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BackgroundChronic migraine can be a profoundly disabling disorder that may be treated with preventive medications. However, uncertainty remains as to which preventive medication is the most effective. We present a network meta-analysis to determine the effectiveness and rank of preventive drugs for chronic migraine in adults.MethodsWe identified, reviewed, and extracted data from randomised controlled trials (RCTs) of preventive drugs for chronic migraine with at least 200 participants. Data were analysed using network meta-analysis.FindingsWe included 12 RCTs of six medications (Eptinezumab, Erenumab, Fremanezumab, Galcanezumab, Onabotulinumtoxin A, and Topiramate) compared to placebo or each other. All drugs effectively reduced monthly headache and migraine days compared with placebo. The most effective drug for monthly headache days was Eptinezumab 300mg, with a mean difference of -2.46 days, 95% Credible Interval (CrI): -3.23 to -1.69. On the Surface Under the Cumulative Ranking Area (SUCRA) analysis, the probability that Eptinezumab 300mg was ranked highest was 0.82. For monthly migraine days, the most effective medication was Fremanezumab-monthly, with a mean difference: -2.77 days, 95% CrI: -3.36 to -2.17, and 0.98 probability of being ranked the highest. All included drugs, except Topiramate, improved headache-related quality of life. No eligible studies were identified for the other common preventive oral medications such as Amitriptyline, Candesartan, and Propranolol. The main reasons were that the studies did not define chronic migraine, were undertaken before the definition of chronic migraine, or were too small.InterpretationAll six medications were more effective than the placebo on monthly headache and migraine days. The absolute differences in the number of headache/migraine days are, at best, modest. No evidence was found to determine the relative effectiveness of the six included drugs with other oral preventive medications.RegistrationPROSPERO (number CRD42021265990).

Cardiorespiratory phase determination has numerous applications during cardiac imaging. We propose a novel view-angle independent prospective cardiorespiratory motion gating technique for X-ray fluoroscopy images that are used to guide cardiac electrophysiology procedures. The method is based on learning coronary sinus catheter motion using principal component analysis and then applying the derived motion model to unseen images taken at arbitrary projections. We validated our technique on 7 sequential biplane sequences in normal and very low dose scenarios and on 5 rotational sequences in normal dose. For the normal dose images we established average systole, end-inspiration and end-expiration gating success rates of 100 %, 97.4 % and 95.2 %, respectively. For very low dose applications, the method was tested on images with added noise. Average gating success rates were 93.4 %, 90 % and 93.4 % even at the low SNR value of $$\\sqrt{5}$$ , representing a dose reduction of more than 10 times. This technique can extract clinically useful motion information whilst minimising exposure to ionising radiation.

Sheila Hollins, Christopher Jefferies, Ian Hurst, Jacqui Hames, HJK, Ben Jackson, Mike Hollingsworth, Alex Best, Ed Blum, Sky Andrew, Tricia Cooklin