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Women who work night shifts are more likely to suffer with moderate or severe asthma compared to women who work in the daytime, according to a study published in ERJ Open Research.

The research, which included more than 270,000 people, found no such link between asthma and working nightshifts in men.

The study was by Dr Robert Maidstone from the University of Manchester, UK, and colleagues. He said: “Asthma disproportionately affects women. Women generally have more severe asthma, and higher rate of hospitalisation and death from asthma compared to men.

“In our previous research we found a higher risk of moderate or severe asthma in nightshift workers, so we wanted to see whether there were further differences between the sexes.”

The researchers used data from the UK Biobank. They included a total of 274,541 working people and found that 5.3% of these had asthma, with 1.9% suffering with moderate or severe asthma (meaning they were taking an asthma preventer inhaler and at least one other asthma treatment, such as an oral steroid). They categorised these people according to whether they worked only during the day, only nightshifts, or a combination of the two.

Their analysis revealed that, overall, women who work shifts are more likely to have asthma. Women who only work nightshifts are around 50% more likely to suffer with moderate or severe asthma compared to women who only work in the daytime.

The risk of asthma in men did not alter according to whether they worked days or nights.

Dr Maidstone said: “This is the first study to evaluate sex differences in the relationship between shift work and asthma. We found that permanent night shift-workers had higher odds of moderate-severe asthma when compared to corresponding day workers.

“This type of research cannot explain why shift work and asthma are linked; however, it could be because shift work disrupts the body clock, including the levels of male and female sex hormones. High testosterone has previously been shown to be protective against asthma, and so lower testosterone in women could play a role. Alternatively, men and women work different types of shift jobs, and this could be a factor.”

In postmenopausal women, the risk of moderate or severe asthma was almost doubled in night workers, compared to day workers, in those not taking hormone replacement therapy (HRT).

Dr Maidstone added: “Our results suggest that HRT might be protective against asthma for nightshift workers, however further research is needed to test this hypothesis in prospective studies and randomised controlled trials.”

The researchers plan to study whether sex hormones play a role in the relationship between shift work and asthma by using data from the UK Biobank and from Our Future Health, a new health research programme in the UK population.

Professor Florence Schleich from the European Respiratory Society’s expert group on airway diseases, asthma, COPD and chronic cough, based at the University of Liège, Belgium, and was not involved in the research. She said: “Asthma is a common, long- term condition that affects millions of people worldwide. We know that women are more likely to have asthma, to have worse asthma and more likely to die from asthma, but we do not fully understand why.

“This research suggests that working nightshifts could be a risk factor for asthma in women, but not in men. The majority of workers will not have an easy option of switching their shift pattern, so we need further research to verify and understand this link and find out what could be done to reduce the risk for women who work shifts.”

Reference:

Robert J. Maidstone, Increased risk of asthma in female night shift workers, ERJ Open Research, https://doi.org/10.1183/23120541.00137-2025 

Vestibular migraine is a leading cause of recurrent spontaneous vertigo, affecting an estimated 1–2.7% of the global population. In India, it remains significantly underdiagnosed, often misattributed to benign paroxysmal positional vertigo (BPPV), Meniere’s disease, or psychogenic dizziness.(1) Recent studies from India reported that up to 30% of patients with recurrent vertigo symptoms may be suffering from vestibular migraine.(2)

Vestibular Migraine: Diagnostic Dilemma

An Indian study including recurrent vertigo patients (n=110) highlighted the diagnostic challenge of overlapping symptoms and inconclusive test findings, such as frequently exhibited post-ictal squinting, low-velocity nystagmus with normal vestibulo-ocular and audiometric findings, emphasizing that vestibular migraine may present with measurable oculomotor disturbances even when standard vestibular testing appears unremarkable.(3)

Vestibular migraine involves complex neurovascular and sensory integration mechanisms, including cortical spreading depression, trigeminovascular activation, altered ion channel dynamics,(4) and vestibular hyperexcitability.(5) Common vestibular migraine triggers—especially relevant in Indian populations—include psychological stress, fasting, sleep disturbances, irregular routines, sedentary lifestyle, and increased screen time.(2)

Vestibular Migraine: How Does It Differ from Other Common Types of Peripheral Vertigo?(6)

Vestibular migraine is marked by recurrent vertigo episodes—spontaneous, positional, or visually/motion-induced—lasting 5 to 72 hours with moderate to severe intensity. These episodes are frequently accompanied by nausea, vomiting, unsteadiness, prostration, and a heightened susceptibility to motion sickness.

Unlike BPPV, which causes brief positional vertigo, vestibular migraine episodes are longer and often present with bilateral low-velocity nystagmus. In contrast to Meniere’s disease, vestibular migraine typically lacks progressive or profound hearing loss and tinnitus.

Per the International Classification of Headache Disorders, 3rd edition (ICHD-3), diagnosis requires at least five episodes of vestibular symptoms (spontaneous, positional, visually- or motion-induced vertigo or dizziness with nausea) and a history of migraine, with or without aura. Additionally, at least 50% of vertigo episodes must be associated with migraine features, such as headache, photophobia, phonophobia, visual aura, and other vestibular disorders must be excluded.

Vestibular Migraine-Treatment Overview: Management of vestibular migraine includes acute agents such as triptans, NSAIDs, and vestibular suppressants. Prochlorperazine is commonly used in acute settings due to its dopamine D2 receptor antagonism, which modulates central vestibular pathways and helps relieve vertigo, headache, and associated nausea.(2)

Prophylactic options include propranolol, flunarizine, amitriptyline, and topiramate, selected based on comorbid profiles. Prochlorperazine remains a clinically valuable option for vestibular-dominant episodes, particularly when motion sensitivity or gastrointestinal symptoms are prominent.(7)

Novel Buccal Prochlorperazine: Emerging Option & Clinical Evidence Recent pharmacokinetic and clinical studies have highlighted the promise of buccal prochlorperazine, particularly in the 3 mg range, as a rapid-acting and well-tolerated alternative to conventional oral or parenteral formulations for the acute management of migraine-associated vertigo and nausea, core symptoms also encountered in vestibular migraine.(8,9)

Buccal Formulation of Prochlorperazine – Pharmacokinetic Edge: A buccal formulation of prochlorperazine (3–6 mg) has demonstrated significantly enhanced systemic bioavailability and reduced interindividual variability compared to the 5 mg oral tablet. In a randomized crossover pharmacokinetic study (Finn et al), the 6 mg buccal tablet showed 2.5-fold greater systemic exposure (AUC₀–∞) and a Cmax nearly twice that of the 5 mg oral tablet, with less than half the variability. Importantly, the relative bioavailability of the buccal route was reported at 241.7%, reflecting a substantial bypass of hepatic first-pass metabolism.(8)

Buccal Formulation of Prochlorperazine Benefits at One Hour in Acute Migraine: In a double-blind, placebo-controlled crossover study involving 45 participants (114 migraine episodes), 3 mg buccal prochlorperazine was compared with oral ergotamine (1 mg) + caffeine (100 mg) and placebo. At 2 hours post-administration, 59.46% of episodes treated with buccal prochlorperazine reported complete symptom relief versus 21.74% to 28.57% in the comparator arms [p≤ 0.05].(7) Onset of relief was observed as early as 15 to 60 minutes, as supported by another clinical evaluation.(10) Additionally, onset of relief was observed as early as 60 minutes in over half of the buccal prochlorperazine group (51.39%, P ≤ 0.001), with concurrent improvement in associated symptoms such as nausea, photophobia, and phonophobia.(7)

Buccal Formulation of Prochlorperazine – Acceptable Safety Profile: The buccal formulation was well tolerated across studies. In a general practice study on dizziness (Ward et al), 3 mg buccal prochlorperazine was favored over the 5 mg oral tablet for tolerability, with fewer sedative side effects and better overall acceptance by patients.(11)

Take Home Messages

• Vestibular migraine is often underdiagnosed in India due to symptom overlap with BPPV and Meniere’s disease.
• Diagnosis of vestibular migraine depends on a history of migraine and recurring vertigo with associated migraine features like headache or photophobia.
• Buccal prochlorperazine 3 mg demonstrates a rapid onset of action as early as 15 to 60 minutes, superior systemic bioavailability, and improved tolerability compared to the oral tablet formulation.
• Buccal prochlorperazine is particularly advantageous during acute vestibular migraine episodes complicated by gastric dysmotility and associated symptoms such as nausea, photophobia, and phonophobia.

References

1. Ilambarathi, M., A. Yeolekar, D. Roy, S. Saxena, and S. Kumar. “A Prospective, Multicenter Study to Evaluate the Effectiveness and Safety of Prochlorperazine in Patients Suffering from Vestibular Migraine”. International Journal of Otorhinolaryngology and Head and Neck Surgery, vol. 10, no. 3, Apr. 2024, pp. 258-64, doi:10.18203/issn.2454-5929.ijohns20240950.

2. M., I., A. Bijlani, and D. Roy. “Vestibular Migraine and Its Management in Indian Clinical Setting: A Narrative Review”. International Journal of Otorhinolaryngology and Head and Neck Surgery, vol. 9, no. 12, Nov. 2023, pp. 1003-10, doi:10.18203/issn.2454-5929.ijohns20233517.

3. Vyas, M et al. “CLINICAL AND OBJECTIVE TEST CHARACTERISTICS OF VESTIBULAR MIGRAINE: IMPLICATIONS FOR DIAGNOSIS AND MANAGEMENT.” Georgian medical news ,340-341 (2023): 284-289.

4. Baloh, Robert W. “Vestibular Migraine I: Mechanisms, Diagnosis, and Clinical Features.” Seminars in neurology vol. 40,1 (2020): 76-82. doi:10.1055/s-0039-3402735

5. Silva, Viviane Passarelli Ramin et al. “Vestibular migraine.” Arquivos de neuro-psiquiatria vol. 80,5 Suppl 1 (2022): 232-237. doi:10.1590/0004-282X-ANP-2022-S111

6. Lempert, Thomas et al. “Vestibular migraine: Diagnostic criteria1.” Journal of vestibular research : equilibrium & orientation vol. 32,1 (2022): 1-6. doi:10.3233/VES-201644

7. Smyth, Duncan et al. “Vestibular migraine treatment: a comprehensive practical review.” Brain : a journal of neurology vol. 145,11 (2022): 3741-3754. doi:10.1093/brain/awac264

8. Sharma S, Sharma R, Kaul DK. Efficacy and Tolerability of Prochlorperazine Buccal Tablets in Treatment of Acute Migraine. Headache. 2002;42(8):747–753.

9. Finn A, Collins J, Voyksner R, Lindley C. Bioavailability and Metabolism of Prochlorperazine Administered via the Buccal and Oral Delivery Route. J Clin Pharmacol. 2005;45(12):1383–1390.

10. Singh S, Sharma DR, Chaudhary A. Evaluation of prochlorperazine buccal tablets (Bukatel) and metoclopramide oral tablets in the treatment of acute emesis. J Indian Med Assoc. 1999 Aug;97(8):346-7. PMID: 10643185.

11. Ward AE. Studies of prochlorperazine as a buccal tablet (Buccastem) and an oral tablet (Stemetil) for the treatment of dizziness, nausea or vomiting in a general practice setting. Br J Clin Pract. 1988;42(6):228–232.