The updated guidelines recommend, in brief:

This woman’s headache started suddenly three months ago. It begins as a dull, localized pain at the top of the head, starting within 30 minutes of rising, and increases in intensity, becoming a global headache as the day progresses. Bedrest alleviates the symptoms. Review the MRI and choose an appropriate therapy.

The analysis found similar benefits for most nonpharmacologic treatments and antidepressants as first-step treatments in MDD. As 1st-line therapy, cognitive behavioral therapies (CBTs) were similar in response to second-generation antidepressants (SGAs) in terms of benefit and remission rates, but discontinuation for adverse events was higher with SGAs. The complementary and alternative medicine interventions St. Johns Wart and acupuncture were also similar to SGAs in terms of response and remission. However, the combination of acupuncture and SGAs yielded higher remission rates. Exercise was also similar to SGAs in remission rates; adding exercise to SGAs gave no added benefit. Antidepressants had a higher risk of discontinuation because of adverse events. For second-step therapies, different switching and augmentation strategies provided similar symptomatic relief.

Shift work has previously been linked to an increased risk of developing MS, presumably due to the resulting sleep deprivation and circadian desynchrony. The current study compared sleeping 7–9 hours/night during adolescence, with less than 7 hours/night and found a 40% increase in risk for developing MS in the short-sleep cohort. The authors conclude that “insufficient sleep and low sleep quality during adolescence seem to increase the risk of subsequently developing MS.”

This physician sounds the alarm on CDC’s ill-founded mandates for mandatory masking, citing the recent Cochrane Review.

Christen Fuller, MD, describes her approach to the often-conflicted situation. One of her keys? “Know your own limitations.” Another? Don’t let the frequency of the patient coming in for pain management lead you into defensiveness and minimizing their pain.