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Am Fam Physician. 2019;100(1):12

When should clinicians consider prescribing preventive therapy for migraine headache?

Preventive therapy should be considered in patients having four or more headaches per month or at least eight headache days per month, significantly debilitating attacks despite appropriate acute management, contraindications or difficulty tolerating acute therapy, medication overuse headache, patient preference, or the presence of certain migraine subtypes (i.e., hemiplegic migraine; migraine with brainstem aura; migrainous infarction; or frequent, persistent, or uncomfortable aura symptoms).

What diagnostic testing is recommended in children and adolescents with hypertension?

All children and adolescents with hypertension should be screened for hyperlipidemia and underlying renal disease via urinalysis and electrolyte, blood urea nitrogen, and creatinine testing. Children younger than six years with hypertension and children and adolescents with abnormal renal function or urinalysis results should undergo renal ultrasonography. Children and adolescents who are obese should be evaluated for diabetes mellitus and fatty liver.

Is the CAC score a valuable addition to cardiovascular risk assessment models based on traditional risk factors?

The U.S. Preventive Services Task Force (USPSTF) found inadequate evidence to assess whether treatment decisions guided by the coronary artery calcium (CAC) score, when added to existing cardiovascular disease (CVD) risk assessment models, lead to reduced incidence of CVD events or mortality. The USPSTF concludes that current evidence is insufficient to assess the balance of benefits and harms of adding nontraditional risk factors to existing CVD risk assessment models to prevent CVD events in asymptomatic adults.

Is acupuncture effective for the treatment of chronic pain?

A meta-analysis, based on data from almost 21,000 patients, found acupuncture to be more effective than no treatment and, to a lesser extent, more effective than sham acupuncture. Given this evidence of benefit and our limited options for chronic pain treatments that do not harm more than help, acupuncture should be added to our armamentarium.

Incarcerated persons should be screened for which communicable diseases?

Incarcerated adults and adolescents benefit from HIV screening. Incarcerated or formerly incarcerated individuals should be screened for hepatitis C and syphilis infection. Incarcerated persons should also be screened for latent tuberculosis infection.

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