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As the novel COVID-19 pandemic was on the rise, its impact on the healthcare system was devastating. Patients became more reluctant to present to the hospital and elective procedures were being postponed for patient safety. We wanted to assess the effects of the COVID-19 pandemic on the door-to-device time in our small community hospital in the heart of Trenton, New Jersey. We created a retrospective study that evaluated all STEMI cases that presented to our institute from January 2018 until the end of May, 2021. Our primary outcome was the door-to-device time. Secondary outcomes were the length of hospital stay, ICU admission, length of ICU stay, cardiac arrest, and death during the hospitalization. We studied 114 patients that presented with STEMI to our emergency department, 77 of these patients presented pre-COVID-19, and 37 presented during the pandemic. Our median door-to-device for STEMI cases pre-COVID-19, and during the pandemic were 70 min (IQR 84–57) and 70 min (IQR 88–59) respectively with no significant difference found (P-value 0.55, Mann Whitney Test). It is, however, interesting to note that the number of STEMI admissions significantly decreased during the pandemic era. There are limitations to our study, most noticeably the number of STEMI cases at our small community hospital which limits its generalizability. Moreover, we did not assess other comorbidities which might have confounded our outcomes and we were also unable to follow patients post-discharge to assess the long-term sequela of their STEMI admission. Therefore, more dedicated studies of this clinical conundrum are required to further assess and implement guidelines for the future.

Headache therapy is an unmet need in idiopathic intracranial hypertension (IIH).This was a prospective, real world, open-label cohort study over 9 months in the UK. Adult females with confirmed diagnosis of IIH now in ocular remission with chronic migraine (CM)-like headaches and failure of ≥3 preventative medications received Erenumab 70mg monthly. Clinical assessment was 3-monthly and primary endpoint was mean change in monthly migraine days (MMD) from baseline (30-day pre- treatment period) compared to 6 months.Study included 55 patients with mean(SD) age 35.3(9) years. Mean(SD) baseline monthly migraine days (MMD) was 16.1(4.7) and monthly headache days (MHD) was 29(2.3). MMD reduced significantly at 6 months by 10.3(4.8) (P<.001) and MHD reduced by 10.6 (8.7) (P<.001). Crystal clear days increased by 10.5(9) (P<.001) and monthly analgesic days reduced by 3.9(8.3) (P=.001). Significant improvements were also noted in patient reported outcomes. Results were consistent at 3 and 9 months.This prospective real world open-label study provides evidence for the efficacy of Erenumab for the treatment of headache in this population. It provides important mechanistic insights suggesting that CGRP is likely a key modulator driving headache in patients with IIH in ocular remission and worthy of evaluation in a future randomised trial.a.yiangou@bham.ac.uk137

Headache is an uncommon feature of Guillain-Barre syndrome (GBS), which is more frequently associated with severe limb and/or back pain. However, when it does it occur, headache in GBS may emanate from a range of causes, including raised intracranial pressure, reversible cerebral vasoconstriction syndrome, posterior reversible encephalopathy syndrome, or due to complications of intravenous immunoglobulin (IVIg) therapy, such as aseptic meningitis and cerebral venous sinus thrombosis. Hypnic headache (HH)like phenomenon has not been thus far described in association with GBS. We report herein a patient with GBS who developed HH-like phenomenon during the recovery phase; she developed a cyclical nocturnal headache lasting around four hours and demonstrated exquisite response to caffeine. We postulate potential mechanisms for the same.