Intensive blood pressure lowering after intracerebral haemorrhage cut recurrent stroke by about a third

The edition in brief

RECAP-ICH pooled individual data from four randomised trials of 2944 patients with previous spontaneous intracerebral haemorrhage, three-quarters of them Asian. An 11 mm Hg lower systolic pressure reduced first recurrent stroke from 10.4% to 6.5% (HR 0.62), mostly through fewer recurrent haemorrhages (HR 0.39), with no excess serious adverse events; a 1% absolute benefit accrued in about six months. The AAN and American Headache Society have published updated recommendations on preventive drugs for migraine in adults, covering when and what to start, specific populations and stopping. A target-trial emulation of 9529 adults with epilepsy on DOACs associated levetiracetam and strong enzyme inducers with more thromboembolic events than lamotrigine or lacosamide, and valproate with more intracranial bleeding. STRATEGY found tirofiban added to aspirin did not reduce early deterioration or new stroke in branch atheromatous disease (HR 0.88). PREVAIL found weekly self-injected gefurulimab improved MG-ADL by 1.6 points more than placebo in AChR-antibody-positive generalised myasthenia. Today's pearl: in a patient with epilepsy starting a DOAC, check the antiseizure drug for interactions before the first dose.