Leon S. Moskatel, MD

All Publications

• Postpartum Depression in Patients with Chronic Migraine: A Retrospective, Observational Analysis. Journal of women's health (2002) Linfield, R. H., Peretz, A. M., Moskatel, L. S. 2025

  Abstract

  Purpose: To evaluate how migraine impacts the risk for postpartum depression (PPD) in women of reproductive age as well as the effect of comorbidities on this risk. Methods: This is a retrospective observational study in a tertiary neurology center involving 6248 women with migraine and 4154 women without migraine between the ages of 18 and 45 seen from January 1, 2017, to January 30, 2024. The primary outcome was the odds ratio (OR) for PPD in migraine relative to women without migraine. Secondary outcomes included the OR for PPD in women with chronic migraine who also had comorbidities. Results: After adjusting for demographic factors and comorbid conditions, only chronic migraine, with and without aura, was associated with higher OR for PPD; chronic migraine without aura had the highest risk for PPD (OR: 2.13; 95% CI: 1.29 to 3.53, p = 0.003). In patients with chronic migraine, preeclampsia was associated with the largest OR for PPD, followed by depression, gestational diabetes, and premenstrual dysphoric disorder. Anxiety, advanced maternal age, endometriosis, and post-traumatic stress disorder were not associated with a statistically significant increase in OR for PPD. Conclusions: Chronic migraine, with and without aura, is associated with a higher OR for PPD relative to non-migraine controls. Patients with chronic migraine, preeclampsia, depression, gestational diabetes, and premenstrual dysphoric disorder were also associated with increased risk of PPD. These data support screening patients with both chronic migraine and these comorbidities for PPD with validated screening tools to connect them with optimal resources best.

  View details for DOI 10.1089/jwh.2024.0955

  View details for PubMedID 40171673

• Concordance of International Classification of Diseases, 10th Edition Diagnostic Codes for Chronic Migraine without Aura with International Classification of Headache Disorders, 3rd Edition Diagnoses at a Tertiary Headache Center: a retrospective analysis. Pain medicine (Malden, Mass.) Patlolla, R., Moskatel, L. S. 2025

  View details for DOI 10.1093/pm/pnaf038

  View details for PubMedID 40163715

• The Gut Microbiome and Migraine: Updates in Understanding. Current neurology and neuroscience reports Zhang, N., Tran, S., Moskatel, L. S. 2025; 25 (1): 20

  Abstract

  We provide an overview of the field of microbiome research, the current understanding of the microbiome-gut-brain axis, and the most recent updates on the interplay between migraine and the gut microbiome.Pre-clinical studies suggest that gut microbiota is required for normal pain sensation. There is also evidence in rodent models that there is potential application of food, herbal medicines, probiotics, and short chain fatty acids (SCFAs) as novel therapies for migraine. Evidence from human cohorts suggests that there is altered gut microbiota in people with migraine, and that the microbiome dysbiosis is from both compositional and functional aspects. Recent metagenome-wide association studies (MWAS) that employ Mendelian Randomization support the causal association between gut microbiota and migraine. The connection between migraine and the gut microbiome remains underexplored, but recent preclinical and clinical studies support the association between gut microbiota and the development of migraine.

  View details for DOI 10.1007/s11910-025-01408-8

  View details for PubMedID 39985639

  View details for PubMedCentralID 5037083

• The impact of headache specialist density and the introduction of gepants and lasmitidan on prescriptions for acute migraine treatments: a regression and interrupted time series analysis. Frontiers in neurology Moskatel, L. S., Linfield, R. Y., Zhang, N. 2025; 16: 1530499

  Abstract

  Understanding all factors that affect a patient's acute migraine treatment care is crucial. We sought to determine the impact of headache specialist density and the introduction of the gepants and lasmiditan on the prescription of acute treatments for migraine.We analyzed three scenarios: first, we performed linear regression analysis with the percentage of patients with migraine prescribed an acute medication in 2023, obtained via Epic Cosmos, and the density of headache specialists at the state level. Second, we conducted interrupted time-series analysis examining the change in patients prescribed the triptans before (2016-2019) and after (2020-2023) the introduction of the gepants and lasmiditan. Finally, we used regression analysis to look at the association of one pharmaceutical company, Pfizer, payments to physicians with prescriptions for that company's gepant, rimegepant.We included 6,559,854 patients with migraine and found that increased headache specialist density was associated with increased eletriptan, almotriptan, and naratriptan; there was no association with the other queried acute medications. In our interrupted time-series analysis, the introduction of the gepants and lasmiditan was linked to decreases in triptan utilization, except for eletriptan which remained stable, and rizatriptan which rose at a slower rate. Finally, increased Pfizer payments to physicians were associated with a higher percentage of patients prescribed rimegepant.Our study suggests increased headache provider availability is associated with more prescriptions for naratriptan, eletriptan, and almotriptan. Additionally, the introduction of the gepants and lasmiditan broadly decreased the utilization of triptans. Critically, there was a strong association between a pharmaceutical company's, Pfizer, payments to physicians and utilization of their medication, rimegepant.

  View details for DOI 10.3389/fneur.2025.1530499

  View details for PubMedID 39990263

  View details for PubMedCentralID PMC11843553

• Dyspareunia and pelvic pain in women with chronic migraine: A retrospective, observational analysis. Headache Smirnoff, L., Moskatel, L. S. 2025

  Abstract

  Dyspareunia and pelvic pain are commonly comorbid conditions with migraine, with chronic migraine potentially contributing to the exacerbation of sexual dysfunction and pain.We conducted a retrospective cohort study of female patients seen at the Stanford Headache Clinic between January 1, 2022, and March 24, 2024, for the management of chronic migraine for dyspareunia and pelvic pain and stratified for comorbidities related to both conditions.Patients with chronic migraine were overall found to be at higher likelihood of having a comorbid pelvic pain condition after adjusting for age, race-ethnicity, and marital status (adjusted odds ratio [aOR] 2.46; 95% confidence interval [CI]: 2.17-2.79, p < 0.001), with interstitial cystitis (aOR 3.04; 95% CI: 1.98-4.66, p < 0.001), vaginismus (aOR 2.51; 95% CI: 1.29-4.88, p = 0.007), dyspareunia (aOR 1.97; 95% CI: 1.57-2.49, p < 0.001), and vulvodynia (aOR 1.88; 95% CI: 1.04-3.40, p = 0.036) all increased in the chronic migraine population. Furthermore, conditions that are commonly comorbid with migraine, such as irritable bowel syndrome, fibromyalgia, and mood disorders, independently contributed to increased risk of pelvic pain conditions and dyspareunia.Conditions that cause pelvic pain and sexual dysfunction in women are disproportionally common in women with chronic migraine and may contribute to disability and difficulties in interpersonal relationships. Early screening for disorders of pelvic pain in patients with chronic migraine and appropriate referrals can improve the quality of life of these patients.

  View details for DOI 10.1111/head.14905

  View details for PubMedID 39902805

• Red-Tape Roadblocks: How Prior Authorization Intermediaries Delay Optimal Patient Care. Annals of internal medicine Linfield, R. Y., Moskatel, L. S. 2025; 178 (1): 136-137

  View details for DOI 10.7326/ANNALS-24-02781

  View details for PubMedID 39832383

• Assessing traditional medicine in the treatment of neurological disorders in Mali: prelude to efficient collaboration. BMC complementary medicine and therapies Maiga, Y., Moskatel, L. S., Diallo, S. H., Sangho, O., Dolo, H., Konipo, F., Diallo, S., Coulibaly, A., Daou, M., Sangaré, M., Coulibaly, T., Sissoko, A., Landouré, G., Albakaye, M., Traoré, Z., Dao, A. K., Togo, M., Mahamadou, S., Coulibaly, S. D., Kissani, N., Nimaga, K., Sanogo, R., Berna, F., Ouologem, M., Kuaté, C., Cowan, R., Nizard, J. 2024; 24 (1): 352

  Abstract

  Neurological disorders (ND) have a high incidence in sub-Saharan Africa (SSA). In this region, systemic challenges of conventional medicine (CM) and cultural beliefs have contributed to a large utilization of traditional medicine (TM). Yet, data on TM and those who use it in the treatment of ND in SSA are scarce. Here, we systematically analyze its role as a therapy modality for ND in Mali, the socio-demographic characteristics of its users, and propose next steps to optimize the dual usages of TM and CM for patients with ND.We conducted a questionnaire study in two phases. In phase one, patients with ND answered questions on their usage of and attitudes towards TM. In phase two, the TM therapists who provided care to the patients in phase one answered questions regarding their own practices for treating ND. Patients were recruited from the country's two university neurology departments.3,534 of the 4,532 patients seen in the Departments of Neurology in 2019 met the inclusion criteria. Among these 3,534 patients, 2,430 (68.8%) had previously consulted TM for their present ND. Patients over 60 years of age most often used TM (83.1%). By education, illiterate patients utilized TM the most (85.5%) while those with more than a secondary education used TM the least (48.6%). An income greater than the minimum guaranteed salary was associated with decreased use of traditional medicine (OR 0.29, CI 0.25-0.35, p < 0.001). Among those using TM, it was overwhelmingly thought to be more effective than CM (84.6%). Linking illness to supernatural causes and believing TM therapists had a better understanding of illnesses were the most common reasons patients used traditional medicine (82.3% and 80.5%, respectively). We then interviewed 171 TM therapists who had provided care to the patients in phase one. These providers most commonly "sometimes" (62.6%) referred patients to CM and 4.1% never had. A majority of TM providers (62.6%) believed collaboration with CM could be improved by having doctor "take into account" our existence.Our work shows that TM plays a central role in the provision of care for patients with ND in SSA with certain cohorts using it at higher rates. Future development of treatment of ND in SSA will require optimizing TM with CM and needs buy-in from all stakeholders including conventional medicine clinicians, traditional medicine therapists, researchers, politicians, and most importantly, patients.

  View details for DOI 10.1186/s12906-024-04645-5

  View details for PubMedID 39363271

  View details for PubMedCentralID 4531526

• The impact of Mpox virus incidence and Mpox virus first-dose vaccination on recent HIV testing. AIDS (London, England) Linfield, R. Y., Slusky, D. J., Moskatel, L. S. 2024; 38 (10): 1595-1597

  Abstract

  Understanding the impact of Mpox incidence and Mpox first dose vaccination on recent HIV testing is critical to better address both epidemics. We conducted a regression analysis of Mpox incidence and Mpox first dose vaccinations with recent HIV testing during the 2022 Mpox epidemic. We found that increased Mpox first dose vaccination was associated with a decrease in recent HIV testing in men but not women. Mpox incidence was not associated with changes in HIV testing.

  View details for DOI 10.1097/QAD.0000000000003919

  View details for PubMedID 39422633

  View details for PubMedCentralID PMC11489595

• The impact of Mpox virus incidence and Mpox virus first-dose vaccination on recent HIV testing AIDS Linfield, R. Y., Slusky, D. G., Moskatel, L. S. 2024; 38 (10): 1595-1597

  View details for DOI 10.1097/QAD.0000000000003919

  View details for Web of Science ID 001270587100009

• The burden of headache and a health-care needs assessment in the adult population of Mali: a cross-sectional population-based study. The journal of headache and pain Maiga, Y., Diallo, S. H., Sangho, O., Moskatel, L. S., Konipo, F., Bocoum, A., Diallo, S., Coulibaly, A., Daou, M., Dolo, H., Sangaré, M., Albakaye, M., Traoré, Z., Coulibaly, T., Sissoko, A., Landouré, G., Guindo, B., Ahamadou, M., Toure, M. D., Dembele, A., Sacko, H., Kadri Sao, C. A., Coulibaly, D., Dembele, S., Coulibaly, C. O., Sanogo, M., Boiguilé, S., Nizard, J., Cowan, R., Steiner, T. J., Husøy, A. A. 2024; 25 (1): 107

  Abstract

  Our recent studies have shown headache disorders to be very common in the central and western sub-Saharan countries of Benin and Cameroon. Here we report headache in nearby Mali, a strife-torn country that differs topographically, culturally, politically and economically. The purposes were to estimate headache-attributed burden and need for headache care.We used cluster-random sampling in seven of Mali's eleven regions to obtain a nationally representative sample. During unannounced household visits by trained interviewers, one randomly selected adult member (18-65 years) from each household was interviewed using the structured HARDSHIP questionnaire, with enquiries into headache in the last year and, additionally, headache yesterday (HY). Headache on ≥ 15 days/month (H15+) was diagnosed as probable medication-overuse headache (pMOH) when associated with acute medication use on ≥ 15 days/month, and as "other H15+" when not. Episodic headache (on < 15 days/month) was recorded as such and not further diagnosed. Burden was assessed as impaired participation (days lost from paid and household work, and from leisure activity). Need for headache care was defined by criteria for expectation of benefit.Data collection coincided with the SARS-CoV-2 pandemic. The participating proportion was nonetheless extremely high (99.4%). The observed 1-year prevalence of any headache was 90.9%. Age- and gender-adjusted estimates were 86.3% for episodic headache, 1.4% for pMOH and 3.1% for other H15+. HY was reported by 16.8% with a mean duration of 8.7 h. Overall mean headache frequency was 3.5 days/month. Participants with pMOH lost more days from paid (8.8 days/3 months) and household work (10.3 days/3 months) than those with other H15+ (3.1 and 2.8 days/3 months) or episodic headache (1.2 and 0.9 days/3 months). At population level, 3.6-5.8% of all time was spent with headache, which led to a 3.6% decrease in all activity (impaired participation). Almost a quarter (23.4%) of Mali's adult population need headache care.Headache is very common in Mali, as in its near neighbours, Benin and Cameroon, and associated with substantial losses of health and productivity. Need for headache care is high - a challenge for a low-income country - but lost productivity probably translates into lost gross domestic product.

  View details for DOI 10.1186/s10194-024-01811-5

  View details for PubMedID 38937699

  View details for PubMedCentralID 10956204

• Long-Term Epidural Patching Outcomes and Predictors of Benefit in Patients With Suspected CSF Leak Nonconforming to ICHD-3 Criteria. Neurology Carroll, I., Han, L., Zhang, N., Cowan, R. P., Lanzman, B., Hashmi, S., Barad, M. J., Peretz, A., Moskatel, L., Ogunlaja, O., Hah, J. M., Hindiyeh, N., Barch, C., Bozkurt, S., Hernandez-Boussard, T., Callen, A. L. 2024; 102 (12): e209449

  Abstract

  Spinal CSF leaks lead to spontaneous intracranial hypotension (SIH). While International Classification of Headache Disorders, Third Edition (ICHD-3) criteria necessitate imaging confirmation or low opening pressure (OP) for SIH diagnosis, their sensitivity may be limited. We offered epidural blood patches (EBPs) to patients with symptoms suggestive of SIH, with and without a documented low OP or confirmed leak on imaging. This study evaluates the efficacy of this strategy.We conducted a prospective cohort study with a nested case-control design including all patients who presented to a tertiary headache clinic with clinical symptoms of SIH who completed study measures both before and after receiving an EBP between August 2016 and November 2018.The mean duration of symptoms was 8.7 ± 8.1 years. Of 85 patients assessed, 69 did not meet ICHD-3 criteria for SIH. At an average of 521 days after the initial EBP, this ICHD-3-negative subgroup experienced significant improvements in Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical Health score of +3.3 (95% CI 1.5-5.1), PROMIS Global Mental Health score of +1.8 (95% CI 0.0-3.5), Headache Impact Test (HIT)-6 head pain score of -3.8 (95% CI -5.7 to -1.8), Neck Disability Index of -4.8 (95% CI -9.0 to -0.6) and PROMIS Fatigue of -2.3 (95% CI -4.1 to -0.6). Fifty-four percent of ICHD-3-negative patients achieved clinically meaningful improvements in PROMIS Global Physical Health and 45% in HIT-6 scores. Pain relief following lying flat prior to treatment was strongly associated with sustained clinically meaningful improvement in global physical health at an average of 521 days (odds ratio 1.39, 95% CI 1.1-1.79; p < 0.003). ICHD-3-positive patients showed high rates of response and previously unreported, treatable levels of fatigue and cognitive deficits.Patients who did not conform to the ICHD-3 criteria for SIH showed moderate rates of sustained, clinically meaningful improvements in global physical health, global mental health, neck pain, fatigue, and head pain after EBP therapy. Pre-treatment improvement in head pain when flat was associated with later, sustained improvement after EBP therapy among patients who did not meet the ICHD-3 criteria.This study provides Class IV evidence that epidural blood patch is an effective treatment of suspected CSF leak not conforming to ICHD-3 criteria for SIH.

  View details for DOI 10.1212/WNL.0000000000209449

  View details for PubMedID 38820488

• Long-term persistence to OnabotulinumtoxinA to prevent chronic migraine: Results from 11 years of patient data from a tertiary headache center. Pain medicine (Malden, Mass.) Moskatel, L. S., Graber-Naidich, A., He, Z., Zhang, N. 2024

  Abstract

  OBJECTIVE: To determine if patients with chronic migraine continue onabotulinumtoxinA (onabotA) long-term.METHODS: We performed a retrospective cohort analysis using aggregated, de-identified patient data from the Stanford Headache Center. We included patients in California who received at least one prescription for onabotA during the years of 2011-2021. The primary outcome was the number of onabotA treatments each patient received. Secondary outcomes included sex, age, race, ethnicity, body mass index (BMI), distance to the treatment facility, and zip code income quartile.RESULTS: A total of 1,551 patients received a mean of 7.60±7.26 treatments and a median of 5 treatments, with 16.2% of patients receiving only one treatment and 10.6% receiving at least 19. Time-to-event survival analysis suggested 26.0% of patients would complete at least 29 treatments if able. Younger age and female sex were associated with statistically significant differences between quartile groups of number of onabotA treatments (p=0.007, p=0.015). BMI, distance to treatment facility, and zip code income quartile were not statistically significantly different between quartile groups (p>0.500 for all). Prescriptions of both triptans and non-onabotA preventive medications showed a statistically significant increase with each higher quartile of number of onabotA treatments (p<0.001; p<0.001).DISCUSSION: We show long-term persistence to onabotA is high and that distance to treatment facility and income are not factors in continuation. Our work also demonstrates that as patients continue onabotA over time, there may be an increased need for adjunctive or alternative treatments.

  View details for DOI 10.1093/pm/pnae020

  View details for PubMedID 38518091

• Alcohol Use Disorder in Patients with Chronic Migraine: A Retrospective, Observational Study. The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques Moskatel, L. S., Zhang, N. 2024: 1-11

  Abstract

  The relationship between migraine and alcohol consumption is unclear. We assessed the association between chronic migraine and alcohol use disorder(AUD), relative to chronic disease controls, and in conjunction with common comorbidities.We conducted a retrospective, observational study. The primary outcome was the odds ratio for AUD in patients with chronic migraine or with chronic migraine and additional comorbidities relative to controls.A total of 3701 patients with chronic migraine, 4450 patients with low back pain, and 1780 patients with type 2 diabetes mellitus met inclusion criteria. Patients with chronic migraine had a lower risk of AUD relative to both controls of low back pain (OR 0.37; 95% CI: 0.29-0.47, p < 0.001) and type 2 diabetes mellitus (OR 0.39; 95% CI: 0.29-0.52, p < 0.001). Depression was associated with the largest OR for AUD in chronic migraine (OR 8.62; 95% CI: 4.99-14.88, p < 0.001), followed by post-traumatic stress disorder (OR 6.63; 95% CI: 4.13-10.64, p < 0.001) and anxiety (OR 3.58; 95% CI: 2.23-5.75, p < 0.001).Patients with chronic migraine had a lower odds ratio of AUD relative to controls. But in patients with chronic migraine, those with comorbid depression, anxiety, or PTSD are at higher risk of AUD. When patients establish care, comorbid factors should be assessed and for those at higher risk, AUD should be screened for at every visit.

  View details for DOI 10.1017/cjn.2024.10

  View details for PubMedID 38268310

• The introduction of the CGRP monoclonal antibodies and their effect on the prescription patterns of chronic migraine preventive medications in a tertiary headache center: A retrospective, observational analysis. Headache Moskatel, L. S., Graber-Naidich, A., He, Z., Zhang, N. 2023

  Abstract

  OBJECTIVE: To determine the effect of the introduction of the calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) in 2018 on the prescribing of older medications for the prevention of chronic migraine.BACKGROUND: Prior to 2018, the preventive treatment of migraine borrowed from medications intended to treat other illnesses with the last medication, onabotulinumtoxinA, receiving Food and Drug Administration (FDA) approval for the prevention of chronic migraine in 2010. The FDA approval of three CGRP mAbs in 2018 provided the ideal natural experiment to assess how the introduction of these medications, and a fourth in 2020, affected the generally stable migraine preventive medications market.METHODS: We performed a retrospective cohort analysis using the aggregated de-identified data of 6595 patients. The percentage of patients with chronic migraine who had been prescribed one of ten most prescribed oral preventive medications or onabotulinumtoxinA, or any of the four CGRP mAbs, were calculated relative to the total number of patients with chronic migraine who received a prescription for any medication from our clinic during the pre-CGRP mAb years of 2015-2017 and post-approval years of 2019-2021.RESULTS: We observed a statistically significant decrease in the prescription of the top 10 most prescribed medications after the introduction of the CGRP mAbs overall (1456/3144, 46.3%, to 1995/4629, 43.1%, p=0.001), as well as with most individual medications, including large decreases in verapamil (230/3144, 7.3%, to 125/4629, 2.7%; p<0.001), the tricyclic antidepressants (494/3144, 15.7%, to 532/4629, 11.5%; p<0.001), topiramate (566/3144, 18.0%, to 653/4629, 14.1%; p<0.001), and onabotulinumtoxinA (861/3144, 27.4%, to 1134/4629, 24.5%; p=0.001).CONCLUSION: The introduction of the CGRP mAbs during 2018 resulted in a decrease in utilization of most oral medications and onabotulinumtoxinA for the prevention of migraine. Future work should continue to observe how the prescription patterns of these medications evolve with time.

  View details for DOI 10.1111/head.14642

  View details for PubMedID 37882379

• Comparative prevalence and characteristics of fabricated citations in large language models in headache medicine. Headache Moskatel, L. S., Zhang, N. 2023

  View details for DOI 10.1111/head.14638

  View details for PubMedID 37837216

• An exploratory, comparative case series of calcitonin gene-related peptide monoclonal antibodies in migraine patients with rosacea. The British journal of dermatology Sia, T., Webb, T., Li, S., Moskatel, L. S., Chang, A. L. 2023

  View details for DOI 10.1093/bjd/ljad277

  View details for PubMedID 37596936

• The utility of ChatGPT in the assessment of literature on the prevention of migraine: an observational, qualitative study. Frontiers in neurology Moskatel, L. S., Zhang, N. 2023; 14: 1225223

  Abstract

  It is not known how large language models, such as ChatGPT, can be applied toward the assessment of the efficacy of medications, including in the prevention of migraine, and how it might support those claims with existing medical evidence.We queried ChatGPT-3.5 on the efficacy of 47 medications for the prevention of migraine and then asked it to give citations in support of its assessment. ChatGPT's evaluations were then compared to their FDA approval status for this indication as well as the American Academy of Neurology 2012 evidence-based guidelines for the prevention of migraine. The citations ChatGPT generated for these evaluations were then assessed to see if they were real papers and if they were relevant to the query.ChatGPT affirmed that the 14 medications that have either received FDA approval for prevention of migraine or AAN Grade A/B evidence were effective for migraine. Its assessments of the other 33 medications were unreliable including suggesting possible efficacy for four medications that have never been used for the prevention of migraine. Critically, only 33/115 (29%) of the papers ChatGPT cited were real, while 76/115 (66%) were "hallucinated" not real papers and 6/115 (5%) shared the names of real papers but had not real citations.While ChatGPT produced tailored answers on the efficacy of the queried medications, the results were unreliable and inaccurate because of the overwhelming volume of "hallucinated" articles it generated and cited.

  View details for DOI 10.3389/fneur.2023.1225223

  View details for PubMedID 37662036

  View details for PubMedCentralID PMC10469750

• The Role of Step Therapy in the Treatment of Migraine. Current pain and headache reports Moskatel, L. S., Zhang, N. 2023

  Abstract

  PURPOSE OF REVIEW: This review examines recent evidence and applies bioethical principles to evaluate the benefits and risks of using step therapy in the treatment of migraine.RECENT FINDINGS: With the CGRP mAbs, gepants, and lasmiditan now on the market for up to 5years, new research, including network meta-analyses and long-term use studies, can evaluate the comparative efficacy, tolerability, and adherence of these medications relative to older acute and preventive medications for the treatment of migraine. Deciding how medications are chosen for patients requires accounting for many factors including sustainability, efficacy, tolerability, and preference. Newer research can help give clarity on the appropriateness of gating certain treatment options behind others.

  View details for DOI 10.1007/s11916-023-01155-w

  View details for PubMedID 37542597

• Real world evidence of changes in CGRP monoclonal antibody and onabotulinumtoxinA prescription practices at the start of the COVID-19 pandemic: An observational, retrospective study. Headache Moskatel, L. S., Graber-Naidich, A., He, Z., Zhang, N. 2023

  View details for DOI 10.1111/head.14585

  View details for PubMedID 37358470

• "The Impact of COVID-19 on Alcohol Sales and Consumption in the United States: a Retrospective, Observational Analysis". Alcohol (Fayetteville, N.Y.) Moskatel, L. S., Slusky, D. J. 2023

  Abstract

  Understanding the COVID-19 pandemic's effect on alcohol sales and consumption is critical in mitigating alcohol abuse and morbidity. We sought to determine how the onset of the COVID-19 pandemic and changes in viral incidence affected alcohol sales and consumption in the United States. We conducted a retrospective observational analysis regressing National Institute on Alcohol Abuse and Alcoholism (NIAAA) alcohol sales data and Behavioral Risk Factor Surveillance System (BRFSS) survey data for 14 states for 2017 to 2020 with COVID-19 incidence in 2020 in the United States. The onset of the pandemic was associated with higher monthly alcohol sales per capita of 1.99 standard drinks (95% Confidence Interval: 0.63 to 3.34, p=0.007). Increases of one COVID-19 case per 100 were associated with lower monthly alcohol sales per capita of 2.98 standard drinks (95% CI: -4.47 to -1.48, p=0.001) as well as broad decreases in alcohol consumption, notably 0.17 fewer days per month with alcohol use (95% CI: -0.31 to -0.23, p=0.008) and 0.14 fewer days per month of binge drinking (95% CI: -0.23 to -0.052, p<0.001). The COVID-19 pandemic is associated with increased monthly average alcohol purchases, but higher viral incidence is linked to lower alcohol purchases and consumption. Continued monitoring is needed to mitigate the effects of higher population alcohol use during the pandemic.

  View details for DOI 10.1016/j.alcohol.2023.05.003

  View details for PubMedID 37230334

• The Impact of COVID-19 Incidence on Emergency Medical Services Utilization. The Journal of emergency medicine Moskatel, L. S., Slusky, D. J. 2023

  View details for DOI 10.1016/j.jemermed.2023.04.017

  View details for PubMedID 37460386

• Headache and Dizziness after Roller Coaster Rides: A Case Series of 31 Patients CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES Moskatel, L. S., Smirnoff, L. 2022: 1-4

  Abstract

  Previous literature on roller coaster injuries focuses on catastrophic injuries. We conducted a retrospective study of 31 adults with headache or dizziness after roller coaster rides. Twenty five of 31 (81%) patients presented with new or worsening headache, predominantly migraine (15/25, 60%), including 8/25 (32%) with chronic migraine. Of the chronic migraine patients, 4/8 (50%) already had the diagnosis and presented with an exacerbation. Five of the 25 (20%) were ultimately found to have a cerebrospinal fluid (CSF) leak. While persistent symptoms appear to be relatively rare, patients with chronic migraine and potential CSF leaks should consider skipping these attractions.

  View details for DOI 10.1017/cjn.2022.315

  View details for Web of Science ID 000896788200001

  View details for PubMedID 36329659

• Protracted headache after COVID-19: A case series of 31 patients from a tertiary headache center. Headache Moskatel, L. S., Smirnoff, L. 2022

  Abstract

  BACKGROUND: Headache can be a prominent feature of Post-Acute Sequelae of SARS-Cov2 infection (PASC) and previous studies have centered around PASC headaches that have resolved within a month of infection.METHODS: We performed a retrospective chart review of 31 adults evaluated at the Stanford Headache Clinic between September 2020 and January 2022 who developed new or worsening headaches after COVID-19 infection that were unresolved at time of evaluation for demographics, medical history, and headache diagnosis.RESULTS: Headache had been present for a mean duration of 7.4±4.8 months after infection. Notably, 25/31 (81%) had a previous history of headache. The specific features of the headache varied considerably, but 23/31 (74%) met International Classification of Headache Disorders, Third Edition (ICHD-3) criteria for migraine, with 20/31 (65%) meeting ICHD-3 criteria for chronic migraine, while only 5/31 (16%) met these criteria before COVID infection. Additionally, full-time employment decreased from 25/31 (81%) to 17/31 (55%). Prior to establishing care at our clinic, 13/18 (72%) of the patients who were started on preventive medications currently indicated for migraine management, reported a decrease in frequency and/or severity of headaches.CONCLUSIONS: Our study presents a group of patients with protracted headache after COVID-19 infection that includes both patients with a previously lower headache burden who largely exhibited chronification from episodic to chronic migraine, as well as patients with no previous history of headache who meet ICHD-3 criteria for headache attributed to a systemic viral illness, mostly with a migrainous phenotype.

  View details for DOI 10.1111/head.14337

  View details for PubMedID 35670231

• Migraine and Diet: Updates in Understanding. Current neurology and neuroscience reports Moskatel, L. S., Zhang, N. 2022

  Abstract

  PURPOSE OF REVIEW: We explore recent developments in the prevention and treatment of migraine through dietary interventions.RECENT FINDINGS: Healthier diets (defined in multiple ways), meal regularity, and weight loss are associated with decreased headache burden. Specific diets including the ketogenic diet, the low-glycemic index diet, and the DASH diet are supported by modest evidence for the prevention of migraine. Neither a gluten-free diet, in patients without celiac disease, nor elimination diets have sufficient evidence for their routine consideration. Diet remains a crucial, but underexplored, component of comprehensive migraine management. Multiple interventions exist for providers and patients to consider integrating into their treatment plan. Larger studies are needed to support stronger recommendations for utilization of specific dietary interventions for the prevention and treatment of migraine.

  View details for DOI 10.1007/s11910-022-01195-6

  View details for PubMedID 35482279

• Headache Made SIMPAL: A Simple Mnemonic for the Approach to Headache Evaluation and Migraine Treatment. Pain medicine (Malden, Mass.) Migdal, C. W., Moskatel, L. S., Schuster, N. M. 2021; 22 (3): 754–58

  View details for DOI 10.1093/pm/pnaa429

  View details for PubMedID 33735383

• Staphylococcus intermedius Brain Abscess as a Complication of Pulmonary Arteriovenous Malformation in a Patient With Hereditary Hemorrhagic Telangiectasia OPEN FORUM INFECTIOUS DISEASES Moskatel, L. S., Vo, J. N., Nayak, K. R., Crum-Cianflone, N. F. 2020; 7 (11): ofaa467

  Abstract

  Staphylococcus intermedius is a rare cause of human infections ranging from skin and soft tissue infections to bacteremia. It is particularly known for its association with exposure to dogs. We report an unusual case of a 73-year-old female with a brain abscess caused by S intermedius who was recently diagnosed with hereditary hemorrhagic telangiectasia and a pulmonary arteriovenous malformation. The patient underwent debridement of the brain abscess followed by a 6-week course of vancomycin and rifampin, after which she made a near complete recovery. This is the first case of a brain abscess in an adult due to S intermedius in the published literature, and we provide a comprehensive review of the literature of all human infections caused by this pathogen and summarize its clinical manifestations, treatment recommendations, and outcomes.

  View details for DOI 10.1093/ofid/ofaa467

  View details for Web of Science ID 000604521300025

  View details for PubMedID 33209954

  View details for PubMedCentralID PMC7652099