.9%, and 0.6% of patients did not respond to ≥1, ≥2 triptans, ≥3 triptans, and ≥3 triptans including a subcutaneous formulation, respectively, with triptan non-responders vs responders having a significantly higher migraine frequency (P < .001), intensity (P < .05), and disability (P < .001).

Study details: This study evaluated 2284 patients with migraine using cross-sectional data from the German Migraine and Headache Society Headache Registry.

Disclosures: This study was supported by Projekt DEAL. Several authors declared serving as advisory boards members or consultants for or receiving travel or research grants or honoraria for consulting, lectures, advisory boards, adboards, and educational talks from various sources.

Source: Ruscheweyh R et al. Triptan non-response in specialized headache care: Cross-sectional data from the DMKG Headache Registry. J Headache Pain. 2023;24:135 (Oct 10). doi: 10.1186/s10194-023-01676-0

Key clinical point: A significant proportion of patients with migraine do not respond to ≥1 triptans, and this lack of response is associated with increased migraine severity and disability.

Major finding: Overall, 42.5%, 13.1%, 3.9%, and 0.6% of patients did not respond to ≥1, ≥2 triptans, ≥3 triptans, and ≥3 triptans including a subcutaneous formulation, respectively, with triptan non-responders vs responders having a significantly higher migraine frequency (P < .001), intensity (P < .05), and disability (P < .001).

Study details: This study evaluated 2284 patients with migraine using cross-sectional data from the German Migraine and Headache Society Headache Registry.

Disclosures: This study was supported by Projekt DEAL. Several authors declared serving as advisory boards members or consultants for or receiving travel or research grants or honoraria for consulting, lectures, advisory boards, adboards, and educational talks from various sources.

Source: Ruscheweyh R et al. Triptan non-response in specialized headache care: Cross-sectional data from the DMKG Headache Registry. J Headache Pain. 2023;24:135 (Oct 10). doi: 10.1186/s10194-023-01676-0

Key clinical point: A significant proportion of patients with migraine do not respond to ≥1 triptans, and this lack of response is associated with increased migraine severity and disability.

Major finding: Overall, 42.5%, 13.1%, 3.9%, and 0.6% of patients did not respond to ≥1, ≥2 triptans, ≥3 triptans, and ≥3 triptans including a subcutaneous formulation, respectively, with triptan non-responders vs responders having a significantly higher migraine frequency (P < .001), intensity (P < .05), and disability (P < .001).

Study details: This study evaluated 2284 patients with migraine using cross-sectional data from the German Migraine and Headache Society Headache Registry.

Disclosures: This study was supported by Projekt DEAL. Several authors declared serving as advisory boards members or consultants for or receiving travel or research grants or honoraria for consulting, lectures, advisory boards, adboards, and educational talks from various sources.

Source: Ruscheweyh R et al. Triptan non-response in specialized headache care: Cross-sectional data from the DMKG Headache Registry. J Headache Pain. 2023;24:135 (Oct 10). doi: 10.1186/s10194-023-01676-0