BACKGROUND AND PURPOSE: The coronavirus 2019 (COVID-19) pandemic has been continuing its global spread ever since it’s onset and efforts to curb the infection in multiple reports have contrasting effects on stroke severity, admissions and outcomes. In the Philippines, where the COVID-19 pandemic shows no signs of slowing down and has been in the world’s longest lockdown, we investigated the effect of the pandemic in the stroke admissions and outcomes in one of the largest tertiary hospitals in the Philippines. METHODS: This is a retrospective, comparative study of all adult stroke patients admitted between Pre-COVID (February 2019-January 2020) and COVID period (February 2020-January 2021). The differences of stroke types, severity, classification, and discharge outcomes between pre-COVID and during COVID was analyzed in the study. RESULTS: There is a decrease in total number of stroke admissions from 597 in the pre-COVID period to 487 during the pandemic. Stroke patients take significantly longer time to seek hospital consultation from onset of stroke symptoms and significantly higher proportion of patients have moderate and severe stroke. The discharge outcome showed significantly higher proportions of dependency upon discharge (13%) and higher proportion of death in stroke patients from 7% pre-COVID19 pandemic to 13% during the pandemic. CONCLUSIONS: There was reduction in total stroke admissions, mild and transient stroke during the pandemic. There was significantly higher proportion of stroke patients having moderate and severe stroke. The discharge outcome of stroke patients is functionally poorer during the pandemic and more stroke patients have died compared to before COVID-19 pandemic. keywords: Stroke, Philippines, COVID-19, acute stroke

Objectives: We aimed to describe the current preferences of Filipino neurologists in the diagnosis and management of migraine. Methods: This is an observational descriptive study using a web-based survey done from November 2019 to June 2020 among certified locally practicing neurologists belonging to the Philippine Neurological Association. Results: A total of 259 (56.67%) from the 2018 roster of 457 neurologists participated in the survey. The prevalence of migraine in the respondents was 49.81% with a F:M ratio of 3.3:1. The majority (78%) based their diagnosis on established international criteria for migraine. Many (77%) would request neuroimaging for their patients with a history of more than 3 years of recurrent severe migraine. The most preferred class of drugs for acute migraine was NSAIDs (48.26%). One-third of respondents would give anti-nausea medications for moderate to severe attacks of migraine. About half would not consider using triptans for their patients with moderate to severe episodic migraine attacks. The top three drugs used for migraine prophylaxis were topiramate (80.69%) followed by flunarizine (73.36%) and propranolol (49.03%). Among patients with two or more headaches per week, 74.13% would prescribe prophylactic drugs. The use of a headache diary and the Migraine Disability Assessment Scale (MIDAS) was advised by 62.16% and 14.67% of respondents respectively, while cautioning about medication overuse headache was done by 68.34%. Conclusions: We have described the preferred practice of Filipino neurologists in diagnosing and treating migraine patients with locally available resources. The use of measurement tools (specifically MIDAS scoring to assess migraine disability), triptans, and anti-nausea drugs are not popular practices among Filipino neurologists The survey shows the need to promote the use of prophylactic drugs, counselling for medication overuse and more teaching about primary headaches in medical school.

Background: Acute severe migraine requiring Emergency Room (ER) visit is managed by giving analgesics for pain relief. Since music medicine has been beneficial in other pain syndromes, the study of its effect as a noninvasive add-on to current management is worth pursuing. Objective: To identify if music medicine in addition to medical therapy will reduce the severity and duration of an acute attack of moderate to severe migraine compared to medical management alone. Methods: An open label randomized controlled trial was conducted at the ER of a tertiary hospital in the Philippines from July 2017 to June 2018. Patients who presented at the ER with acute moderate to severe headache fulfilling the ICH-3 criteria for migraine were included. They were randomized to medical therapy or to medical therapy with music medicine. A decrease in the severity of the headache after one hour of medical treatment was the primary outcome. Results: One hundred eighty-three adult migraneurs were included without difference between group in age, gender, and occupation. There was a statistically significant reduction (p=0.037) in pain severity after one hour in 82 of 87 patients given medical treatment with music medicine (94%) compared to 73 of 86 in the medical therapy alone (85%). There were more headache-free patients at one hour in the music group (55% versus 42%, p=0.05). Conclusion: There is decreased duration and severity of pain when music medicine is added to conventional medical therapy in treating patients with an acute migraine. This is the first randomized trial done in the acute ER setting.