Add topic to email alerts Receive an email when new articles are posted on Please provide your email address to receive an email when new articles are posted on . “ data-action=”subscribe”> Subscribe We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: A “top-down” infliximab/immunomodulator therapy reduced long-term risk for abdominal surgery vs. a “step-up” approach in newly diagnosed Crohn’s. It also lowered risk for disease progression and hospitalization. CHICAGO — Early treatment with infliximab and an immunomodulator was associated with more than five times reduced risk for abdominal surgery at 5 years among patients with newly diagnosed Crohn’s disease, according to a presenter. Follow-up PROFILE trial data presented at Digestive Disease Week showed that early control of inflammation during a 48-week treatment period also lowered long-term risk for disease progression and hospitalization. Nurulamin “Nuru” Noor, MD, speaks at Digestive Disease Week. Image: Robert Stott. “Historically, there has been a reluctance among some clinicians to use a ‘top-down’ approach due to potential concerns about overtreatment,” Nurulamin “Nuru” Noor, MD, clinical lecturer in gastroenterology at University of Cambridge, said at the presentation. “Over 5 years follow-up, we found no difference in safety outcomes between the two groups, either for serious infections or malignancies. “Patients receiving ‘top-down’ infliximab from diagnosis had a more than five times lower risk of Crohn’s disease-related abdominal surgery.” Prior data from the randomized, controlled PROFILE trial showed improved clinical outcomes at 48 weeks for patients who received the “top-down” therapy approach with infliximab and an immunomodulator compared with an accelerated “step-up” strategy, or conventional treatment. Noor and colleagues followed 386 participants for a median 5 years after the 48-week visit to evaluate whether early treatment can impact long-term outcomes of Crohn’s disease. They reviewed medical records for abdominal surgeries, hospital admissions and disease progression. Follow-up data were available for 358 patients (93%), of whom 182 received top-down therapy and 176 received step-up therapy. Analysis showed 28 Crohn’s-related abdominal surgeries were required among patients who received step-up therapy compared with six surgeries among those who received top-down therapy (adjusted HR = 5.23: 95% CI, 1.99-13.76). Time to surgery also was earlier in the step-up group. Patients who received top-down therapy were about 2.5 times less likely to experience disease progression and two times less likely to be hospitalized. “Our data suggest that the course of Crohn’s disease can be modified with therapy and this should be considered the standard of care,” Noor said. Published by: Sources/Disclosures Source: Noor N, et al. Profile trial 5-year disease modification outcomes. Presented at: Digestive Disease Week; May 2-5, 2026; Chicago. Disclosures: Noor reports educational or travel grants and/or speaker fees from AbbVie, Bristol Myers Squibb, Celltrion, Falk, Ferring, Johnson & Johnson, Eli Lilly and Co., Medfyle, Pfizer, Pharmacosmos, Spyre, Takeda and Tillotts Pharma. Please see the study for all other authors’ relevant financial disclosures. Ask a clinical question and tap into Healio AI’s knowledge base. PubMed, enrolling/recruiting trials, guidelines Clinical Guidance, Healio CME, FDA news Healio’s exclusive daily news coverage of clinical data Learn more Add topic to email alerts Receive an email when new articles are posted on Please provide your email address to receive an email when new articles are posted on . “ data-action=”subscribe”> Subscribe We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Source link
La mejor defensa es un buen ataque: Aquí encontrarás porque deberías recibir una vacuna contra el VRS.
English + Infographic text Slide 2: VRS es la sigla del virus respiratorio sincitial. Es un virus común que causa infecciones en el pulmón y en las vías respiratorias. El VRS usualmente empieza a propagarse en el otoño y llega a su punto máximo en los meses invernales. Slide 3: La mayoría de personas experimentan síntomas moderados similares a los de la gripe y se recuperan en 1 o 2 semanas. Rinitis Congestión Tos Estornudos Sibilancia Fiebre Apetito reducido Slide 4: Pero algunas personas, especialmente bebés y adultos de edades avanzadas, pueden tener infecciones más graves y el VRS podría ser mortal. Las complicaciones que pueden causar dificultad para respirar incluyen: Infecciones de las vías respiratorias Bronquiolitis Neumonía Hipoxia (niveles bajos de oxígeno) Deshidratación Ataques cardíacos y accidentes cardiovasculares Slide 5: Puedes controlar los síntomas del VRS: Tomando antifebriles de venta sin receta Bebiendo muchos líquidos Descansando Si tienes hipertensión o si tomas medicamentos de venta con receta, asegúrate de hablar con tu proveedor de atención médica antes de tomar medicamentos de venta sin receta. Slide 6: El VRS puede empeorar trastornos pulmonares subyacentes tales como EPOC y asma. Las personas que tienen esos trastornos podrían requerir tratamientos para brotes si se contagian del VRS. Slide 7: Habla con tu proveedor de atención médica o ve a una sala de emergencias si: Tienes dificultad para respirar No puedes comer o beber Tienes dolor de pecho Slide 8: La prevención es la mejor medicina. Vacunarse es la mejor forma de protegerse de trastornos respiratorios graves. Slide 9: Las vacunas contra el VRS se recomiendan para: Bebés Adultos de 75 años o más Adultos entre las edades de 50 y 74 años que tienen un mayor riesgo de infecciones graves del VRS Slide 10: Logo Este recurso educativo se preparó con el apoyo de Moderna. Source link
Misdiagnosing Hair Loss: — Donovan Hair Clinic
Diagnosing hair loss can be challenging. Many hair disorders share overlapping clinical features, and subtle differences in history, examination, trichoscopy, and sometimes biopsy are required to arrive at the correct diagnosis. As a result, several hair loss conditions are commonly misdiagnosed in everyday clinical practice. One of the most frequent diagnostic errors occurs when telogen effluvium (TE) or chronic telogen effluvium (CTE) is diagnosed in patients who actually have early androgenetic alopecia (AGA). Patients with early AGA often present with increased shedding, which can easily mimic telogen effluvium. However, careful examination frequently reveals early miniaturization of follicles, particularly along the central scalp or frontal region. Another condition that is frequently misunderstood is short anagen syndrome. Women who report that their hair never seems to grow long are sometimes incorrectly given this diagnosis. In reality, many of these patients have androgenetic alopecia, where progressive follicular miniaturization leads to shorter and finer hairs over time. True short anagen syndrome is relatively uncommon, and distinguishing it from other causes of reduced hair length requires careful evaluation. There is also frequent confusion between short anagen syndrome and loose anagen syndrome. These are distinct conditions with different mechanisms. Alopecia areata incognita is another diagnosis that is often applied too liberally. This condition presents with diffuse shedding and can resemble telogen effluvium. However, most patients referred to me with a presumed diagnosis of alopecia areata incognita ultimately do not have the condition. While certain trichoscopic findings may raise suspicion, a scalp biopsy is generally required to confirm the diagnosis. Finally, fibrosing alopecia in a pattern distribution (FAPD) is commonly misdiagnosed. Many clinicians incorrectly assume any LPP patient with androgenetic alopecia (AGA) should be laboratory as FAPD. FAPD is a special presentation. Careful history, clinical examination, trichoscopy, and occasionally biopsy are essential tools in avoiding these common diagnostic pitfalls. Source link
Survey launched to explore access to migraine treatment
Share your experience of accessing treatment for migraine in our new survey to help shape our work This week, The Migraine Trust launched a new survey into people’s experience of accessing migraine treatment. Everyone living with migraine should be able to see the right health professionals, get the medicines or treatments they need and be able to use them without too much difficulty. But we know finding the right treatment for migraine can be challenging – from knowing what treatments are available, to trying multiple treatments that don’t work for you, or cause side effects that are difficult to manage. We want to ensure that people living with migraine have fair access to treatments and care. That’s why we’re asking you to share your experiences. If you’re based in the UK and live with migraine, please consider completing our survey. Your voice will help us represent the 1 in 7 people affected by migraine to push for change. Financial support has been provided to The Migraine Trust through grants from Pfizer Ltd and Dr Reddy’s Laboratories (UK) Ltd, who have had no input or influence into the development and delivery of any activities related to this project. Source link
Social Security Disability and Chronic Pain: Understanding the Claims Process
By Brian Mittman, Markhoff & Mittman, PC Chronic pain can affect every aspect of your life, especially your ability to work. When pain makes work unsustainable, Social Security Disability Insurance (SSDI) is designed as a safety net. However, applying for SSDI with chronic pain is complex, since the Social Security Administration (SSA) does not approve claims based on having pain alone. This guide explains, in plain language, how SSA evaluates chronic pain-related claims, how to strengthen your application, and what to expect throughout the process. (This is not legal advice; consult a qualified attorney for personalized help.) Learn more during a FREE webinar, “Preparing for Your Social Security (SSA) Disability Claim,” at 1 p.m. ET on Thursday, March 12. Register today. How SSA Views Pain The SSA does not grant benefits for “pain” itself. Instead, it requires a medically determinable impairment—a diagnosed condition, supported by objective medical evidence such as imaging or lab findings—that could reasonably cause your pain. Examples include spine disorders, neuropathy, inflammatory arthritis, fibromyalgia, complex regional pain syndrome (CRPS), and other well-documented pain syndromes. Once a qualifying diagnosis is established, SSA looks at your symptoms: how severe and frequent your pain is, how long it has persisted, and how it impacts your ability to function. Your own statements are important, but SSA cross-checks them with your medical records, imaging, physical exams, medication lists, and sometimes reports from family or coworkers. The goal is to see a consistent story of how pain has altered your life—not just a list of medical terms. Crucially, SSDI is not about whether you can push through pain for a short period. It is about whether you can work reliably, full-time, week after week. If pain causes you to miss work, need frequent breaks, or prevents you from maintaining a consistent work schedule, that can be disabling. The Five-Step Disability Evaluation Every adult SSDI claim is reviewed using a five-step “sequential evaluation.” Chronic pain does not change the steps, but it influences how you present your case and the evidence needed at each stage. Step 1: Are You Working Above the Earnings Limit? SSA first checks if you are performing substantial gainful activity (SGA)—earning more than a set monthly amount, which changes yearly. If you are, you are not considered disabled at Step 1, regardless of your pain or diagnoses. If you are not working, or earning below SGA, your claim moves forward. Are you pushing yourself despite your pain because of bills and obligations? When you finally reduce hours or stop altogether, the timing should be supported in the medical records—notes about increased flares, missed days, reduced productivity, not just a sudden work stoppage with no context. Step 2: Do You Have a ‘Severe’ Medically Determinable Impairment? Here, SSA looks for at least one medically determinable impairment that has significantly limited, or is expected to significantly limit, your physical or mental ability to do basic work activities for at least 12 continuous months. Pain, by itself, is not enough; there must be a documented medical condition behind it. Conditions like degenerative disc disease, rheumatoid arthritis, or CRPS, supported by imaging or clinical findings, often meet this requirement. “Severe” means your condition significantly limits basic work activities like standing, walking, lifting, concentrating, or staying on a schedule. For chronic pain, this is where clear documentation starts to matter. If your records show only “doing well” or “stable” with minimal detail, SSA may decide your pain is not severe—even if your day‑to‑day reality is very different. A clear diagnosis along with comments about pain will move you forward. Step 3: Does Your Condition Meet or Equal a “Listing”? SSA maintains a list of impairments (the “Listings”) that are considered automatically disabling if certain criteria are met. There is no Listing for “chronic pain” itself. Some chronic pain conditions, like spine disorders or inflammatory arthritis, may meet a Listing. Other pain syndromes like fibromyalgia rarely do. Even if your condition doesn’t fit a Listing exactly, SSA considers whether your combined symptoms are as severe as a listed impairment. If you do not meet or equal a Listing, Social Security simply moves on to Step 4 to look more closely at what you can still do. Step 4: What is Your RFC—And Can You Do Your Past Relevant Work? SSA will assign you a residual functional capacity (RFC)—its assessment of what you can still do on a regular, sustained basis despite your impairments. This includes: How long you can sit, stand, and walk in a workday How much weight you can lift and carry How often you need to change positions or lie down Whether you can stay focused, concentrate, and keep pace How many days you would likely miss due to flares, fatigue, or medical appointments At Step 4, SSA compares your RFC to the easiest job you have done in the recent 5 years. If they believe you could still perform that job as it’s generally done, you will be found not disabled. If you cannot do that work, then you move on to Step 5. Step 5: Can You Do Any Other Work? If you can’t do your past work, SSA considers your RFC, age, education, and transferable skills to determine if there is other work you could do in the national economy. At this stage, the burden shifts: SSA must show there are jobs you can still perform. This is often where chronic pain cases are decided. SSA may point to sedentary, simple jobs and say, “You can sit and do these.” To overcome that, the record must show that even sedentary work is not sustainable—for example, because you cannot sit long enough, must lie down unpredictably, cannot maintain pace and concentration, or would miss too many days due to flares and treatment. Medication side effects and mental health issues related to pain also play a key role. Again, SSDI is about sustainability, not isolated moments of functioning. If you are just braving it out in short bursts, SSA needs to
How To Keep Your Reproductive System Health & Why
For women, having a healthy reproductive system is not merely important for childbearing. It’s also imperative for overall health, including emotional wellbeing, bone strength, cardiovascular health, immune system, pelvic health, and aging. Your reproductive system is strongly connected to your hormones, which essentially control a lot of your bodily functions. Bottom line? Having a healthy reproductive system is crucial for many different parts of the body. Today, we’re going to look at the various ways that a healthy reproductive system contributes to an overall healthier you, as well as ways in which to keep your reproductive system healthy. Here are 8 different ways your reproductive system works to keep your body healthy. 1. Hormonal Health Firstly, as mentioned, your reproductive system is a major hormone producer… and hormonal balance affects your whole body. For example, estrogen, progesterone, and testosterone, all produced in the female reproductive system, influence your energy levels and fatigue, mood, anxiety and depression risk, sleep quality, metabolism and weight regulation, sex life, skin, hair, and bone health. When your reproductive system is unhealthy, these hormones can be imbalanced, having a negative effect on all of these things, all the while rippling through every organ system. 2. Fertility & Childbearing Reproductive health is essential before conception as it promotes healthy eggs, regular ovulation, balanced hormones for conception, and a lower risk of miscarriage. During pregnancy, it’s important for proper implantation, placenta development, and reduced risk of pre-eclampsia, preterm birth, gestational diabetes, and low birth weight. 3. Bone Strength & Mobility A woman’s reproductive system, and the hormones it makes, plays an important part in maintaining bone density. For example, if estrogen and testosterone are low, it can increase the risk of osteoporosis, fractures, and chronic joint and back pain. And these ailments can persist for longer than reproductive years. 4. Heart Health When your reproductive hormones are healthy, you should be able to benefit from a more regulated cholesterol, protected blood vessels, and reduced inflammation. When there is a disruption in hormone production, the opposite may occur, such as heart disease, high blood pressure, and stroke. 5. Emotional Wellbeing Our hormones are strongly linked to our emotional and mental health. When your reproductive hormones aren’t functioning at their best, it may disrupt your brain chemistry. For example, when serotonin, dopamine, and oxytocin aren’t in balance, you may experience mood swings, brain fog, anxiety and low levels of motivation, and reduced resilience because of stress. 6. Sexual Health Your reproductive system, when in balance, supports a healthy libido and arousal, allows for comfortable and pain-free penetration, enhances orgasm quality, promotes natural lubrication, and the strengthening of emotional bonding between partners. If you have an unhealthy reproductive system, these factors may suffer, creating issues in your sex life, solo or with a partner. 7. Immune System & Inflammation Your reproductive system regulates your immune system by deciding when it should react strongly or calm down to infections, injuries, and more, and how much inflammation is appropriate. If this is out of balance, and there is chronic inflammation in reproductive organs, it could cause increased fatigue, affect gut health, and raise the risk for an autoimmune issue. 8. Pelvic Health A healthy reproductive system supports pelvic floor strength, bladder and bowel control, and posture and spinal stability. With an unhealthy reproductive system, you could face pain, incontinence, or discomfort in everyday life. Different Ways to Keep Your Reproductive System Healthy We’ve established that having a healthy reproductive system is important for almost all bodily functions. So, here are some ways you can help keep it healthy and functioning optimally. Lifestyle Choices To support your reproductive system, and keep hormones balanced, you could: get 7-9 hours of sleep every night manage stress eat enough calories avoid excess alcohol and caffeine maintain a healthy body fat range enjoy balanced exercise In terms of nutrition, you can focus on nutrient-dense foods that support hormones, eggs, and tissue. For example: Healthy fats: olive oil, avocado, nuts, seeds, fatty fish Protein: eggs, fish, legumes, lean meat, tofu Micronutrients: zinc, iron, folate, selenium, omega-3s. In terms of exercise, moderate, regular activity is best. Chronic overtraining isn’t a good idea, as it can actually hinder your health. You could engage in: Strength training to support testosterone and bone health Cardio for improved blood flow to reproductive organs At the same time, you could experience negative effects when it comes to arousal, orgasm, tissue health, and fertility if you aren’t active, sit for prolonged periods of time, or don’t manage your blood pressure and cholesterol. As per weight management, maintaining a healthy weight, without extremes, is the best way to keep your reproductive system healthy. With severe dieting or obesity, ovulation, menstrual regulation, and libido may be affected. Some other lifestyle choices can disrupt your endocrine hormones. For example, smoking can damage your levels of fertility and cause hormonal damage, and using plastic, pesticides and harsh chemicals are toxins that can be harmful. Additionally, avoid taking unnecessary hormone supplements. Manage Health Conditions If you have any current health conditions, make sure to manage them correctly in hopes of keeping them in control. For example, if you have any infections, make sure to treat them immediately. And for chronic conditions, like diabetes or thyroid issues, regular check ups and medication (if prescribed by your healthcare professional) are essential. Health Screenings For preventative care, routine health screenings are a great idea… even if you don’t have any symptoms. Visiting a gynecologist/healthcare professional for a pap smear, pelvic exam, and hormone testing regularly can help you maintain good reproductive health, and any early detection means that treatment could be more effective with possibly better outcomes. Mental Health Because your hormones play a big part in how you feel mentally, you may be experiencing an unhealthy reproductive system that gives off mental side effects. After all, your mental health directly affects your reproductive health. For example: Listen To Your Body Your body is very intuitive, and it’ll give you signals. It’s important
The Best Defense Is a Good Offense: Here’s Why You Should Get an RSV Vaccine
Español + Flipbook text Slide 2: RSV stands for respiratory syncytial virus. It’s a common virus that causes infections in the lung and respiratory tract. RSV usually starts spreading in the fall and peaks in the winter months. Slide 3: Most people have mild symptoms similar to cold symptoms and recover in 1–2 weeks. Runny nose Congestion Cough Sneezing Wheezing Fever Reduced appetite Slide 4: But some people, especially infants and older adults, can have more serious infections, and RSV may be life-threatening. Complications that can cause difficulty with breathing include: Respiratory tract infections Bronchiolitis Pneumonia Hypoxia (low oxygen levels) Dehydration Heart attack and stroke Slide 5: You can manage the symptoms of RSV by: Taking over-the-counter fever reducers Drinking plenty of fluids Resting If you have high blood pressure or take prescription medicines, be sure to check with your healthcare provider before taking over-the-counter medications. Slide 6: RSV can worsen underlying lung conditions like COPD and asthma. People who have those conditions might need treatment for a flareup if they get RSV. Slide 7: Talk to your healthcare provider or go to the emergency department if you: Have trouble breathing Can’t eat or drink Have chest pain Slide 8: Prevention is the best medicine. Getting vaccinated is the best way to stay protected from severe respiratory disease. Slide 9: RSV vaccines are recommended for: Infants Adults ages 75 and older Adults ages 50 to 74 who are at increased risk for severe RSV Slide 10: Logo This educational resource was created with support from Moderna. Source link
Low Level Laser Therapy (LLLT) for Hair Loss: Which Lasers are Better — Donovan Hair Clinic
I enjoyed discussions around the topic of low level laser devices for treating hair loss. Low-level light therapy (often called LLLT or “photobiomodulation”) is a non-drug option for androgenetic alopecia that uses red light (roughly 620–670 nm) to stimulate hair follicles. Two recent systematic reviews (one if which was also a meta-analysis) of randomized controlled trials (RCTs) concluded that the home-use devices can meaningfully increase hair density compared with sham (placebo-like) devices. But how do various types of devices- including laser diode vs LED compare? Nowadays, some devices are based on laser diodes, some LED and some have both!! Let’s review two important recent systematic reviews. First, some definitions! Laser vs LED — what do these terms mean? * Laser (LD = laser diode): emits a highly collimated, narrow-band beam (very “focused” light at a fairly specific wavelength). * LED (light-emitting diode): emits non-coherent, broader-band light that spreads more. Biologically, both aim to trigger follicle “energy” pathways: red light is absorbed by cytochrome-c oxidase in mitochondria, increasing ATP/ROS signaling that can promote cellular activity supportive of hair growth. What the studies show (and which is better)?? Across 7 double-blind RCTs (607 participants), laser therapies improved hair density versus sham with an overall standardized mean difference (SMD) ~1.27. When trials/devices were grouped by light source (LD vs LED) both reviews found a statistically significant difference favoring laser diodes alone over mixed LED+laser devices: * LDs alone: SMD 1.52 (95% CI 1.16–1.88) * LEDs + LDs: SMD 0.85 (95% CI 0.55–1.16) (p=0.043). Based on current RCT level evidence, laser-diode based devices seem a bit better. That said, these are not perfect head-to-head comparisons, follow-up is generally short (≤26 weeks), and LED-only data are limited References 1. Lueangarun S et al. J Clin Aesthet Dermatol. 2021;14(11):E64–75. 2. Gentile P, Garcovich S. Facial Plast Surg Aesthet Med. 2024;26(2) #lllt #hairloss #laser #androgeneticalopecia Source link
Best Migraine Cocktails for Acute Relief: A Full Medication Breakdown
This post may contain affiliate links. Migraine Strong, as an Amazon Affiliate, makes a small percentage from qualified sales made through affiliate links at no cost to you. Migraine disease affects over 1 billion people worldwide, including more than 39 million in the United States, making it the 3rd most disabling illness globally, according to the Migraine Research Foundation. For those of us navigating this chronic condition, finding an effective migraine cocktail—a personalized mix of medications and therapies that stop an attack—is often a game-changer. In the Migraine Strong Facebook community, we talk daily about which acute medications work best, which ones can be combined, and how many triptans are actually available. This article brings together everything you need to know about building a migraine cocktail, including over-the-counter (OTC) options, prescription treatments, second-line rescue meds, and even devices. I’ll also share what works for me personally, as well as treatments for vestibular migraine and emergency care options. 🩺 Disclaimer: This post is written from the perspective of a patient and patient advocate. It is not a substitute for professional medical advice. Please consult your healthcare provider to find the best treatment plan for you. What Is a Migraine Cocktail? A migraine cocktail is a combination of medications—prescription, OTC, and/or natural remedies—used together to treat a migraine attack effectively. The goal is to interrupt the migraine process and relieve symptoms like head pain, nausea, and sensory sensitivity. It’s important to note that not all medications are safe to combine. Always speak to your doctor or pharmacist before trying a new combination. Triptans: First-Line Acute Treatment Triptans are often the first prescription medication added after OTC treatments have failed. These drugs work by narrowing blood vessels and blocking CGRP (calcitonin gene-related peptide), a protein involved in migraine pain pathways. CGRP causes blood vessels to swell and triggers the inflammation cascade that leads to migraine pain.¹ While sumatriptan (Imitrex) is the most commonly prescribed, not everyone finds it effective—or tolerable. Digestive issues during attacks can also interfere with absorption. In these cases, nasal sprays or injections might provide better relief. If one triptan doesn’t work, it’s worth trying another. Each is formulated differently. Trying a different triptan or combining it with other medications may lead to better outcomes. Triptans should be limited to 10 days a month or about twice a week to avoid rebound headaches.² #AD Acute Medications – Triptans Medication Brand Name Dosage Maximum per Day Almotriptan Axert 12.5mg tablet 25mg/day Eletriptan Relpax 40mg tablet 80mg/day Frovatriptan Frova 2.5mg tablet 5mg/day Naratriptan Amerge 1–2.5mg tablet 2 doses/day Rizatriptan Maxalt 10mg tablet or ODT 3 doses/day Rizatriptan/Meloxicam Symbravo 1 tablet (20mg meloxicam/10 mg rizatriptan) 1 dose/day Sumatriptan Imitrex 50–100mg tablet, 40mg nasal spray 200mg/day or 40mg nasal spray Sumatriptan Injection Imitrex, STATdose, Sumavel, DosePro 4–6mg subcutaneous Twice/day Sumatriptan + Naproxen Treximet 85mg sumatriptan + 500mg naproxen 2 tablets/day Zolmitriptan Zomig 2.5–5mg dissolvable tablet or nasal spray 10mg/day or one nasal spray NSAIDs and Other Non-Triptan Acute Medications NSAIDs such as ibuprofen, naproxen, and diclofenac block the neuroinflammation that fuels migraine pain. These medications may be more effective for fully developed attacks—especially those that strike during the night or early morning.³ NSAIDs can also complement triptans to form a well-rounded migraine cocktail that targets multiple pain pathways. If used alone, NSAIDs may be taken up to 15 days per month. However, when part of a combination drug like Excedrin Migraine or used in combination with a triptan, they should be limited to 10 days/month to avoid rebound. Other Acute Medications Medication Brand Name Dosage Maximum per Day Diclofenac potassium powder Cambia 50mg packet 150mg/day Naproxen/Naproxen sodium Aleve, Anaprox 220mg or 500mg 1000mg/day Diclofenac sodium Voltaren 75mg tablet 2 tablets/day Ibuprofen Advil, Motrin 400–800mg 2400mg/day Excedrin Migraine – 1–2 tablets 4 tablets/day Prodrin – 1–2 tablets 5 tablets/day Timolol maleate (ophthalmic solution) – 0.5% solution – 1 drop/eye 2 drops/eye/day Why Timolol? Timolol eye drops are a fast-acting beta blocker with no rebound risk. In a small study, they were found to help relieve migraine symptoms.⁴ They work faster than the oral version used preventively and are worth discussing with your doctor. Compounding pharmacies can make a nasal spray that is also a 0.5% solution. The formulation was published in the International Journal of Pharmacy Compounding. You can read more in our article about Timolol for migraine. New Migraine-Specific Medications Recent additions to migraine treatment include CGRP receptor blockers like Ubrelvy, Nurtec, and Zavzpret, as well as Reyvow, which works like a triptan without affecting blood vessels. Many headache specialists recommend taking these meds early in the attack. They may also be combined with NSAIDs to enhance their effectiveness. New Migraine Medications Medication Brand Name Dosage Maximum per Day Ubrogepant Ubrelvy 50–100mg tablet 200mg/day Rimegepant Nurtec 75mg orally dissolving tablet (ODT) 75mg/day Lasmiditan Reyvow 50, 100, or 200mg tablet 1 dose/day Dihydroergotamine Trudhesa 1 spray per nostril (upper nasal) Follow prescription Zavegepant Zavzpret 10mg nasal spray (1 spray in 1 nostril) 1 spray/day Rescue and Second-Line Treatments When first-line medications don’t work, rescue meds may be used. These are often prescribed for severe or prolonged attacks and are sometimes combined with Benadryl or anti-nausea meds. Our article on Benadryl for migraine provides more in-depth information. Second-Line Rescue Medications Medication Brand Name Dosage Max/Day Diclofenac sodium Voltaren 75mg tablet 2 tablets/day Dihydroergotamine Migranal Nasal spray Per RX Ketorolac Toradol, Sprix Injection 60mg/2ml 2/day Ketorolac Tablets – Oral tablets 2/day Ketorolac Nasal Spray Sprix 1 spray per nostril 4 doses/day Steroids Prednisone, Dexamethasone Varies 40–80mg max/day Ergotamine Ergomar, Cafergot Varies 2 tablets/day Controversial Rescue Treatments These medications are generally not recommended due to addiction and rebound risks. They may be prescribed in rare situations. Dr. David Watson notes that when used occasionally, opioids may offer relief.⁵ However, studies show they can lead to central sensitization⁶ and cause rebound headaches when used more than four times per month.⁷ Controversial Treatments Medication Brand Name Max Dose Guidance Butalbital combos Fiorinal, Fioricet, Phrenilin, Esgic As directed, limit per
Artificial Intelligence and Disparities in Colorectal Care
by Dr Elissa Dabaghi (Frontline Gastroenterology Global Taskforce 2025-6) Colorectal cancer remains one of the most prevalent causes of cancer-related deaths in the United States, where geographic location can significantly affect whether appropriate colorectal cancer care is available. Individuals living in low socioeconomic status areas have about a 37% higher risk of colorectal cancer and a 24% higher risk of cancer-related death than those living in higher socioeconomic status areas. Given the rapid integration of artificial intelligence into medicine, we must assess its potential impact on health equity. As the use of artificial intelligence (AI) in medicine grows, will this technology bridge or deepen existing socioeconomic disparities in access to colorectal care? Rural healthcare demonstrates the critical need to bridge the gap in healthcare disparities. The number of practicing general surgeons in rural communities has declined rapidly. Meanwhile, specialists, including colorectal surgeons, predominantly reside in urban communities. The general surgeon workforce in rural areas is projected to drop significantly in the next decade, while the workforce in urban and metropolitan communities is projected to almost double. Furthermore, there are substantial geographic barriers for patients living in rural areas. Some statistics show that 1 in 5 Americans residing in rural areas live more than 60 miles from a medical oncologist. These trends directly threaten colorectal cancer screening and treatment, as general surgeons perform over 50% of screening colonoscopies in these rural areas. With the growing use of technology and the implementation of AI, many wonder whether AI can help bridge this gap in healthcare, particularly in colorectal care, with regard to screening for colorectal cancer and potentially surgical planning. New systems, such as GI Genius, can identify colonic polyps that can be easily missed by the human eye. Certain studies have shown that this technology can decrease the adenoma miss rate from 32.4% to 15.5% when AI is utilized, with improvement seemingly most apparent in non-expert endoscopists. This is critical for reducing colorectal cancer risk over 5 years and can have a significant impact on rural healthcare, which already has limited access to specifically expert endoscopists. These AI systems could therefore help to both train less-experienced endoscopists to achieve higher adenoma detection rates and, beyond that may serve as expert-level support during these screenings going forward. However, it is important to mention that even with the implementation of AI-assisted polyp detection during colonoscopy, endoscopists remain essential to ensuring these systems are utilized effectively and appropriately. Endoscopists must understand the limitations of AI, and avoid overreliance, but rather utilize this technology as an adjunct to clinical judgement and shared decision-making, as highlighted by Frontline Gastroenterology’s review (1). Another potential utility of AI and machine learning algorithms in rural or resource-strapped settings is to triage patients who require urgent referral to specialist centers. Some AI-based prediction models have succeeded in stratifying colorectal cancer patients by one-year mortality risk, allowing the streamlining of care for more urgent cases as well as the tailoring of appropriate perioperative care to each patient. Additionally, although patients in rural areas often already use telemedicine for remote consultations and office visits, it could be interesting to pair AI with diagnostics in this setting. Patients in these rural areas who require endoscopic screening could choose to undergo a capsule endoscopy that integrates AI and machine-based polyp detection at their local center. This would ultimately facilitate more convenient (and likely, by extension, timely) colorectal cancer screening for patients that may not have access to specialist centers. Despite its promise, it is important to acknowledge the potential of AI to widen gaps in US healthcare, either through financial barriers or by creating additional limitations on access to resources. Additionally, implementing the use of AI in a rural healthcare system could be challenging due to the substantial investments and costs required to roll and maintain such systems (at all levels of care). Not only are these communities already financially stretched, but they may also lack the essential resources required to operate this technology (such as platform upgrades and even high-speed internet). Furthermore, many diagnostic AI systems are trained on data from large urban populations, which could lead to higher rates of incorrect diagnostic readings for rural populations with different demographics. As discussed in an article by Frontline Gastroenterology, the reliability of AI-driven predictions is dependent on high-quality data input (2). This article emphasizes that reducing irrelevant data input and systemic bias through precise and rigorous data selection to properly train the algorithm is essential to developing predictive tools that genuinely benefit patients of all demographics. Finally, given the relative ease of implementing these AI systems in large, urban healthcare facilities, as opposed to rural settings, there is a potential for this technology to drive patients away from local already struggling rural hospitals to these centers. This can place further strain on the finances of these institutions, and ultimately potentially worsen healthcare accessibility through their closure. Finally, as things currently stand, healthcare insurance systems and Medicare do not offer differential reimbursement rates for the use of AI-assisted technology, which could represent a challenge for rural hospitals in generating the initial financial outlay required to deploy this technology. In conclusion, we must ensure that AI reduces and prevents the worsening of disparities in colorectal care, and healthcare in the US as a whole. This includes strengthening and training these algorithms on rural populations to prevent inequities in underserved areas, as well as ensuring adequate funding for AI-assisted care to be implemented in these rural hospitals, which already have limited resources. Overall, however, there is great potential for AI to augment, not replace, rural providers and enhance triaging patients, risk stratification, and access to expert and specialized support. References Olabintan O, Fearnley L, Iniesta R, et al. Artificial intelligence in endoscopy: navigating risk, responsibility and ethical challenges. Frontline Gastroenterology Published Online First: 17 November 2025. doi: 10.1136/flgastro-2025-103107 https://fg.bmj.com/content/early/2025/11/17/flgastro-2025-103107 Ashton JJ, Brooks-Warburton J, Allen PB On behalf of the British Society of Gastroenterology artificial intelligence in IBD special interest group, et al. The importance of
