Background: Migraine is a highly prevalent and disabling primary headache disorder frequently accompanied by gastrointestinal symptoms and comorbid gastrointestinal diseases. Increasing evidence suggests that alterations in the gut microbiota and dysregulation of the microbiome–gut–brain axis may contribute to migraine pathophysiology through immune activation, oxidative stress, impaired intestinal barrier function, and neuroinflammatory signaling. Objectives: This narrative review aims to summarize current mechanistic and clinical evidence linking the gut–brain axis to migraine, with a particular focus on the potential roles of probiotics, prebiotics, and postbiotics as adjunctive strategies in migraine management. Methods: A narrative synthesis of experimental, translational, and clinical studies was performed, focusing on microbiome composition, gut barrier integrity, immune and oxidative pathways, and interventional trials evaluating probiotics, prebiotics, synbiotics, and microbiota-derived metabolites in adult and pediatric migraine populations. Results: Migraine has been associated with intestinal dysbiosis, increased gut permeability, and low-grade systemic inflammation. Probiotics, most commonly strains of Lactobacillus and Bifidobacterium, may modulate inflammatory cytokine profiles, enhance tight junction integrity, reduce oxidative stress, and influence neurotransmitter-related pathways along the gut–brain axis. Clinical trials evaluating probiotic supplementation report heterogeneous but promising signals, including reductions in migraine frequency, severity, disability scores, and analgesic use, particularly in chronic migraine and pediatric populations. Emerging evidence also supports a potential role for prebiotics (e.g., inulin-type fructans) and microbiota-derived metabolites such as short-chain fatty acids, although direct clinical data remain limited. Conclusions: Modulation of the microbiome–gut–brain axis represents a biologically plausible adjunct approach in migraine management. While probiotics, prebiotics, and postbiotics show potential benefits with favorable safety profiles, current evidence of their strain-, formulation-, and population-specific characteristics is lacking. Well-powered, placebo-controlled trials with standardized migraine endpoints and integrated microbiome and metabolomic analyses are needed to define responders, optimal interventions, and clinical relevance.

Introduction/Aims: The repetitive nerve stimulation (RNS) test is fundamental to test the functional integrity of the neuromuscular junction. RNS data are scarce for newborns and young children, limiting early diagnostic efforts to identify children with neuromuscular diseases. Here, we performed RNS in young children.Methods: RNS of the axillary nerve was performed in 34 otherwise healthy young children (0 to 48 months of age) undergoing procedural sedation or analgesia. Compound muscle action potentials (CMAP) were recorded over the deltoid muscle. CMAP amplitude and area decrement between the 1st and 4th potential were determined at 3 Hz stimulation. Post‐tetanic facilitation, twitch‐to‐tetanus ratio, and heart rates were recorded.Results: The largest CMAP amplitude decrement value was 7% at rest, having a median of 1%, and an interquartile range of 1%–3%. There was no correlation between the CMAP amplitude decrement and age. In contrast, a moderate positive correlation was found between the CMAP area decrement and age, occasionally exceeding 10% in infants younger than 6 months. Both post‐tetanic facilitation and twitch‐to‐tetanus ratio exhibited a moderate positive correlation with age.Discussion: While the CMAP amplitude decrement in young children was within the adult normal range, the area decrement may be higher. Studies of RNS on other nerves in unsedated children are needed to investigate the findings from this study further.

Background: Myasthenia gravis (MG) and idiopathic inflammatory myopathy (IIM) are autoimmune diseases that affect the musculoskeletal system. The association of the two diseases is rare. Their management is different, so it is important to recognize the concomitant presentation. Methods: In this cross-sectional study, we study the presence of CK elevation, myositis-specific and myositis-associated antibodies (MSA/MAA), and vitamin D levels in a cohort of 101 MG patients. Electromyography, limb magnetic resonance imaging (MRI), and, in some cases, muscle biopsy were performed when IIM was suspected. We reviewed the patients’ medical records to access the results of these tests if they had been performed previously. Results: CK elevation was detected in 10 patients (9.9%). We identified one case of anti-Jo-1 antibody-positive polymyositis and two cases of possible myositis. MSA/MAA antibodies were not found in the patients with high CK levels, except for the one with anti-Jo-1-positive IIM. One patient with elevated CK levels had an overlapping muscular dystrophy. MSA/MAA antibodies were detected in 19 patients (18.8%). A total of 37% had high-titer antibodies and concomitant systemic autoimmune diseases, while 63% had low-titer antibodies, most of whom had no systemic autoimmune disease. Low serum vitamin D levels were found in 67.3% of patients. Comparison of myasthenia gravis composite (MGC) scores between patients with low and normal vitamin D levels did not show a statistically significant difference. Conclusions: Our results may raise awareness among neuromuscular specialists caring for MG patients of the possibility of associated myositis or other neuromuscular diseases and the need to assess vitamin D levels. Although deficiency was frequent, its impact on MG severity remains unclear, necessitating further investigation into its immunological relevance.

Purpose: Clostridioides difficile infection (CDI) represents a major healthcare associated infection with potentially life-threatening complications. While gastrointestinal and systemic manifestations are well recognized, severe micronutrient deficiencies, particularly vitamin K deficiency are rarely described. We aimed to report a unique case of CDI-and antibiotic-associated dysbiosis and malabsorption leading to profound vitamin K deficiency and coagulopathy, thereby highlighting the clinical intersection between infection, microbiome disruption, and hemostasis. Methods: We report the clinical course, diagnostic work-up, and therapeutic management of an elderly female patient with CDI complicated by life-threatening coagulopathy. In addition, a narrative review of published case reports of antibiotic-associated vitamin K deficiency was performed to contextualize our findings. Results: The patient developed extensive subcutaneous hematomas with a severely deranged coagulation profile (PT > 100 s, INR > 8, markedly reduced activities of vitamin K–dependent factors). Normal liver function and preserved platelet count excluded disseminated intravascular coagulation and hepatic failure. The findings were consistent with severe vitamin K deficiency secondary to antibiotic-induced dysbiosis, malnutrition, and persistent diarrhea. High-dose intravenous vitamin K supplementation resulted in rapid normalization of coagulation parameters within 24 h, with subsequent clinical stabilization and resolution of bleeding manifestations. Conclusion: This case illustrates a rare but clinically significant complication of CDI: profound vitamin K deficiency–associated coagulopathy. Clinicians should maintain a high index of suspicion for vitamin K deficiency in elderly, malnourished, and antibiotic-exposed patients with CDI who present with unexplained coagulopathy or bleeding.

Purpose of Review: This narrative review summarizes current knowledge on infection-related headaches, with focus on classification, clinical presentation, and underlying pathophysiology. As infections increasingly present with neurological symptoms, recognizing headache as a potential red flag remains essential. Recent Findings: Headaches attributed to infection range from typical forms such as bacterial meningitis to more subtle parasitic, fungal, or postinfectious entities. The ICHD-3 provides structured diagnostic subtypes, including acute, chronic, and persistent forms. Emerging data on CSF biomarkers and neuroimaging aid in distinguishing secondary headaches from primary mimics. Postinfectious headache, particularly after viral illness or in immunocompromised states, is gaining attention as a long-term sequela. Summary: Infectious headaches are clinically diverse and require a structured, classification-based diagnostic approach. Integrating clinical phenotype, imaging, and CSF analysis can support early diagnosis. Further research is warranted to clarify pathogen-specific mechanisms and optimize management.

Spontaneous Gram-negative bacillary meningitis in adults is rare and carries high mortality, particularly in elderly patients with significant comorbidities. Although multiplex meningitis-encephalitis (ME) panels have improved diagnostic turnaround time, their limited pathogen spectrum may reduce sensitivity for certain clinically relevant Gram-negative organisms. We report a 78-year-old man presenting with acute meningoencephalitis, septic deterioration, and cerebrospinal fluid (CSF) findings strongly suggestive of bacterial infection. Despite marked neutrophilic pleocytosis and elevated protein levels, the multiplex ME panel was negative. Blood cultures subsequently yielded Proteus mirabilis . Given the discordance between inflammatory CSF findings and routine molecular testing, following interdisciplinary consultation, an off-label BioFire ^® Joint Infection multiplex PCR panel was performed directly on CSF. The assay identified Proteus mirabilis harboring a cefotaximase-Munich (CTX-M)-type extended-spectrum β-lactamase (ESBL) resistance determinant. Based on this result, antimicrobial therapy was escalated from ceftriaxone-based empiric treatment to meropenem prior to availability of phenotypic susceptibility data. Despite early pathogen identification and targeted antimicrobial therapy, the patient died due to multiorgan dysfunction secondary to severe sepsis. This case suggests a potential diagnostic limitation of standard ME panels in selected high-risk scenarios and indicates that selective off-label use of broader multiplex PCR platforms may provide additional clinically relevant information in carefully selected patients. In the setting of high clinical suspicion and negative routine multiplex testing, rapid resistance-gene detection may provide actionable information within a decisive therapeutic window and support timely antimicrobial optimization in severe Gram-negative central nervous system infections. Further studies are required to evaluate the diagnostic performance and clinical impact of such approaches. Written informed consent for publication was obtained from the patient’s next of kin, and the study was conducted in accordance with institutional and ethical standards. Clinical trial number Not applicable.