What are the best therapies for acute migraine in pregnancy?

No randomized controlled trials of pharmacologic therapy for acute migraine in pregnant women are available. Three treatment studies suggest that nonpharmacological therapies (combinations of skin warming, relaxation, biofeedback, and physical therapy) were effective for pain relief (strength of recommendation [SOR]: C, poor-quality cohort and case-control studies). Practice guidelines and most review articles recommend acetaminophen as the first-line therapy (SOR: C, expert opinion). Treatment modalities, including medications, should be chosen based on both effectiveness for nonpregnant patients and established pregnancy safety from surveillance studies

Ureteral calculi: What should you consider before intervening?

The size of the calculi, their location, and complicating factors such as infection should all be considered. Most ureteral calculi smaller than 5 mm pass spontaneously, as do approximately half of calculi between 5 and 10 mm. Calculi larger than 10 mm are unlikely to pass without intervention. Distal calculi are more likely to pass spontaneously than calculi in mid- or proximal ureteral locations; most spontaneous passage occurs within 4 to 6 weeks (strength of recommendation [SOR]: A, prospective cohort studies). All patients with calculi complicated by such factors as obstruction, infection, renal injury, or a single kidney require surgical consultation (SOR: C, expert opinion). Medical expulsion therapy with alpha-blockers (usually tamsulosin) and nifedipine improves passage rates, including for some calculi larger than 10 mm (SOR: A, metaanalysis of prospective cohort studies)

What is the preferred treatment for a child with mild persistent asthma?

Low-dose inhaled corticosteroids are the preferred treatment for children with mild persistent asthma because they demonstrate superior reduction in severity and frequency of asthma exacerbations compared with alternatives (strength of recommendation [SOR]: A, based on multiple randomized controlled trials). As add-on therapy, nedocromil, theophylline, and cromolyn have all demonstrated a modest benefit in symptom control; leukotriene receptor antagonists are also recommended based on data from older children (SOR: B, cohort study). Unlike treatment of moderate or severe asthma, long-acting beta-agonists are not recommended (SOR: A, randomized trials)

What is the best way to diagnose menopause?

No single test for menopause is highly sensitive and specific. The best predictors that a woman will enter menopause within 4 years include age at least 50 years, amenorrhea for 3 to 11 months, and menstrual cycle irregularity within 12 months (strength of recommendation [SOR]: B; based on multiple prospective cohort studies). For diagnosing perimenopause, the level of follicle-stimulating hormone (FSH) is most useful for clinical situations in which the pretest probability, as based on history, is midrange (SOR: B, based on 1 systematic review and 2 cross-sectional studies)