Pharmacologic Treatment for Migraine Prevention in Adults Practice Guideline Recommendations: Report of the AAN Guidelines Subcommittee and the American Headache Society
The AAN and American Headache Society released an updated practice guideline (first since 2012) on pharmacologic migraine prevention in adults, based on a systematic review through June 2024. The headline shift is that CGRP-targeting therapies/monoclonal antibodies (erenumab, fremanezumab, galcanezumab, eptinezumab) and gepants (rimegepant, atogepant) — are now recommended as first-line options, with no requirement to first fail older agents like beta-blockers, topiramate, or amitriptyline. Preventive therapy is generally indicated for patients with four or more migraine days per month or significant functional impairment. Older repurposed agents (antihypertensives, antiepileptics, antidepressants) remain valid options but no longer hold default first-line status. Urgent Care clinical implications: Patients frequently seeking care for recurrent migraine (≥4 days/month) or significant disability should be counseled that preventive therapy — including CGRP agents — can now be considered up front. Full Access: Neurology Journal
FDA Clears Visby Medical’s At-Home Covid-19 and Influenza PCR Test
The FDA has cleared Visby Medical’s over-the-counter combination PCR test for Covid-19 and influenza A/B, delivering results in about 30 minutes at home. Unlike rapid antigen tests, PCR offers higher sensitivity, and this is the first at-home PCR platform to detect multiple respiratory viruses without lab processing. Urgent Care clinical implications: Expect more patients to arrive with a positive at-home PCR result already in hand, which is more reliable than antigen self-tests and may prompt earlier presentation — useful since antivirals are most effective when started early. Full Access: Respiratory Therapy
Randomized Controlled Feasibility Trial of an Intervention to Reduce Infant Bathing
This UK feasibility RCT randomized 105 pregnant women with a family history of atopy to either standard infant care advice or an intervention encouraging bathing their infant no more than once weekly (short, cool baths, minimal wash products) for the first 6 months. At 6 months, all eczema outcomes trended lower in the intervention arm, including a 46% relative reduction in blinded-assessed visible eczema (16% vs. 29%). Urgent Care clinical implications: For parents of infants with atopic family history presenting with dry skin or early eczema concerns, reduced bathing frequency (≤1x/week), lukewarm short baths, and minimal soap use is a reasonable, low-risk counseling point pending larger trial confirmation — this doesn’t replace standard eczema treatment (emollients, topical steroids when indicated) but can be added to routine skin-barrier guidance. Full Access: BJD
Biliary Events and GLP-1 Receptor Agonist Therapy in Adolescents and Young Adults
This retrospective cohort study showed stronger associations, with 2- to 3-fold higher hazard ratios across cholecystitis, biliary colic, and cholecystectomy, likely driven by rapid weight loss and GLP-1-mediated gallbladder dysmotility. Cholecystitis alone did not reach significance in the cross-sectional analysis, but did in time-to-event modeling. The findings extend the known adult GLP-1 RA biliary safety signal to a pediatric/young adult population for the first time at this scale. Urgent Care clinical implications: Maintain a high index of suspicion for biliary colic or cholecystitis in adolescent/young adult patients on GLP-1 therapy who present with right upper quadrant pain, nausea, or vomiting, even without classic risk factors, and pursue appropriate diagnostic testing rather than attributing symptoms solely to GI side effects of the medication. Full Access: JAMA