Friday, March 24, 2023
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 0.25 ABIM MOC points
Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)
Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)
Physician Assistant - 0.25 AAPA hour(s) of Category I credit
IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit
This activity is intended for neurologists, family medicine/primary care clinicians, internists, nurses, pharmacists, physician assistants, and other members of the health care team for patients with migraine.
The goal of this activity is for learners to be better able to describe the relationship between dietary zinc intake and migraine, based on a cross-sectional study of US National Health and Nutrition Examination Survey data from 1999 to 2004.
Upon completion of this activity, participants will:
Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.
This activity was planned by and for the healthcare team, and learners will receive 0.25 Interprofessional Continuing Education (IPCE) credit for learning and change.
Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
Awarded 0.25 contact hour(s) of nursing continuing professional development for RNs and APNs; 0.00 contact hours are in the area of pharmacology.
Medscape, LLC designates this continuing education activity for 0.25 contact hour(s) (0.025 CEUs) (Universal Activity Number JA0007105-0000-23-080-H01-P).
Medscape, LLC has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.25 AAPA Category 1 CME credits. Approval is valid until 03/10/2024. PAs should only claim credit commensurate with the extent of their participation.
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]
There are no fees for participating in or receiving credit for this online educational activity. For information on applicability
and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those
credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the
activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.
Follow these steps to earn CME/CE credit*:
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate, but you cannot alter it.
Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period, you can print
out the tally as well as the certificates from the CME/CE Tracker.
*The credit that you receive is based on your user profile.
CME / ABIM MOC / CE Released: 3/10/2023
Valid for credit through: 3/10/2024
processing....
Worldwide prevalence of migraine is approximately 1 billion. The 2016 Global Burden of Disease study showed that it is the second most common cause and the most common neurological cause of disability.
Neuroinflammatory and oxidative stress have been implicated in the pathogenesis of migraine. Zinc, an anti-inflammatory and antioxidant trace element, is a cofactor for antioxidant enzymes that plays a key role in neuronal signaling.
People with higher dietary zinc intake have a nearly one third lower risk for migraine than those who get little zinc in their diets, according to results from a cross-sectional study of more than 11,000 American adults.
For their research, published online in Headache, Huanxian Liu, MD, and colleagues at Chinese PLA General Hospital in Beijing, analyzed publicly available data from the US National Health and Nutrition Examination Survey to determine whether people self-reporting migraine or severe headache saw lower zinc intake compared with people without migraine.[1] The data used in the analysis were collected between 1999 and 2004 and contained information on foods and drinks consumed by participants in a 24-hour period, along with additional health information.
The investigators divided their study’s 11,088 participants (mean age, 46.5 years; 50% female) into quintiles based on dietary zinc consumption, as inferred from foods eaten. They also considered zinc supplementation, for which data were available for 4324 participants, of whom 2607 reported use of supplements containing zinc.
Some 20% of the cohort (n = 2236) reported migraine or severe headache within the previous 3 months. Pregnant women were excluded from analysis, and the investigators adjusted for a range of covariates, including age, sex, ethnicity, education level, body mass, smoking, diabetes, cardiovascular disease, and nutritional factors.
Dr Liu and colleagues reported an inverse association between dietary zinc consumption and migraine, with the highest-consuming quintile of the cohort (15.8 mg or more zinc per day) seeing the lowest risk for migraine (odds ratio [OR], 0.70; 95% CI, 0.52-0.94; P=.029) compared with the low-consuming quintile (5.9 mg or less daily). Among people getting high levels of zinc (19.3-32.5 mg daily) through supplements, risk for migraine was lower still, to between an OR of 0.62 (95% CI: 0.46-0.83; P=.019) and an OR of 0.67 (95% CI, 0.49-0.91; P=.045).
Although the investigators acknowledged limitations of the study, including its cross-sectional design and use of a broad question to discern prevalence of migraine, the findings suggest that “zinc is an important nutrient that influences migraine,” they wrote, citing evidence for its antioxidant and anti-inflammatory properties.
Commenting on the research findings, Deborah I. Friedman, MD, MPH, a headache specialist in Dallas, said that Dr Liu and colleagues’ findings added to a growing information base about nutritional factors and migraine. For example, “low magnesium levels are common in people with migraine, and magnesium supplementation is a recommended preventive treatment for migraine.”
Dr Friedman cited a recent study showing that vitamin B12 and magnesium supplementation in women, combined with high-intensity interval training, “silenced” the inflammation signaling pathway, helped migraine pain, and decreased levels of calcitonin gene-related peptide.[2] A 2022 randomized trial found that alpha lipoic acid supplementation reduced migraine severity, frequency, and disability in women with episodic migraine.[3]
Vitamin D levels are also lower in people with migraine compared with controls, Dr Friedman noted, and a randomized trial of 2,000 IU of vitamin D3 daily saw reduced monthly headache days, attack duration, severe headaches, and analgesic use compared with placebo.[4,5] Other nutrients implicated in migraine include coenzyme Q10, calcium, folic acid, vitamin B6, and vitamin B1.
“What should a patient with migraine do with all of this information? First, eat a healthy and balanced diet,” Dr Friedman said. “Sources of dietary zinc include red meat, nuts, legumes, poultry, shellfish (especially oysters), whole grains, some cereals, and even dark chocolate. The recommended daily dosage of zinc is 9.5 mg in men and 7 mg in women. Most people get enough zinc in their diet; vegetarians, vegans, pregnant or breastfeeding women, and adults over age 65 may need to take supplemental zinc.”
Dr Liu and colleagues’ work was supported by China’s National Natural Science Foundation. The investigators reported no financial conflicts of interest. Dr Friedman has received financial support from Alder, Allergan, Amgen, Biohaven, Eli Lilly, Merck, Teva, and other pharmaceutical manufacturers.
Headache. 2023;63(1):127-135.
