Optimize migraine management in primary care

Migraine attacks vary in frequency, severity, symptomatology, and degree of disability. The episodic, heterogeneous nature of migraine can be a barrier to the assessment of impact and optimal management. Migraine is often under-diagnosed and undertreated. Optimizing migraine management requires a systematic assessment of symptoms, including the degree of disability and development of an individualized plan of care.     

Do whole-grain oat cereals reduce the need for antihypertensive medications and improve blood pressure control?

OBJECTIVES: Our study compared 2 whole grain oat-based cereals with 2 refined grain wheat-based cereals to determine their effects on the need for antihypertensive medications in people with high blood pressure (BP). STUDY DESIGN: This 12-week, randomized controlled parallel-group trial with = 6 weeks of voluntary follow-up was designed to investigate the antihypertensive effects of oats. After 4 weeks of baseline feeding, medication dose was maintained or reduced by half or completely throughout the middle 4 weeks of the study. In the final 4 weeks, participants continued cereal consumption; medication was adjusted according to the protocol. POPULATION: Men and women (n = 88) being treated for hypertension with a mean baseline BP below 160/100. OUTCOMES MEASURED: Primary study outcomes included change in SBP and DBP as well as antihypertensive medication reduction. Secondary measures included blood lipid, fasting glucose, and insulin levels and side effects related to elevated BP and increased dietary fiber intake. RESULTS: Seventy-three percent of participants in the oats group versus 42% in the control group were able to stop or reduce their medication by half. Treatment group participants whose medication was not reduced had substantial decreases in BP. The oats group experienced a 24.2-mg/dL reduction in total cholesterol levels, a 16.2-mg/dL decrease in low-density lipoprotein cholesterol levels, and a 15.03-mg/dL drop in plasma glucose levels vs controls. CONCLUSIONS: Results suggest that a diet containing soluble fiber-rich whole oats can significantly reduce the need for antihypertensive medication and improve BP control. Considering the lipid and glucose improvements as well, increased consumption of whole oats may significantly reduce cardiovascular disease risk.