Migraines, Murmurs and Meddling Rats

👋 Happy Friday. It’s been a long week, hasn’t it?

Work, uni, exams, yadda yadda ya.
Life can feel like a never-ending all-you-can-eat smorgasbord of stress🤕

So time to relax, kick back and enjoy, there’s no scary NEWS of 8 in here, just your medical news at 8 instead 🤝 ☕

Here’s what we got:

If you want to read any previous editions of The Handover, you can on our website.

Common things are common. And there is nothing common-er than a headache. 

Usually, you can chalk it up to dehydration, stress, or mysteriously needing a sick note on a Monday morning 🤔

But when those headaches come in that one-sided, throbbing, please-turn-off-the-sun flavour, we need a more tailored approach. 

You see, migraine management has a problem…

Treating a migraine attack is super straightforward.

But stopping it from coming back? Something curious happens. It takes the pain in your patient's head and makes it a pain in your arse. 

How about propanolol? Oh… you’re asthmatic
How about toparimate? Oh… you’re trying to get pregnant
And acupuncture(NICE-recommended)? Oh… you’re traumatised by Final Destination 5

There are a load of wonderful ways to tackle migraine prophylaxis. 

Contenders included heritage drugs, like propranolol, topiramate, and Botox(Botulinum Toxins). None of which has the primary job of treating migraines. It’s like a side-hustle for them. 

And also, the new, sexy CGRP-targeted therapies. A class of drugs that finally treats migraines as a day job. TLDR: they block the chemical released during migraine attacks that causes inflammation.

But which is definitively the best? And which aren’t worth the hype? This meta-analysis and systematic review from the Annals of Internal Medicine has the answers. 

This study is the Migraine Olympics.
A head-to-head comparison of the biggest names in chronic migraine prevention.

The review looked at 43 randomised controlled trials involving 14,725 patients with chronic migraine.

Researchers wanted to answer three big questions:

And after an industrial quantity of unpaid academic labour, these were the key findings:

Headline Finding = CGRP therapies on top.
The new-gen CGRP-targeted therapies were the most effective class overall. A load of them reducing monthly migraine days by about 2 days vs placebo

What about the old faithfuls? Well… they had an evidence quality problem

This is fascinating because the CGRPs, according to NICE scripture(1.3.24), should only be recommended AFTER 3 of our old fathfuls had failed. Even though they have stronger evidence.

You would think these findings would lead to the Migraine Union boycotting NICE HQ, but the study found several shortcomings. 

Overall, after years of treating migraines with meds that don’t quite fit the bill, we might finally have a class of meds that takes these “headaches” as seriously as patients do 🤝

You slump into a seat at the M&S cafe and chow into your £6.90 chicken & stuffing sandwich.

Finally, lunch (it’s 4:30 pm).
A time to rest, ingest, and slog through the ever-growing pile of Outlook emails.

…99+ Notifications.🫠

Anything fun? A cheeky ST1 offer perchance?
Dream on, hun. It’s the usual lineup:

Subject: Staff Reminder - Theatre Equipment Is NOT Gym Equipment!
Orthopaedics, stop trying to ‘squeeze in a set or two’ with the intramedullary rods during surgery.

Subject: Poor Spelling Noted Frequently on Patients' Notes.
Some recently noted errors:

And then, righttt at the bottom of your inbox: Subject: Urgent Results Available⚠

“Patient X’s Echocardiogram showed severe stenosis.”

Sh**. You should’ve been on this yesterday.

And that's the kicker.
An inconspicuous “results available”.
No mention of the ticking time bomb hiding within.

But, what if you were ALERTed instead?

Published in JACC, the ALERT trial set out to do just that.
Researchers conducted a multicentre RCT trial across 5 US health systems, involving 35 hospitals and 765 clinicians. They analysed over 1,900 patients with significant valvular heart disease identified on echo.

The clinicians were split into two groups:

The primary outcome?
Whether these alerts improved timely, guideline-based care, measured via:

Let’s just say the results deserve a half-swipe at the minimum, because the study found a pretty significant difference between the groups:

i.e., Patients seen by the Alert group were more likely to get care quicker

But don’t forget to read the community notes for extra context on those results:

Most notifications you get don’t matter. But don’t miss the ones that do.

Delete, ignore, and scroll may remain the default options for now.

But if you start getting big alerts reminding you that valve disease is severe, and even a guide on what to do, it's time to pay attention.

Let’s just hope no one misspells Aortic Stenosis as “ASS”, because an ASS valve replacement would be a very awkward consent procedure.

The Pandemic that Shall Not be Named of 2020 and its worldwide impact is permanently scarred into our collective consciousness.

And although the new virus on the block - Hantavirus, is not transmitted as easily as its predecessor, it’s little wonder the world is holding its breath over the 5 confirmed cases thus far. 

The current alarm began aboard the MV Hondius, where passengers thought they were signing up for Antarctic views and cute penguins, but were instead faced with a bubonic plague-esque rodent-transmitted nightmare. 

By the time the outbreak was confirmed, 29 passengers had already disembarked and dispersed across a dozen countries (this is generally considered less than ideal in infectious disease circles)

Three people have died thus far, and authorities are scrambling to trace all remaining passengers. The strain involved, Andes hantavirus, can spread between humans but usually only through close, intimate contact.

So it’s not quite giving Covid 2.0. The World Health Organisation desperately stresses that the overall risk to the public remains low.

Still, not easily transmissible is only mildly comforting when your fellow passengers spent weeks sharing buffet tongs, shot glasses and mics during karaoke renditions of My Heart Will Go On.

For now, there’s no cause for panic.
But just in case, best keep the hand sanny nearby 👀🧴

📡The NHS x Palantir Problem

Data governance has never been the NHS’s strong point 🥴
And now with a major US data analytics company, Palantir, lined up to process huge chunks of UK patient data, it’s not set to improve anytime soon.

Palantir is at the heart of the NHS’s £330 million Federated Data Platform, a decision that has faced huge controversy.
The reasons are many, including political concerns and worries over the lack of healthy competition.

Read all about the details here

💉Ketamine Cure for Depression?

IV Ketamine might not be your first thought when treatment of depression comes up, but given time, it just might be.

Turns out, the crazy spaced-out + dissociative feelings* from ket might be good for numbing the real bad stuff too.
*⚠️DISCLAIMER: NOT AUTHOR ANECDOTAL EVIDENCE. All creds to FRANK. 

A meta-analysis published in JAMA looked at 26 RCTs totalling 1,166 patients, and found that intravenous ketamine reduced depressive symptoms within 4 hours, lasting up to a week after a single infusion.

AND suicidal symptoms were also significantly lower by 24 hours, with effects lasting up to a month. Repeated infusions showed similar benefits.

Common side effects (e.g. headache) were transient. A lot more research is needed, especially as longer-term outcomes remain uncertain. 

But in the acute phase, ketamine might just give a quick boost to those who need it most📈

🫁 Asthma Management is Having a Certified MART Moment

More than a million people in England are now using combination inhalers for their asthma, surpassing the few who still rely on the classic blue SABA alone.

New data shows 1.09 million patients on MART/AIR regimens, rising 63% in the past year. 

This follows updated 2024 guidance from NICE, which pushed for earlier combo therapy as just bronchodilating temporarily via a SABA simply wasn’t doing anything to address inflammation.

Combination inhalers (usually ICS + formoterol) target both symptoms and underlying inflammation via the steroid, either as PRN (AIR) or as maintenance plus reliever (MART).

Despite a higher cost, NICE estimates fewer exacerbations, fewer ED trips, and overall fewer admissions. 

It ain’t easy being wheezy, but it’s a sMART step in the right direction. 

Handover Over 🫡

IIf you liked it, tell your mates
(It takes just 9 seconds, making this took well over 9 hours 🙏 )
If you hated it, tell your enemies.

Please vote in the poll below (even if you’ve voted before! Give it another go ;)

Before you depart(if you haven’t voted already), please let us know your role in the poll below - It means the world when you do 🫶