Michele G. Sullivan

WASHINGTON – Almost half of patients with episodic migraine report having at least one unmet medical need, according to the findings of more than 20,000 people participating in a population-based survey.

The findings suggest that despite the expanding armamentarium of acute migraine-specific therapies, patient satisfaction with treatment is at best low to moderate for many, Dawn Buse, Ph.D., said at the annual meeting of the American Headache Society.

"You all know this is nothing new. You keep working to meet your patients’ needs while considering side effects, cost, effectiveness, and speed of onset." But despite all these efforts, some patients report unsatisfactory results.

Dr. Buse, director of behavioral medicine at the Montefiore Headache Center, New York, and her colleagues examined data from the AMPP (American Migraine Prevalence and Prevention) study (Headache 2008 Sept. 2 [doi:10.1111/j.1526-4610.2008.01217.x]). This population-based survey began in 2004, when a general-population headache screening netted 162,756 respondents, 36,000 of whom reported having severe headache.

The study that was presented at the meeting examined data from the 2009 sample of 11,792 who had been followed since 2005, including 5,600 who met the International Classification of Headache Disorders definition of episodic migraine. A control group comprised 8,315 who were free of severe headache or migraine in the original 2004 survey.

Dr. Buse and her coinvestigators identified five domains of possible unmet treatment needs, and resurveyed the migraine population for their response. The domains included the following:

• Dissatisfaction with current acute treatment (assessed by the 3-item summary from the Patient Perception of Migraine Questionnaire).

• Moderate or severe headache-related disability (defined by a score of at least 11 on the Migraine Disability Assessment Test).

• Excessive use of opioids or barbiturates (that is, using the drugs at least 4 days per month or meeting the DSM-IV criteria for dependence).

• Excessive use of the emergency department or urgent care clinic for headache (that is, at least two visits in the preceding year).

• History of cardiovascular events that might preclude triptan therapy (including heart attack, stroke, angina, claudication, stent placement, or coronary artery bypass graft).

The samples were not significantly different in demographics; most (81%) were women. The mean age in the control group was 51 years vs. 52 years in the two groups with unmet needs. The mean body mass index also differed slightly. Among the control group, the mean BMI was 29 kg/m², compared with 30 in the group with one unmet need and 32 in the group with two or more unmet needs.

Headache days per month also varied between the groups. Those with no unmet needs reported a mean of 2 days per month with headache, compared with 3 days per month for the group with one unmet need, and 5 days per month for those with two or more needs.

Overall, 41% of those with episodic migraine reported having at least one unmet need; 26% reported one and 14% reported two or more.

The unmet need that was most commonly reported was headache-related disability of moderate to severe intensity (19%). Some 15% claimed dissatisfaction with their current therapy. Opioid or barbiturate use or dependence was seen in 13% of respondents. In all, 10% reported cardiovascular disease that could preclude triptan use, although 26% of these used the drugs despite these risks. Finally, 2% reported frequent headache-related visits to the ED or urgent care center.

"When we looked at the three most frequently reported areas, we saw an interesting overlap," Dr. Buse said. "Of the 19% who met the criteria for moderate to severe headache-related disability, 10% met that area only. But 4% of them also reported opioid overuse, 3% also reported dissatisfaction with their medications, and 2% endorsed all three of these areas."

The investigators then contrasted psychological comorbidities between the group with unmet needs and the 60% who reported no unmet needs. Anxiety and depression correlated significantly with the number of unmet needs.

Among the control group, 5% met criteria for anxiety and 10% for depression. Among the group with one unmet need, the rates were 11% for anxiety and 22% for depression. Among the group with at least two unmet needs, the rates were 21% for anxiety and 41% for depression.

In an interview, Dr. Buse said the relationship between headache and psychiatric disorders is not well-understood, but appears to be bidirectional. Anxiety increases the likelihood and the severity of headache, whereas headaches increase the risk of anxiety. The brain neurotransmitters that are involved in depression may also predispose a person to headache, but years of headache pain also increase the risk of becoming depressed, she said.

The AMPP study is funded by the American Headache Society through grants from Ortho-McNeil Neurologics and Merck Sharp & Dohme Corp., a subsidiary of Merck.

Dr. Buse has received research support from Allergan Pharmaceuticals, Iroko Pharmaceuticals, MAP Pharmaceuticals, and Merck.

WASHINGTON – Almost half of patients with episodic migraine report having at least one unmet medical need, according to the findings of more than 20,000 people participating in a population-based survey.

The findings suggest that despite the expanding armamentarium of acute migraine-specific therapies, patient satisfaction with treatment is at best low to moderate for many, Dawn Buse, Ph.D., said at the annual meeting of the American Headache Society.

"You all know this is nothing new. You keep working to meet your patients’ needs while considering side effects, cost, effectiveness, and speed of onset." But despite all these efforts, some patients report unsatisfactory results.

Dr. Buse, director of behavioral medicine at the Montefiore Headache Center, New York, and her colleagues examined data from the AMPP (American Migraine Prevalence and Prevention) study (Headache 2008 Sept. 2 [doi:10.1111/j.1526-4610.2008.01217.x]). This population-based survey began in 2004, when a general-population headache screening netted 162,756 respondents, 36,000 of whom reported having severe headache.

The study that was presented at the meeting examined data from the 2009 sample of 11,792 who had been followed since 2005, including 5,600 who met the International Classification of Headache Disorders definition of episodic migraine. A control group comprised 8,315 who were free of severe headache or migraine in the original 2004 survey.

Dr. Buse and her coinvestigators identified five domains of possible unmet treatment needs, and resurveyed the migraine population for their response. The domains included the following:

• Dissatisfaction with current acute treatment (assessed by the 3-item summary from the Patient Perception of Migraine Questionnaire).

• Moderate or severe headache-related disability (defined by a score of at least 11 on the Migraine Disability Assessment Test).

• Excessive use of opioids or barbiturates (that is, using the drugs at least 4 days per month or meeting the DSM-IV criteria for dependence).

• Excessive use of the emergency department or urgent care clinic for headache (that is, at least two visits in the preceding year).

• History of cardiovascular events that might preclude triptan therapy (including heart attack, stroke, angina, claudication, stent placement, or coronary artery bypass graft).

The samples were not significantly different in demographics; most (81%) were women. The mean age in the control group was 51 years vs. 52 years in the two groups with unmet needs. The mean body mass index also differed slightly. Among the control group, the mean BMI was 29 kg/m², compared with 30 in the group with one unmet need and 32 in the group with two or more unmet needs.

Headache days per month also varied between the groups. Those with no unmet needs reported a mean of 2 days per month with headache, compared with 3 days per month for the group with one unmet need, and 5 days per month for those with two or more needs.

Overall, 41% of those with episodic migraine reported having at least one unmet need; 26% reported one and 14% reported two or more.

The unmet need that was most commonly reported was headache-related disability of moderate to severe intensity (19%). Some 15% claimed dissatisfaction with their current therapy. Opioid or barbiturate use or dependence was seen in 13% of respondents. In all, 10% reported cardiovascular disease that could preclude triptan use, although 26% of these used the drugs despite these risks. Finally, 2% reported frequent headache-related visits to the ED or urgent care center.

"When we looked at the three most frequently reported areas, we saw an interesting overlap," Dr. Buse said. "Of the 19% who met the criteria for moderate to severe headache-related disability, 10% met that area only. But 4% of them also reported opioid overuse, 3% also reported dissatisfaction with their medications, and 2% endorsed all three of these areas."

The investigators then contrasted psychological comorbidities between the group with unmet needs and the 60% who reported no unmet needs. Anxiety and depression correlated significantly with the number of unmet needs.

Among the control group, 5% met criteria for anxiety and 10% for depression. Among the group with one unmet need, the rates were 11% for anxiety and 22% for depression. Among the group with at least two unmet needs, the rates were 21% for anxiety and 41% for depression.

In an interview, Dr. Buse said the relationship between headache and psychiatric disorders is not well-understood, but appears to be bidirectional. Anxiety increases the likelihood and the severity of headache, whereas headaches increase the risk of anxiety. The brain neurotransmitters that are involved in depression may also predispose a person to headache, but years of headache pain also increase the risk of becoming depressed, she said.

The AMPP study is funded by the American Headache Society through grants from Ortho-McNeil Neurologics and Merck Sharp & Dohme Corp., a subsidiary of Merck.

Dr. Buse has received research support from Allergan Pharmaceuticals, Iroko Pharmaceuticals, MAP Pharmaceuticals, and Merck.

WASHINGTON – Almost half of patients with episodic migraine report having at least one unmet medical need, according to the findings of more than 20,000 people participating in a population-based survey.

The findings suggest that despite the expanding armamentarium of acute migraine-specific therapies, patient satisfaction with treatment is at best low to moderate for many, Dawn Buse, Ph.D., said at the annual meeting of the American Headache Society.

"You all know this is nothing new. You keep working to meet your patients’ needs while considering side effects, cost, effectiveness, and speed of onset." But despite all these efforts, some patients report unsatisfactory results.

Dr. Buse, director of behavioral medicine at the Montefiore Headache Center, New York, and her colleagues examined data from the AMPP (American Migraine Prevalence and Prevention) study (Headache 2008 Sept. 2 [doi:10.1111/j.1526-4610.2008.01217.x]). This population-based survey began in 2004, when a general-population headache screening netted 162,756 respondents, 36,000 of whom reported having severe headache.

The study that was presented at the meeting examined data from the 2009 sample of 11,792 who had been followed since 2005, including 5,600 who met the International Classification of Headache Disorders definition of episodic migraine. A control group comprised 8,315 who were free of severe headache or migraine in the original 2004 survey.

Dr. Buse and her coinvestigators identified five domains of possible unmet treatment needs, and resurveyed the migraine population for their response. The domains included the following:

• Dissatisfaction with current acute treatment (assessed by the 3-item summary from the Patient Perception of Migraine Questionnaire).

• Moderate or severe headache-related disability (defined by a score of at least 11 on the Migraine Disability Assessment Test).

• Excessive use of opioids or barbiturates (that is, using the drugs at least 4 days per month or meeting the DSM-IV criteria for dependence).

• Excessive use of the emergency department or urgent care clinic for headache (that is, at least two visits in the preceding year).

• History of cardiovascular events that might preclude triptan therapy (including heart attack, stroke, angina, claudication, stent placement, or coronary artery bypass graft).

The samples were not significantly different in demographics; most (81%) were women. The mean age in the control group was 51 years vs. 52 years in the two groups with unmet needs. The mean body mass index also differed slightly. Among the control group, the mean BMI was 29 kg/m², compared with 30 in the group with one unmet need and 32 in the group with two or more unmet needs.

Headache days per month also varied between the groups. Those with no unmet needs reported a mean of 2 days per month with headache, compared with 3 days per month for the group with one unmet need, and 5 days per month for those with two or more needs.

Overall, 41% of those with episodic migraine reported having at least one unmet need; 26% reported one and 14% reported two or more.

The unmet need that was most commonly reported was headache-related disability of moderate to severe intensity (19%). Some 15% claimed dissatisfaction with their current therapy. Opioid or barbiturate use or dependence was seen in 13% of respondents. In all, 10% reported cardiovascular disease that could preclude triptan use, although 26% of these used the drugs despite these risks. Finally, 2% reported frequent headache-related visits to the ED or urgent care center.

"When we looked at the three most frequently reported areas, we saw an interesting overlap," Dr. Buse said. "Of the 19% who met the criteria for moderate to severe headache-related disability, 10% met that area only. But 4% of them also reported opioid overuse, 3% also reported dissatisfaction with their medications, and 2% endorsed all three of these areas."

The investigators then contrasted psychological comorbidities between the group with unmet needs and the 60% who reported no unmet needs. Anxiety and depression correlated significantly with the number of unmet needs.

Among the control group, 5% met criteria for anxiety and 10% for depression. Among the group with one unmet need, the rates were 11% for anxiety and 22% for depression. Among the group with at least two unmet needs, the rates were 21% for anxiety and 41% for depression.

In an interview, Dr. Buse said the relationship between headache and psychiatric disorders is not well-understood, but appears to be bidirectional. Anxiety increases the likelihood and the severity of headache, whereas headaches increase the risk of anxiety. The brain neurotransmitters that are involved in depression may also predispose a person to headache, but years of headache pain also increase the risk of becoming depressed, she said.

The AMPP study is funded by the American Headache Society through grants from Ortho-McNeil Neurologics and Merck Sharp & Dohme Corp., a subsidiary of Merck.

Dr. Buse has received research support from Allergan Pharmaceuticals, Iroko Pharmaceuticals, MAP Pharmaceuticals, and Merck.

By improving the risk factors of weight, exercise, and alcohol consumption, women could reduce their 20-year risk of breast cancer by more than 4%, depending on age and other risk factors.

A new risk model suggests that a risk reduction of 1.6% could prevent 16,000 cases of breast cancer in a population of 1 million women. On an individual basis, a 55-year-old woman with the most nonmodifiable risk factors could see the biggest benefit, an absolute risk reduction of 4.4%

Even younger women at the highest risk of breast cancer could reduce their risk over 20 years by more than 3% if they optimally improved all three modifiable risk factors, Elisabetta Petracci, Ph.D., reported in the June 24 issue of the Journal of the National Cancer Institute.

Kristan Hutchison (Property of National Science Foundation)/ (Antarctic Photo Library (Image link)), via Wikimedia Commons .

"The absolute risk model developed in this study could help clinicians make decisions about implementing interventions to reduce a patient’s exposure to modifiable risk factors, thereby reducing their absolute risk of breast cancer," wrote Dr. Petracci and her colleagues (J. Natl. Cancer Inst. 2011;103:1-12). "Because programs to encourage less alcohol consumption, increase leisure activity, and encourage some weight control are likely to be safe, they can be widely administered."

The researchers began their model with data from an Italian breast cancer case-control study of 2,569 cases and 2,588 controls who were followed during 1991-1994. To compute absolute risk, they employed 5-year, age-specific, breast cancer incidence rates from the Florence Cancer Registry in 1989-1993. Rates were based on an estimated 2006 population of 1,190,516 women.

Another Italian study provided a validation cohort consisting of 10,083 women who were followed during 1998-2004. This study collected demographic information as well as information on anthropomorphic characteristics, age, physical activity, reproductive history, diet and lifestyle, and a family history of breast cancer.

The team considered all of the risk factors and calculated the 10- and 20-year risk of breast cancer as well as the 10- and 20-year absolute risk reductions if the three modifiable factors improved optimally. They performed the calculations in each study cohort, then averaged the results to confirm the possible reductions.

The risk reduction model divided its cohort into nine profiles, ranging from a young, low-risk group to an older, high-risk group. Including the above characteristics, the model also took into account educational level, alcohol consumption, ages at menarche and first live birth, and the number of lifetime breast biopsies.

In the entire population, if women aged 45 years improved all three modifiable risk factors, they could reduce the overall 20-year risk by 1.4%. The population-based risk for 65-year-olds could drop by 1.6%. The risk reduction is less in the older women because they generally had more favorable nonmodifiable risk factors, the authors noted.

On an individual basis, a 45-year-old woman with a positive family history could decrease her absolute 20-year risk by 2.7%; the reduction could be 3.2% in a woman aged 65 years.

For a younger woman with the highest nonmodifiable risk factors (only 10% of the population), optimally improving exercise, weight, and drinking could reduce the 10-year risk by 1.6% and the 20-year risk by 3.2%. A 55-year-old could reduce her 10-year risk by 2.4% and her 20-year risk by 4.4%. The oldest women in this category could reduce their 10-year risk by 2.5% and their 20-year risk by 4.1%.

But these numbers also need to be viewed in the context of a large population, the authors noted. Although an overall reduction of 1.6% would save 16,000 cases annually in a population of 1 million women, it would save only 2,560 cases annually in the 8% of postmenopausal women who have a family history of cancer.

Despite these limitations, the authors wrote, "Calculations of reductions in absolute risk using our model potentially provide additional perspective in the possible benefits of such prevention strategies."

This research was supported by the Division of Cancer Epidemiology and Genetics at the National Cancer Institute, and the Associazione Italiana per la Ricerca sul Cancro. The investigators did not report any conflicts of interest. Dr. Helzlsouer said that she had no relevant financial disclosures.

By improving the risk factors of weight, exercise, and alcohol consumption, women could reduce their 20-year risk of breast cancer by more than 4%, depending on age and other risk factors.

A new risk model suggests that a risk reduction of 1.6% could prevent 16,000 cases of breast cancer in a population of 1 million women. On an individual basis, a 55-year-old woman with the most nonmodifiable risk factors could see the biggest benefit, an absolute risk reduction of 4.4%

Even younger women at the highest risk of breast cancer could reduce their risk over 20 years by more than 3% if they optimally improved all three modifiable risk factors, Elisabetta Petracci, Ph.D., reported in the June 24 issue of the Journal of the National Cancer Institute.

Kristan Hutchison (Property of National Science Foundation)/ (Antarctic Photo Library (Image link)), via Wikimedia Commons .

"The absolute risk model developed in this study could help clinicians make decisions about implementing interventions to reduce a patient’s exposure to modifiable risk factors, thereby reducing their absolute risk of breast cancer," wrote Dr. Petracci and her colleagues (J. Natl. Cancer Inst. 2011;103:1-12). "Because programs to encourage less alcohol consumption, increase leisure activity, and encourage some weight control are likely to be safe, they can be widely administered."

The researchers began their model with data from an Italian breast cancer case-control study of 2,569 cases and 2,588 controls who were followed during 1991-1994. To compute absolute risk, they employed 5-year, age-specific, breast cancer incidence rates from the Florence Cancer Registry in 1989-1993. Rates were based on an estimated 2006 population of 1,190,516 women.

Another Italian study provided a validation cohort consisting of 10,083 women who were followed during 1998-2004. This study collected demographic information as well as information on anthropomorphic characteristics, age, physical activity, reproductive history, diet and lifestyle, and a family history of breast cancer.

The team considered all of the risk factors and calculated the 10- and 20-year risk of breast cancer as well as the 10- and 20-year absolute risk reductions if the three modifiable factors improved optimally. They performed the calculations in each study cohort, then averaged the results to confirm the possible reductions.

The risk reduction model divided its cohort into nine profiles, ranging from a young, low-risk group to an older, high-risk group. Including the above characteristics, the model also took into account educational level, alcohol consumption, ages at menarche and first live birth, and the number of lifetime breast biopsies.

In the entire population, if women aged 45 years improved all three modifiable risk factors, they could reduce the overall 20-year risk by 1.4%. The population-based risk for 65-year-olds could drop by 1.6%. The risk reduction is less in the older women because they generally had more favorable nonmodifiable risk factors, the authors noted.

On an individual basis, a 45-year-old woman with a positive family history could decrease her absolute 20-year risk by 2.7%; the reduction could be 3.2% in a woman aged 65 years.

For a younger woman with the highest nonmodifiable risk factors (only 10% of the population), optimally improving exercise, weight, and drinking could reduce the 10-year risk by 1.6% and the 20-year risk by 3.2%. A 55-year-old could reduce her 10-year risk by 2.4% and her 20-year risk by 4.4%. The oldest women in this category could reduce their 10-year risk by 2.5% and their 20-year risk by 4.1%.

But these numbers also need to be viewed in the context of a large population, the authors noted. Although an overall reduction of 1.6% would save 16,000 cases annually in a population of 1 million women, it would save only 2,560 cases annually in the 8% of postmenopausal women who have a family history of cancer.

Despite these limitations, the authors wrote, "Calculations of reductions in absolute risk using our model potentially provide additional perspective in the possible benefits of such prevention strategies."

This research was supported by the Division of Cancer Epidemiology and Genetics at the National Cancer Institute, and the Associazione Italiana per la Ricerca sul Cancro. The investigators did not report any conflicts of interest. Dr. Helzlsouer said that she had no relevant financial disclosures.

By improving the risk factors of weight, exercise, and alcohol consumption, women could reduce their 20-year risk of breast cancer by more than 4%, depending on age and other risk factors.

A new risk model suggests that a risk reduction of 1.6% could prevent 16,000 cases of breast cancer in a population of 1 million women. On an individual basis, a 55-year-old woman with the most nonmodifiable risk factors could see the biggest benefit, an absolute risk reduction of 4.4%

Even younger women at the highest risk of breast cancer could reduce their risk over 20 years by more than 3% if they optimally improved all three modifiable risk factors, Elisabetta Petracci, Ph.D., reported in the June 24 issue of the Journal of the National Cancer Institute.

Kristan Hutchison (Property of National Science Foundation)/ (Antarctic Photo Library (Image link)), via Wikimedia Commons .

"The absolute risk model developed in this study could help clinicians make decisions about implementing interventions to reduce a patient’s exposure to modifiable risk factors, thereby reducing their absolute risk of breast cancer," wrote Dr. Petracci and her colleagues (J. Natl. Cancer Inst. 2011;103:1-12). "Because programs to encourage less alcohol consumption, increase leisure activity, and encourage some weight control are likely to be safe, they can be widely administered."

The researchers began their model with data from an Italian breast cancer case-control study of 2,569 cases and 2,588 controls who were followed during 1991-1994. To compute absolute risk, they employed 5-year, age-specific, breast cancer incidence rates from the Florence Cancer Registry in 1989-1993. Rates were based on an estimated 2006 population of 1,190,516 women.

Another Italian study provided a validation cohort consisting of 10,083 women who were followed during 1998-2004. This study collected demographic information as well as information on anthropomorphic characteristics, age, physical activity, reproductive history, diet and lifestyle, and a family history of breast cancer.

The team considered all of the risk factors and calculated the 10- and 20-year risk of breast cancer as well as the 10- and 20-year absolute risk reductions if the three modifiable factors improved optimally. They performed the calculations in each study cohort, then averaged the results to confirm the possible reductions.

The risk reduction model divided its cohort into nine profiles, ranging from a young, low-risk group to an older, high-risk group. Including the above characteristics, the model also took into account educational level, alcohol consumption, ages at menarche and first live birth, and the number of lifetime breast biopsies.

In the entire population, if women aged 45 years improved all three modifiable risk factors, they could reduce the overall 20-year risk by 1.4%. The population-based risk for 65-year-olds could drop by 1.6%. The risk reduction is less in the older women because they generally had more favorable nonmodifiable risk factors, the authors noted.

On an individual basis, a 45-year-old woman with a positive family history could decrease her absolute 20-year risk by 2.7%; the reduction could be 3.2% in a woman aged 65 years.

For a younger woman with the highest nonmodifiable risk factors (only 10% of the population), optimally improving exercise, weight, and drinking could reduce the 10-year risk by 1.6% and the 20-year risk by 3.2%. A 55-year-old could reduce her 10-year risk by 2.4% and her 20-year risk by 4.4%. The oldest women in this category could reduce their 10-year risk by 2.5% and their 20-year risk by 4.1%.

But these numbers also need to be viewed in the context of a large population, the authors noted. Although an overall reduction of 1.6% would save 16,000 cases annually in a population of 1 million women, it would save only 2,560 cases annually in the 8% of postmenopausal women who have a family history of cancer.

Despite these limitations, the authors wrote, "Calculations of reductions in absolute risk using our model potentially provide additional perspective in the possible benefits of such prevention strategies."

This research was supported by the Division of Cancer Epidemiology and Genetics at the National Cancer Institute, and the Associazione Italiana per la Ricerca sul Cancro. The investigators did not report any conflicts of interest. Dr. Helzlsouer said that she had no relevant financial disclosures.

By improving the risk factors of weight, exercise, and alcohol consumption, women could reduce their 20-year risk of breast cancer by more than 4%, depending on age and other risk factors.

A new risk model suggests that a risk reduction of 1.6% could prevent 16,000 cases of breast cancer in a population of 1 million women. On an individual basis, a 55-year-old woman with the most nonmodifiable risk factors could see the biggest benefit, an absolute risk reduction of 4.4%

Even younger women at the highest risk of breast cancer could reduce their risk over 20 years by more than 3% if they optimally improved all three modifiable risk factors, Elisabetta Petracci, Ph.D., reported in the June 24 issue of the Journal of the National Cancer Institute.

Kristan Hutchison (Property of National Science Foundation)/ (Antarctic Photo Library (Image link)), via Wikimedia Commons .

"The absolute risk model developed in this study could help clinicians make decisions about implementing interventions to reduce a patient’s exposure to modifiable risk factors, thereby reducing their absolute risk of breast cancer," wrote Dr. Petracci and her colleagues (J. Natl. Cancer Inst. 2011;103:1-12). "Because programs to encourage less alcohol consumption, increase leisure activity, and encourage some weight control are likely to be safe, they can be widely administered."

The researchers began their model with data from an Italian breast cancer case-control study of 2,569 cases and 2,588 controls who were followed during 1991-1994. To compute absolute risk, they employed 5-year, age-specific, breast cancer incidence rates from the Florence Cancer Registry in 1989-1993. Rates were based on an estimated 2006 population of 1,190,516 women.

Another Italian study provided a validation cohort consisting of 10,083 women who were followed during 1998-2004. This study collected demographic information as well as information on anthropomorphic characteristics, age, physical activity, reproductive history, diet and lifestyle, and a family history of breast cancer.

The team considered all of the risk factors and calculated the 10- and 20-year risk of breast cancer as well as the 10- and 20-year absolute risk reductions if the three modifiable factors improved optimally. They performed the calculations in each study cohort, then averaged the results to confirm the possible reductions.

The risk reduction model divided its cohort into nine profiles, ranging from a young, low-risk group to an older, high-risk group. Including the above characteristics, the model also took into account educational level, alcohol consumption, ages at menarche and first live birth, and the number of lifetime breast biopsies.

In the entire population, if women aged 45 years improved all three modifiable risk factors, they could reduce the overall 20-year risk by 1.4%. The population-based risk for 65-year-olds could drop by 1.6%. The risk reduction is less in the older women because they generally had more favorable nonmodifiable risk factors, the authors noted.

On an individual basis, a 45-year-old woman with a positive family history could decrease her absolute 20-year risk by 2.7%; the reduction could be 3.2% in a woman aged 65 years.

For a younger woman with the highest nonmodifiable risk factors (only 10% of the population), optimally improving exercise, weight, and drinking could reduce the 10-year risk by 1.6% and the 20-year risk by 3.2%. A 55-year-old could reduce her 10-year risk by 2.4% and her 20-year risk by 4.4%. The oldest women in this category could reduce their 10-year risk by 2.5% and their 20-year risk by 4.1%.

But these numbers also need to be viewed in the context of a large population, the authors noted. Although an overall reduction of 1.6% would save 16,000 cases annually in a population of 1 million women, it would save only 2,560 cases annually in the 8% of postmenopausal women who have a family history of cancer.

Despite these limitations, the authors wrote, "Calculations of reductions in absolute risk using our model potentially provide additional perspective in the possible benefits of such prevention strategies."

This research was supported by the Division of Cancer Epidemiology and Genetics at the National Cancer Institute, and the Associazione Italiana per la Ricerca sul Cancro. The investigators did not report any conflicts of interest. Dr. Helzlsouer said that she had no relevant financial disclosures.

By improving the risk factors of weight, exercise, and alcohol consumption, women could reduce their 20-year risk of breast cancer by more than 4%, depending on age and other risk factors.

A new risk model suggests that a risk reduction of 1.6% could prevent 16,000 cases of breast cancer in a population of 1 million women. On an individual basis, a 55-year-old woman with the most nonmodifiable risk factors could see the biggest benefit, an absolute risk reduction of 4.4%

Even younger women at the highest risk of breast cancer could reduce their risk over 20 years by more than 3% if they optimally improved all three modifiable risk factors, Elisabetta Petracci, Ph.D., reported in the June 24 issue of the Journal of the National Cancer Institute.

Kristan Hutchison (Property of National Science Foundation)/ (Antarctic Photo Library (Image link)), via Wikimedia Commons .

"The absolute risk model developed in this study could help clinicians make decisions about implementing interventions to reduce a patient’s exposure to modifiable risk factors, thereby reducing their absolute risk of breast cancer," wrote Dr. Petracci and her colleagues (J. Natl. Cancer Inst. 2011;103:1-12). "Because programs to encourage less alcohol consumption, increase leisure activity, and encourage some weight control are likely to be safe, they can be widely administered."

The researchers began their model with data from an Italian breast cancer case-control study of 2,569 cases and 2,588 controls who were followed during 1991-1994. To compute absolute risk, they employed 5-year, age-specific, breast cancer incidence rates from the Florence Cancer Registry in 1989-1993. Rates were based on an estimated 2006 population of 1,190,516 women.

Another Italian study provided a validation cohort consisting of 10,083 women who were followed during 1998-2004. This study collected demographic information as well as information on anthropomorphic characteristics, age, physical activity, reproductive history, diet and lifestyle, and a family history of breast cancer.

The team considered all of the risk factors and calculated the 10- and 20-year risk of breast cancer as well as the 10- and 20-year absolute risk reductions if the three modifiable factors improved optimally. They performed the calculations in each study cohort, then averaged the results to confirm the possible reductions.

The risk reduction model divided its cohort into nine profiles, ranging from a young, low-risk group to an older, high-risk group. Including the above characteristics, the model also took into account educational level, alcohol consumption, ages at menarche and first live birth, and the number of lifetime breast biopsies.

In the entire population, if women aged 45 years improved all three modifiable risk factors, they could reduce the overall 20-year risk by 1.4%. The population-based risk for 65-year-olds could drop by 1.6%. The risk reduction is less in the older women because they generally had more favorable nonmodifiable risk factors, the authors noted.

On an individual basis, a 45-year-old woman with a positive family history could decrease her absolute 20-year risk by 2.7%; the reduction could be 3.2% in a woman aged 65 years.

For a younger woman with the highest nonmodifiable risk factors (only 10% of the population), optimally improving exercise, weight, and drinking could reduce the 10-year risk by 1.6% and the 20-year risk by 3.2%. A 55-year-old could reduce her 10-year risk by 2.4% and her 20-year risk by 4.4%. The oldest women in this category could reduce their 10-year risk by 2.5% and their 20-year risk by 4.1%.

But these numbers also need to be viewed in the context of a large population, the authors noted. Although an overall reduction of 1.6% would save 16,000 cases annually in a population of 1 million women, it would save only 2,560 cases annually in the 8% of postmenopausal women who have a family history of cancer.

Despite these limitations, the authors wrote, "Calculations of reductions in absolute risk using our model potentially provide additional perspective in the possible benefits of such prevention strategies."

This research was supported by the Division of Cancer Epidemiology and Genetics at the National Cancer Institute, and the Associazione Italiana per la Ricerca sul Cancro. The investigators did not report any conflicts of interest. Dr. Helzlsouer said that she had no relevant financial disclosures.

By improving the risk factors of weight, exercise, and alcohol consumption, women could reduce their 20-year risk of breast cancer by more than 4%, depending on age and other risk factors.

A new risk model suggests that a risk reduction of 1.6% could prevent 16,000 cases of breast cancer in a population of 1 million women. On an individual basis, a 55-year-old woman with the most nonmodifiable risk factors could see the biggest benefit, an absolute risk reduction of 4.4%

Even younger women at the highest risk of breast cancer could reduce their risk over 20 years by more than 3% if they optimally improved all three modifiable risk factors, Elisabetta Petracci, Ph.D., reported in the June 24 issue of the Journal of the National Cancer Institute.

Kristan Hutchison (Property of National Science Foundation)/ (Antarctic Photo Library (Image link)), via Wikimedia Commons .

"The absolute risk model developed in this study could help clinicians make decisions about implementing interventions to reduce a patient’s exposure to modifiable risk factors, thereby reducing their absolute risk of breast cancer," wrote Dr. Petracci and her colleagues (J. Natl. Cancer Inst. 2011;103:1-12). "Because programs to encourage less alcohol consumption, increase leisure activity, and encourage some weight control are likely to be safe, they can be widely administered."

The researchers began their model with data from an Italian breast cancer case-control study of 2,569 cases and 2,588 controls who were followed during 1991-1994. To compute absolute risk, they employed 5-year, age-specific, breast cancer incidence rates from the Florence Cancer Registry in 1989-1993. Rates were based on an estimated 2006 population of 1,190,516 women.

Another Italian study provided a validation cohort consisting of 10,083 women who were followed during 1998-2004. This study collected demographic information as well as information on anthropomorphic characteristics, age, physical activity, reproductive history, diet and lifestyle, and a family history of breast cancer.

The team considered all of the risk factors and calculated the 10- and 20-year risk of breast cancer as well as the 10- and 20-year absolute risk reductions if the three modifiable factors improved optimally. They performed the calculations in each study cohort, then averaged the results to confirm the possible reductions.

The risk reduction model divided its cohort into nine profiles, ranging from a young, low-risk group to an older, high-risk group. Including the above characteristics, the model also took into account educational level, alcohol consumption, ages at menarche and first live birth, and the number of lifetime breast biopsies.

In the entire population, if women aged 45 years improved all three modifiable risk factors, they could reduce the overall 20-year risk by 1.4%. The population-based risk for 65-year-olds could drop by 1.6%. The risk reduction is less in the older women because they generally had more favorable nonmodifiable risk factors, the authors noted.

On an individual basis, a 45-year-old woman with a positive family history could decrease her absolute 20-year risk by 2.7%; the reduction could be 3.2% in a woman aged 65 years.

For a younger woman with the highest nonmodifiable risk factors (only 10% of the population), optimally improving exercise, weight, and drinking could reduce the 10-year risk by 1.6% and the 20-year risk by 3.2%. A 55-year-old could reduce her 10-year risk by 2.4% and her 20-year risk by 4.4%. The oldest women in this category could reduce their 10-year risk by 2.5% and their 20-year risk by 4.1%.

But these numbers also need to be viewed in the context of a large population, the authors noted. Although an overall reduction of 1.6% would save 16,000 cases annually in a population of 1 million women, it would save only 2,560 cases annually in the 8% of postmenopausal women who have a family history of cancer.

Despite these limitations, the authors wrote, "Calculations of reductions in absolute risk using our model potentially provide additional perspective in the possible benefits of such prevention strategies."

This research was supported by the Division of Cancer Epidemiology and Genetics at the National Cancer Institute, and the Associazione Italiana per la Ricerca sul Cancro. The investigators did not report any conflicts of interest. Dr. Helzlsouer said that she had no relevant financial disclosures.

By improving the risk factors of weight, exercise, and alcohol consumption, women could reduce their 20-year risk of breast cancer by more than 4%, depending on age and other risk factors.

A new risk model suggests that a risk reduction of 1.6% could prevent 16,000 cases of breast cancer in a population of 1 million women. On an individual basis, a 55-year-old woman with the most nonmodifiable risk factors could see the biggest benefit, an absolute risk reduction of 4.4%

Even younger women at the highest risk of breast cancer could reduce their risk over 20 years by more than 3% if they optimally improved all three modifiable risk factors, Elisabetta Petracci, Ph.D., reported in the June 24 issue of the Journal of the National Cancer Institute.

Kristan Hutchison (Property of National Science Foundation)/ (Antarctic Photo Library (Image link)), via Wikimedia Commons .

"The absolute risk model developed in this study could help clinicians make decisions about implementing interventions to reduce a patient’s exposure to modifiable risk factors, thereby reducing their absolute risk of breast cancer," wrote Dr. Petracci and her colleagues (J. Natl. Cancer Inst. 2011;103:1-12). "Because programs to encourage less alcohol consumption, increase leisure activity, and encourage some weight control are likely to be safe, they can be widely administered."

The researchers began their model with data from an Italian breast cancer case-control study of 2,569 cases and 2,588 controls who were followed during 1991-1994. To compute absolute risk, they employed 5-year, age-specific, breast cancer incidence rates from the Florence Cancer Registry in 1989-1993. Rates were based on an estimated 2006 population of 1,190,516 women.

Another Italian study provided a validation cohort consisting of 10,083 women who were followed during 1998-2004. This study collected demographic information as well as information on anthropomorphic characteristics, age, physical activity, reproductive history, diet and lifestyle, and a family history of breast cancer.

The team considered all of the risk factors and calculated the 10- and 20-year risk of breast cancer as well as the 10- and 20-year absolute risk reductions if the three modifiable factors improved optimally. They performed the calculations in each study cohort, then averaged the results to confirm the possible reductions.

The risk reduction model divided its cohort into nine profiles, ranging from a young, low-risk group to an older, high-risk group. Including the above characteristics, the model also took into account educational level, alcohol consumption, ages at menarche and first live birth, and the number of lifetime breast biopsies.

In the entire population, if women aged 45 years improved all three modifiable risk factors, they could reduce the overall 20-year risk by 1.4%. The population-based risk for 65-year-olds could drop by 1.6%. The risk reduction is less in the older women because they generally had more favorable nonmodifiable risk factors, the authors noted.

On an individual basis, a 45-year-old woman with a positive family history could decrease her absolute 20-year risk by 2.7%; the reduction could be 3.2% in a woman aged 65 years.

For a younger woman with the highest nonmodifiable risk factors (only 10% of the population), optimally improving exercise, weight, and drinking could reduce the 10-year risk by 1.6% and the 20-year risk by 3.2%. A 55-year-old could reduce her 10-year risk by 2.4% and her 20-year risk by 4.4%. The oldest women in this category could reduce their 10-year risk by 2.5% and their 20-year risk by 4.1%.

But these numbers also need to be viewed in the context of a large population, the authors noted. Although an overall reduction of 1.6% would save 16,000 cases annually in a population of 1 million women, it would save only 2,560 cases annually in the 8% of postmenopausal women who have a family history of cancer.

Despite these limitations, the authors wrote, "Calculations of reductions in absolute risk using our model potentially provide additional perspective in the possible benefits of such prevention strategies."

This research was supported by the Division of Cancer Epidemiology and Genetics at the National Cancer Institute, and the Associazione Italiana per la Ricerca sul Cancro. The investigators did not report any conflicts of interest. Dr. Helzlsouer said that she had no relevant financial disclosures.

By improving the risk factors of weight, exercise, and alcohol consumption, women could reduce their 20-year risk of breast cancer by more than 4%, depending on age and other risk factors.

A new risk model suggests that a risk reduction of 1.6% could prevent 16,000 cases of breast cancer in a population of 1 million women. On an individual basis, a 55-year-old woman with the most nonmodifiable risk factors could see the biggest benefit, an absolute risk reduction of 4.4%

Even younger women at the highest risk of breast cancer could reduce their risk over 20 years by more than 3% if they optimally improved all three modifiable risk factors, Elisabetta Petracci, Ph.D., reported in the June 24 issue of the Journal of the National Cancer Institute.

Kristan Hutchison (Property of National Science Foundation)/ (Antarctic Photo Library (Image link)), via Wikimedia Commons .

"The absolute risk model developed in this study could help clinicians make decisions about implementing interventions to reduce a patient’s exposure to modifiable risk factors, thereby reducing their absolute risk of breast cancer," wrote Dr. Petracci and her colleagues (J. Natl. Cancer Inst. 2011;103:1-12). "Because programs to encourage less alcohol consumption, increase leisure activity, and encourage some weight control are likely to be safe, they can be widely administered."

The researchers began their model with data from an Italian breast cancer case-control study of 2,569 cases and 2,588 controls who were followed during 1991-1994. To compute absolute risk, they employed 5-year, age-specific, breast cancer incidence rates from the Florence Cancer Registry in 1989-1993. Rates were based on an estimated 2006 population of 1,190,516 women.

Another Italian study provided a validation cohort consisting of 10,083 women who were followed during 1998-2004. This study collected demographic information as well as information on anthropomorphic characteristics, age, physical activity, reproductive history, diet and lifestyle, and a family history of breast cancer.

The team considered all of the risk factors and calculated the 10- and 20-year risk of breast cancer as well as the 10- and 20-year absolute risk reductions if the three modifiable factors improved optimally. They performed the calculations in each study cohort, then averaged the results to confirm the possible reductions.

The risk reduction model divided its cohort into nine profiles, ranging from a young, low-risk group to an older, high-risk group. Including the above characteristics, the model also took into account educational level, alcohol consumption, ages at menarche and first live birth, and the number of lifetime breast biopsies.

In the entire population, if women aged 45 years improved all three modifiable risk factors, they could reduce the overall 20-year risk by 1.4%. The population-based risk for 65-year-olds could drop by 1.6%. The risk reduction is less in the older women because they generally had more favorable nonmodifiable risk factors, the authors noted.

On an individual basis, a 45-year-old woman with a positive family history could decrease her absolute 20-year risk by 2.7%; the reduction could be 3.2% in a woman aged 65 years.

For a younger woman with the highest nonmodifiable risk factors (only 10% of the population), optimally improving exercise, weight, and drinking could reduce the 10-year risk by 1.6% and the 20-year risk by 3.2%. A 55-year-old could reduce her 10-year risk by 2.4% and her 20-year risk by 4.4%. The oldest women in this category could reduce their 10-year risk by 2.5% and their 20-year risk by 4.1%.

But these numbers also need to be viewed in the context of a large population, the authors noted. Although an overall reduction of 1.6% would save 16,000 cases annually in a population of 1 million women, it would save only 2,560 cases annually in the 8% of postmenopausal women who have a family history of cancer.

Despite these limitations, the authors wrote, "Calculations of reductions in absolute risk using our model potentially provide additional perspective in the possible benefits of such prevention strategies."

This research was supported by the Division of Cancer Epidemiology and Genetics at the National Cancer Institute, and the Associazione Italiana per la Ricerca sul Cancro. The investigators did not report any conflicts of interest. Dr. Helzlsouer said that she had no relevant financial disclosures.

By improving the risk factors of weight, exercise, and alcohol consumption, women could reduce their 20-year risk of breast cancer by more than 4%, depending on age and other risk factors.

A new risk model suggests that a risk reduction of 1.6% could prevent 16,000 cases of breast cancer in a population of 1 million women. On an individual basis, a 55-year-old woman with the most nonmodifiable risk factors could see the biggest benefit, an absolute risk reduction of 4.4%

Even younger women at the highest risk of breast cancer could reduce their risk over 20 years by more than 3% if they optimally improved all three modifiable risk factors, Elisabetta Petracci, Ph.D., reported in the June 24 issue of the Journal of the National Cancer Institute.

Kristan Hutchison (Property of National Science Foundation)/ (Antarctic Photo Library (Image link)), via Wikimedia Commons .

"The absolute risk model developed in this study could help clinicians make decisions about implementing interventions to reduce a patient’s exposure to modifiable risk factors, thereby reducing their absolute risk of breast cancer," wrote Dr. Petracci and her colleagues (J. Natl. Cancer Inst. 2011;103:1-12). "Because programs to encourage less alcohol consumption, increase leisure activity, and encourage some weight control are likely to be safe, they can be widely administered."

The researchers began their model with data from an Italian breast cancer case-control study of 2,569 cases and 2,588 controls who were followed during 1991-1994. To compute absolute risk, they employed 5-year, age-specific, breast cancer incidence rates from the Florence Cancer Registry in 1989-1993. Rates were based on an estimated 2006 population of 1,190,516 women.

Another Italian study provided a validation cohort consisting of 10,083 women who were followed during 1998-2004. This study collected demographic information as well as information on anthropomorphic characteristics, age, physical activity, reproductive history, diet and lifestyle, and a family history of breast cancer.

The team considered all of the risk factors and calculated the 10- and 20-year risk of breast cancer as well as the 10- and 20-year absolute risk reductions if the three modifiable factors improved optimally. They performed the calculations in each study cohort, then averaged the results to confirm the possible reductions.

The risk reduction model divided its cohort into nine profiles, ranging from a young, low-risk group to an older, high-risk group. Including the above characteristics, the model also took into account educational level, alcohol consumption, ages at menarche and first live birth, and the number of lifetime breast biopsies.

In the entire population, if women aged 45 years improved all three modifiable risk factors, they could reduce the overall 20-year risk by 1.4%. The population-based risk for 65-year-olds could drop by 1.6%. The risk reduction is less in the older women because they generally had more favorable nonmodifiable risk factors, the authors noted.

On an individual basis, a 45-year-old woman with a positive family history could decrease her absolute 20-year risk by 2.7%; the reduction could be 3.2% in a woman aged 65 years.

For a younger woman with the highest nonmodifiable risk factors (only 10% of the population), optimally improving exercise, weight, and drinking could reduce the 10-year risk by 1.6% and the 20-year risk by 3.2%. A 55-year-old could reduce her 10-year risk by 2.4% and her 20-year risk by 4.4%. The oldest women in this category could reduce their 10-year risk by 2.5% and their 20-year risk by 4.1%.

But these numbers also need to be viewed in the context of a large population, the authors noted. Although an overall reduction of 1.6% would save 16,000 cases annually in a population of 1 million women, it would save only 2,560 cases annually in the 8% of postmenopausal women who have a family history of cancer.

Despite these limitations, the authors wrote, "Calculations of reductions in absolute risk using our model potentially provide additional perspective in the possible benefits of such prevention strategies."

This research was supported by the Division of Cancer Epidemiology and Genetics at the National Cancer Institute, and the Associazione Italiana per la Ricerca sul Cancro. The investigators did not report any conflicts of interest. Dr. Helzlsouer said that she had no relevant financial disclosures.

WASHINGTON – Returning soldiers with posttraumatic headache seemed to have a poorer treatment outcome than did those with idiopathic migraine, regardless of the concurrent presence of posttraumatic stress disorder, according to the findings of a retrospective study.

"This may suggest that there is some fundamental difference in the pain mechanism between the two headache groups," according to Dr. Jacqueline Rosenthal of the Madigan Army Medical Center, Tacoma, Wash. "One theory is that those with migraine may be more susceptible to stress as a central contributor to their headache," she said at the annual meeting of the American Headache Society.

Dr. Rosenthal and her colleagues retrospectively analyzed 441 solders, mean age 30 years, who presented to the center’s neurology clinic with headache. In addition to headache diagnosis, all of the patients underwent screening for PTSD, defined as a score of at least 50 on the PTSD Symptom Checklist.

All of those with posttraumatic headache had a history of head trauma within 7 days preceding the onset of the headache. In the migraine group, there were patients with head trauma, but the injury did not precipitate the headache, Dr. Rosenthal explained. Individual physicians determined the course of patient treatment, but those with PTSD also received behavioral therapy.

Dr. Rosenthal and her colleagues examined headache frequency at baseline and after 3 months of treatment in four subgroups: migraineurs with and without PTSD, and posttraumatic headache patients with or without PTSD.

Of the total, 171 (39%) had a diagnosis of idiopathic migraine; 270 (61%) were diagnosed with posttraumatic headache. One-third of the entire cohort, (145) also met the criteria for PTSD. Of these, significantly more had posttraumatic headache than migraine (72% vs. 28%).

Patients with migraine and PTSD had significantly more headache days per month than did those with migraine but no PTSD (21 vs. 14 days per month). But PTSD did not affect headache frequency in patients with posttraumatic headache (17 days per month with PTSD vs. 16 days without PTSD).

Chronic daily headache was significantly more common in migraineurs with PTSD than in those without (68% vs. 44%). But PTSD had no significant association with chronic daily headache in the posttraumatic headache group (58% with PTSD vs. 52% without).

Although outcomes were significantly worse in posttraumatic headache patients than in migraineurs, PTSD did not exert any significant effect in either group, Dr. Rosenthal said. Headache frequency declined by 16% in both groups with posttraumatic headache. Among those with migraine, headache frequency declined by 28% among those with PTSD and by 35% in those without the disorder, but that difference did not meet statistical significance.

A discussant pointed out that soldiers with posttraumatic headache might have experienced more serious or frequent blast injuries, which could account for the poorer outcomes. Dr. Rosenthal said the study did not account for any characteristics of the blast injuries incurred, but agreed that these could have an effect on treatment outcome.

Dr. Rosenthal did not report having any conflicts of interest. She indicated that the study conclusions did not necessarily reflect the views of the United States Army.

WASHINGTON – Returning soldiers with posttraumatic headache seemed to have a poorer treatment outcome than did those with idiopathic migraine, regardless of the concurrent presence of posttraumatic stress disorder, according to the findings of a retrospective study.

"This may suggest that there is some fundamental difference in the pain mechanism between the two headache groups," according to Dr. Jacqueline Rosenthal of the Madigan Army Medical Center, Tacoma, Wash. "One theory is that those with migraine may be more susceptible to stress as a central contributor to their headache," she said at the annual meeting of the American Headache Society.

Dr. Rosenthal and her colleagues retrospectively analyzed 441 solders, mean age 30 years, who presented to the center’s neurology clinic with headache. In addition to headache diagnosis, all of the patients underwent screening for PTSD, defined as a score of at least 50 on the PTSD Symptom Checklist.

All of those with posttraumatic headache had a history of head trauma within 7 days preceding the onset of the headache. In the migraine group, there were patients with head trauma, but the injury did not precipitate the headache, Dr. Rosenthal explained. Individual physicians determined the course of patient treatment, but those with PTSD also received behavioral therapy.

Dr. Rosenthal and her colleagues examined headache frequency at baseline and after 3 months of treatment in four subgroups: migraineurs with and without PTSD, and posttraumatic headache patients with or without PTSD.

Of the total, 171 (39%) had a diagnosis of idiopathic migraine; 270 (61%) were diagnosed with posttraumatic headache. One-third of the entire cohort, (145) also met the criteria for PTSD. Of these, significantly more had posttraumatic headache than migraine (72% vs. 28%).

Patients with migraine and PTSD had significantly more headache days per month than did those with migraine but no PTSD (21 vs. 14 days per month). But PTSD did not affect headache frequency in patients with posttraumatic headache (17 days per month with PTSD vs. 16 days without PTSD).

Chronic daily headache was significantly more common in migraineurs with PTSD than in those without (68% vs. 44%). But PTSD had no significant association with chronic daily headache in the posttraumatic headache group (58% with PTSD vs. 52% without).

Although outcomes were significantly worse in posttraumatic headache patients than in migraineurs, PTSD did not exert any significant effect in either group, Dr. Rosenthal said. Headache frequency declined by 16% in both groups with posttraumatic headache. Among those with migraine, headache frequency declined by 28% among those with PTSD and by 35% in those without the disorder, but that difference did not meet statistical significance.

A discussant pointed out that soldiers with posttraumatic headache might have experienced more serious or frequent blast injuries, which could account for the poorer outcomes. Dr. Rosenthal said the study did not account for any characteristics of the blast injuries incurred, but agreed that these could have an effect on treatment outcome.

Dr. Rosenthal did not report having any conflicts of interest. She indicated that the study conclusions did not necessarily reflect the views of the United States Army.

WASHINGTON – Returning soldiers with posttraumatic headache seemed to have a poorer treatment outcome than did those with idiopathic migraine, regardless of the concurrent presence of posttraumatic stress disorder, according to the findings of a retrospective study.

"This may suggest that there is some fundamental difference in the pain mechanism between the two headache groups," according to Dr. Jacqueline Rosenthal of the Madigan Army Medical Center, Tacoma, Wash. "One theory is that those with migraine may be more susceptible to stress as a central contributor to their headache," she said at the annual meeting of the American Headache Society.

Dr. Rosenthal and her colleagues retrospectively analyzed 441 solders, mean age 30 years, who presented to the center’s neurology clinic with headache. In addition to headache diagnosis, all of the patients underwent screening for PTSD, defined as a score of at least 50 on the PTSD Symptom Checklist.

All of those with posttraumatic headache had a history of head trauma within 7 days preceding the onset of the headache. In the migraine group, there were patients with head trauma, but the injury did not precipitate the headache, Dr. Rosenthal explained. Individual physicians determined the course of patient treatment, but those with PTSD also received behavioral therapy.

Dr. Rosenthal and her colleagues examined headache frequency at baseline and after 3 months of treatment in four subgroups: migraineurs with and without PTSD, and posttraumatic headache patients with or without PTSD.

Of the total, 171 (39%) had a diagnosis of idiopathic migraine; 270 (61%) were diagnosed with posttraumatic headache. One-third of the entire cohort, (145) also met the criteria for PTSD. Of these, significantly more had posttraumatic headache than migraine (72% vs. 28%).

Patients with migraine and PTSD had significantly more headache days per month than did those with migraine but no PTSD (21 vs. 14 days per month). But PTSD did not affect headache frequency in patients with posttraumatic headache (17 days per month with PTSD vs. 16 days without PTSD).

Chronic daily headache was significantly more common in migraineurs with PTSD than in those without (68% vs. 44%). But PTSD had no significant association with chronic daily headache in the posttraumatic headache group (58% with PTSD vs. 52% without).

Although outcomes were significantly worse in posttraumatic headache patients than in migraineurs, PTSD did not exert any significant effect in either group, Dr. Rosenthal said. Headache frequency declined by 16% in both groups with posttraumatic headache. Among those with migraine, headache frequency declined by 28% among those with PTSD and by 35% in those without the disorder, but that difference did not meet statistical significance.

A discussant pointed out that soldiers with posttraumatic headache might have experienced more serious or frequent blast injuries, which could account for the poorer outcomes. Dr. Rosenthal said the study did not account for any characteristics of the blast injuries incurred, but agreed that these could have an effect on treatment outcome.

Dr. Rosenthal did not report having any conflicts of interest. She indicated that the study conclusions did not necessarily reflect the views of the United States Army.

WASHINGTON – Returning soldiers with posttraumatic headache seemed to have a poorer treatment outcome than did those with idiopathic migraine, regardless of the concurrent presence of posttraumatic stress disorder, according to the findings of a retrospective study.

"This may suggest that there is some fundamental difference in the pain mechanism between the two headache groups," according to Dr. Jacqueline Rosenthal of the Madigan Army Medical Center, Tacoma, Wash. "One theory is that those with migraine may be more susceptible to stress as a central contributor to their headache," she said at the annual meeting of the American Headache Society.

Dr. Rosenthal and her colleagues retrospectively analyzed 441 solders, mean age 30 years, who presented to the center’s neurology clinic with headache. In addition to headache diagnosis, all of the patients underwent screening for PTSD, defined as a score of at least 50 on the PTSD Symptom Checklist.

All of those with posttraumatic headache had a history of head trauma within 7 days preceding the onset of the headache. In the migraine group, there were patients with head trauma, but the injury did not precipitate the headache, Dr. Rosenthal explained. Individual physicians determined the course of patient treatment, but those with PTSD also received behavioral therapy.

Dr. Rosenthal and her colleagues examined headache frequency at baseline and after 3 months of treatment in four subgroups: migraineurs with and without PTSD, and posttraumatic headache patients with or without PTSD.

Of the total, 171 (39%) had a diagnosis of idiopathic migraine; 270 (61%) were diagnosed with posttraumatic headache. One-third of the entire cohort, (145) also met the criteria for PTSD. Of these, significantly more had posttraumatic headache than migraine (72% vs. 28%).

Patients with migraine and PTSD had significantly more headache days per month than did those with migraine but no PTSD (21 vs. 14 days per month). But PTSD did not affect headache frequency in patients with posttraumatic headache (17 days per month with PTSD vs. 16 days without PTSD).

Chronic daily headache was significantly more common in migraineurs with PTSD than in those without (68% vs. 44%). But PTSD had no significant association with chronic daily headache in the posttraumatic headache group (58% with PTSD vs. 52% without).

Although outcomes were significantly worse in posttraumatic headache patients than in migraineurs, PTSD did not exert any significant effect in either group, Dr. Rosenthal said. Headache frequency declined by 16% in both groups with posttraumatic headache. Among those with migraine, headache frequency declined by 28% among those with PTSD and by 35% in those without the disorder, but that difference did not meet statistical significance.

A discussant pointed out that soldiers with posttraumatic headache might have experienced more serious or frequent blast injuries, which could account for the poorer outcomes. Dr. Rosenthal said the study did not account for any characteristics of the blast injuries incurred, but agreed that these could have an effect on treatment outcome.

Dr. Rosenthal did not report having any conflicts of interest. She indicated that the study conclusions did not necessarily reflect the views of the United States Army.

WASHINGTON – Returning soldiers with posttraumatic headache seemed to have a poorer treatment outcome than did those with idiopathic migraine, regardless of the concurrent presence of posttraumatic stress disorder, according to the findings of a retrospective study.

"This may suggest that there is some fundamental difference in the pain mechanism between the two headache groups," according to Dr. Jacqueline Rosenthal of the Madigan Army Medical Center, Tacoma, Wash. "One theory is that those with migraine may be more susceptible to stress as a central contributor to their headache," she said at the annual meeting of the American Headache Society.

Dr. Rosenthal and her colleagues retrospectively analyzed 441 solders, mean age 30 years, who presented to the center’s neurology clinic with headache. In addition to headache diagnosis, all of the patients underwent screening for PTSD, defined as a score of at least 50 on the PTSD Symptom Checklist.

All of those with posttraumatic headache had a history of head trauma within 7 days preceding the onset of the headache. In the migraine group, there were patients with head trauma, but the injury did not precipitate the headache, Dr. Rosenthal explained. Individual physicians determined the course of patient treatment, but those with PTSD also received behavioral therapy.

Dr. Rosenthal and her colleagues examined headache frequency at baseline and after 3 months of treatment in four subgroups: migraineurs with and without PTSD, and posttraumatic headache patients with or without PTSD.

Of the total, 171 (39%) had a diagnosis of idiopathic migraine; 270 (61%) were diagnosed with posttraumatic headache. One-third of the entire cohort, (145) also met the criteria for PTSD. Of these, significantly more had posttraumatic headache than migraine (72% vs. 28%).

Patients with migraine and PTSD had significantly more headache days per month than did those with migraine but no PTSD (21 vs. 14 days per month). But PTSD did not affect headache frequency in patients with posttraumatic headache (17 days per month with PTSD vs. 16 days without PTSD).

Chronic daily headache was significantly more common in migraineurs with PTSD than in those without (68% vs. 44%). But PTSD had no significant association with chronic daily headache in the posttraumatic headache group (58% with PTSD vs. 52% without).

Although outcomes were significantly worse in posttraumatic headache patients than in migraineurs, PTSD did not exert any significant effect in either group, Dr. Rosenthal said. Headache frequency declined by 16% in both groups with posttraumatic headache. Among those with migraine, headache frequency declined by 28% among those with PTSD and by 35% in those without the disorder, but that difference did not meet statistical significance.

A discussant pointed out that soldiers with posttraumatic headache might have experienced more serious or frequent blast injuries, which could account for the poorer outcomes. Dr. Rosenthal said the study did not account for any characteristics of the blast injuries incurred, but agreed that these could have an effect on treatment outcome.

Dr. Rosenthal did not report having any conflicts of interest. She indicated that the study conclusions did not necessarily reflect the views of the United States Army.

WASHINGTON – Returning soldiers with posttraumatic headache seemed to have a poorer treatment outcome than did those with idiopathic migraine, regardless of the concurrent presence of posttraumatic stress disorder, according to the findings of a retrospective study.

"This may suggest that there is some fundamental difference in the pain mechanism between the two headache groups," according to Dr. Jacqueline Rosenthal of the Madigan Army Medical Center, Tacoma, Wash. "One theory is that those with migraine may be more susceptible to stress as a central contributor to their headache," she said at the annual meeting of the American Headache Society.

Dr. Rosenthal and her colleagues retrospectively analyzed 441 solders, mean age 30 years, who presented to the center’s neurology clinic with headache. In addition to headache diagnosis, all of the patients underwent screening for PTSD, defined as a score of at least 50 on the PTSD Symptom Checklist.

All of those with posttraumatic headache had a history of head trauma within 7 days preceding the onset of the headache. In the migraine group, there were patients with head trauma, but the injury did not precipitate the headache, Dr. Rosenthal explained. Individual physicians determined the course of patient treatment, but those with PTSD also received behavioral therapy.

Dr. Rosenthal and her colleagues examined headache frequency at baseline and after 3 months of treatment in four subgroups: migraineurs with and without PTSD, and posttraumatic headache patients with or without PTSD.

Of the total, 171 (39%) had a diagnosis of idiopathic migraine; 270 (61%) were diagnosed with posttraumatic headache. One-third of the entire cohort, (145) also met the criteria for PTSD. Of these, significantly more had posttraumatic headache than migraine (72% vs. 28%).

Patients with migraine and PTSD had significantly more headache days per month than did those with migraine but no PTSD (21 vs. 14 days per month). But PTSD did not affect headache frequency in patients with posttraumatic headache (17 days per month with PTSD vs. 16 days without PTSD).

Chronic daily headache was significantly more common in migraineurs with PTSD than in those without (68% vs. 44%). But PTSD had no significant association with chronic daily headache in the posttraumatic headache group (58% with PTSD vs. 52% without).

Although outcomes were significantly worse in posttraumatic headache patients than in migraineurs, PTSD did not exert any significant effect in either group, Dr. Rosenthal said. Headache frequency declined by 16% in both groups with posttraumatic headache. Among those with migraine, headache frequency declined by 28% among those with PTSD and by 35% in those without the disorder, but that difference did not meet statistical significance.

A discussant pointed out that soldiers with posttraumatic headache might have experienced more serious or frequent blast injuries, which could account for the poorer outcomes. Dr. Rosenthal said the study did not account for any characteristics of the blast injuries incurred, but agreed that these could have an effect on treatment outcome.

Dr. Rosenthal did not report having any conflicts of interest. She indicated that the study conclusions did not necessarily reflect the views of the United States Army.

WASHINGTON – Returning soldiers with posttraumatic headache seemed to have a poorer treatment outcome than did those with idiopathic migraine, regardless of the concurrent presence of posttraumatic stress disorder, according to the findings of a retrospective study.

"This may suggest that there is some fundamental difference in the pain mechanism between the two headache groups," according to Dr. Jacqueline Rosenthal of the Madigan Army Medical Center, Tacoma, Wash. "One theory is that those with migraine may be more susceptible to stress as a central contributor to their headache," she said at the annual meeting of the American Headache Society.

Dr. Rosenthal and her colleagues retrospectively analyzed 441 solders, mean age 30 years, who presented to the center’s neurology clinic with headache. In addition to headache diagnosis, all of the patients underwent screening for PTSD, defined as a score of at least 50 on the PTSD Symptom Checklist.

All of those with posttraumatic headache had a history of head trauma within 7 days preceding the onset of the headache. In the migraine group, there were patients with head trauma, but the injury did not precipitate the headache, Dr. Rosenthal explained. Individual physicians determined the course of patient treatment, but those with PTSD also received behavioral therapy.

Dr. Rosenthal and her colleagues examined headache frequency at baseline and after 3 months of treatment in four subgroups: migraineurs with and without PTSD, and posttraumatic headache patients with or without PTSD.

Of the total, 171 (39%) had a diagnosis of idiopathic migraine; 270 (61%) were diagnosed with posttraumatic headache. One-third of the entire cohort, (145) also met the criteria for PTSD. Of these, significantly more had posttraumatic headache than migraine (72% vs. 28%).

Patients with migraine and PTSD had significantly more headache days per month than did those with migraine but no PTSD (21 vs. 14 days per month). But PTSD did not affect headache frequency in patients with posttraumatic headache (17 days per month with PTSD vs. 16 days without PTSD).

Chronic daily headache was significantly more common in migraineurs with PTSD than in those without (68% vs. 44%). But PTSD had no significant association with chronic daily headache in the posttraumatic headache group (58% with PTSD vs. 52% without).

Although outcomes were significantly worse in posttraumatic headache patients than in migraineurs, PTSD did not exert any significant effect in either group, Dr. Rosenthal said. Headache frequency declined by 16% in both groups with posttraumatic headache. Among those with migraine, headache frequency declined by 28% among those with PTSD and by 35% in those without the disorder, but that difference did not meet statistical significance.

A discussant pointed out that soldiers with posttraumatic headache might have experienced more serious or frequent blast injuries, which could account for the poorer outcomes. Dr. Rosenthal said the study did not account for any characteristics of the blast injuries incurred, but agreed that these could have an effect on treatment outcome.

Dr. Rosenthal did not report having any conflicts of interest. She indicated that the study conclusions did not necessarily reflect the views of the United States Army.

WASHINGTON – Returning soldiers with posttraumatic headache seemed to have a poorer treatment outcome than did those with idiopathic migraine, regardless of the concurrent presence of posttraumatic stress disorder, according to the findings of a retrospective study.

"This may suggest that there is some fundamental difference in the pain mechanism between the two headache groups," according to Dr. Jacqueline Rosenthal of the Madigan Army Medical Center, Tacoma, Wash. "One theory is that those with migraine may be more susceptible to stress as a central contributor to their headache," she said at the annual meeting of the American Headache Society.

Dr. Rosenthal and her colleagues retrospectively analyzed 441 solders, mean age 30 years, who presented to the center’s neurology clinic with headache. In addition to headache diagnosis, all of the patients underwent screening for PTSD, defined as a score of at least 50 on the PTSD Symptom Checklist.

All of those with posttraumatic headache had a history of head trauma within 7 days preceding the onset of the headache. In the migraine group, there were patients with head trauma, but the injury did not precipitate the headache, Dr. Rosenthal explained. Individual physicians determined the course of patient treatment, but those with PTSD also received behavioral therapy.

Dr. Rosenthal and her colleagues examined headache frequency at baseline and after 3 months of treatment in four subgroups: migraineurs with and without PTSD, and posttraumatic headache patients with or without PTSD.

Of the total, 171 (39%) had a diagnosis of idiopathic migraine; 270 (61%) were diagnosed with posttraumatic headache. One-third of the entire cohort, (145) also met the criteria for PTSD. Of these, significantly more had posttraumatic headache than migraine (72% vs. 28%).

Patients with migraine and PTSD had significantly more headache days per month than did those with migraine but no PTSD (21 vs. 14 days per month). But PTSD did not affect headache frequency in patients with posttraumatic headache (17 days per month with PTSD vs. 16 days without PTSD).

Chronic daily headache was significantly more common in migraineurs with PTSD than in those without (68% vs. 44%). But PTSD had no significant association with chronic daily headache in the posttraumatic headache group (58% with PTSD vs. 52% without).

Although outcomes were significantly worse in posttraumatic headache patients than in migraineurs, PTSD did not exert any significant effect in either group, Dr. Rosenthal said. Headache frequency declined by 16% in both groups with posttraumatic headache. Among those with migraine, headache frequency declined by 28% among those with PTSD and by 35% in those without the disorder, but that difference did not meet statistical significance.

A discussant pointed out that soldiers with posttraumatic headache might have experienced more serious or frequent blast injuries, which could account for the poorer outcomes. Dr. Rosenthal said the study did not account for any characteristics of the blast injuries incurred, but agreed that these could have an effect on treatment outcome.

Dr. Rosenthal did not report having any conflicts of interest. She indicated that the study conclusions did not necessarily reflect the views of the United States Army.

WASHINGTON – Returning soldiers with posttraumatic headache seemed to have a poorer treatment outcome than did those with idiopathic migraine, regardless of the concurrent presence of posttraumatic stress disorder, according to the findings of a retrospective study.

"This may suggest that there is some fundamental difference in the pain mechanism between the two headache groups," according to Dr. Jacqueline Rosenthal of the Madigan Army Medical Center, Tacoma, Wash. "One theory is that those with migraine may be more susceptible to stress as a central contributor to their headache," she said at the annual meeting of the American Headache Society.

Dr. Rosenthal and her colleagues retrospectively analyzed 441 solders, mean age 30 years, who presented to the center’s neurology clinic with headache. In addition to headache diagnosis, all of the patients underwent screening for PTSD, defined as a score of at least 50 on the PTSD Symptom Checklist.

All of those with posttraumatic headache had a history of head trauma within 7 days preceding the onset of the headache. In the migraine group, there were patients with head trauma, but the injury did not precipitate the headache, Dr. Rosenthal explained. Individual physicians determined the course of patient treatment, but those with PTSD also received behavioral therapy.

Dr. Rosenthal and her colleagues examined headache frequency at baseline and after 3 months of treatment in four subgroups: migraineurs with and without PTSD, and posttraumatic headache patients with or without PTSD.

Of the total, 171 (39%) had a diagnosis of idiopathic migraine; 270 (61%) were diagnosed with posttraumatic headache. One-third of the entire cohort, (145) also met the criteria for PTSD. Of these, significantly more had posttraumatic headache than migraine (72% vs. 28%).

Patients with migraine and PTSD had significantly more headache days per month than did those with migraine but no PTSD (21 vs. 14 days per month). But PTSD did not affect headache frequency in patients with posttraumatic headache (17 days per month with PTSD vs. 16 days without PTSD).

Chronic daily headache was significantly more common in migraineurs with PTSD than in those without (68% vs. 44%). But PTSD had no significant association with chronic daily headache in the posttraumatic headache group (58% with PTSD vs. 52% without).

Although outcomes were significantly worse in posttraumatic headache patients than in migraineurs, PTSD did not exert any significant effect in either group, Dr. Rosenthal said. Headache frequency declined by 16% in both groups with posttraumatic headache. Among those with migraine, headache frequency declined by 28% among those with PTSD and by 35% in those without the disorder, but that difference did not meet statistical significance.

A discussant pointed out that soldiers with posttraumatic headache might have experienced more serious or frequent blast injuries, which could account for the poorer outcomes. Dr. Rosenthal said the study did not account for any characteristics of the blast injuries incurred, but agreed that these could have an effect on treatment outcome.

Dr. Rosenthal did not report having any conflicts of interest. She indicated that the study conclusions did not necessarily reflect the views of the United States Army.

WASHINGTON – About a third of children with cyclic vomiting syndrome appear to have some metabolic condition, either mitochondrial dysfunction, fatty acid oxidation dysfunction, or a combination of both.

Unfortunately, there seems to be neither rhyme nor reason to the pattern. "Some showed the abnormalities only when well, some showed them only when acutely ill, and some showed them all the time," Dr. David Rothner said at the annual meeting of the American Headache Society.

Dr. Rothner, director of the Pediatric/Adolescent Headache Program at the Cleveland Clinic, and his colleagues presented the largest-to-date case series of metabolic testing in children with cyclic vomiting syndrome. Considered one of the three subtypes of migraine, cyclic vomiting is a debilitating illness with no known etiology and virtually no physical abnormalities that account for its occurrence.

The condition is a chronic disorder characterized by repeated, stereotypical vomiting episodes accompanied by severe nausea and sometimes by headache. The four components to the syndrome include: the prodrome, when severe nausea is present; the severe emetic phase; the postemetic phase; and the time between cycles, during which the patient is entirely well.

Most frequently, the vomiting episode begins between 4 and 6 a.m. "During a spell, a child can vomit every 10-15 minutes, for up to 2 days. There is more vomiting with this syndrome than in any other disease known to man."

Diagnosis can only be made by ruling out every possible physical cause. "Often, the time from the first episode until diagnosis can be 3 or 4 years, which is tragic," he said.

The prospective cohort consisted of 106 consecutive patients seen at the clinic from 2007 to 2010. Most were 8 or 9 years old, male (57%), and white (77%), and "most importantly, 26% had a personal history of migraine, which did not occur during the vomiting."

Most of the children (71%) also had a family history of migraine; 10% had a family history of epilepsy.

The episodes occurred an average every 4 weeks. The mean duration of the acute phase was 25 hours, with a mean of 18 vomits during that time, up to 5 per hour. "There was complete resolution of symptoms between the spells in 88% of these children," Dr. Rothner said.

Most children (73%) had a prodromal phase, usually abdominal pain and nausea. There were some identifiable triggers for 66%, including viral illness, and motion sickness. Along with vomiting, 25% of the children had some autonomic symptom, including fever and hypertension.

Of the 42 patients who underwent magnetic resonance imaging, 57% had normal results. "Some of them already had the abnormalities recognized before the disorder began, but none of them had anything to do with the vomiting," Dr. Rothner said.

He and his team also performed abdominal ultrasound on 41 children during the acute phase to rule out intestinal malrotation or volvulus. There were no gastrointestinal abnormalities related to vomiting. Likewise, esophagogastroduodenoscopies in 27 patients showed no serious issues, other than six cases of gastritis.

The investigators aimed to perform metabolic testing of blood and urine during both the well and ill phase in all children. At least some testing was accomplished in 58. One-third of the children tested during the ill or well phase, or during both, showed some sign of mitochondrial dysfunction or abnormal oxidation of fatty acid.

But the results were very difficult to interpret, Dr. Rothner said. "Of the 16 patients who had testing at both phases, 13 had abnormalities. But three showed mitochondrial dysfunction when well and not when ill, four had abnormalities when ill but not when well, and another three had some combination of mitochondrial and fatty acid dysfunction during both times. When we looked at the metabolic testing based on timing, we expected to find more abnormalities at the time of acute illness, but this was not the case. The results were not consistent."

There is no universally accepted treatment for the disorder. "Nothing controls it or makes it go away," Dr. Rothner said. For prophylactic treatment, about half of the group experienced some benefit from amitriptyline. During the acute phase, 85 children tried high-dose oral ondansetron, which improved or resolved symptoms in 66%.

Now, based on the metabolic testing, some of the children in the group also receive carnitine and coenzyme Q10, which Dr. Rothner said confers at least some benefit to about half the group.

The children are part of a continuous study which Dr. Rothner hopes will shed more light on the disorder’s connection with metabolic dysfunction.

He reported having no financial disclosures.

WASHINGTON – About a third of children with cyclic vomiting syndrome appear to have some metabolic condition, either mitochondrial dysfunction, fatty acid oxidation dysfunction, or a combination of both.

Unfortunately, there seems to be neither rhyme nor reason to the pattern. "Some showed the abnormalities only when well, some showed them only when acutely ill, and some showed them all the time," Dr. David Rothner said at the annual meeting of the American Headache Society.

Dr. Rothner, director of the Pediatric/Adolescent Headache Program at the Cleveland Clinic, and his colleagues presented the largest-to-date case series of metabolic testing in children with cyclic vomiting syndrome. Considered one of the three subtypes of migraine, cyclic vomiting is a debilitating illness with no known etiology and virtually no physical abnormalities that account for its occurrence.

The condition is a chronic disorder characterized by repeated, stereotypical vomiting episodes accompanied by severe nausea and sometimes by headache. The four components to the syndrome include: the prodrome, when severe nausea is present; the severe emetic phase; the postemetic phase; and the time between cycles, during which the patient is entirely well.

Most frequently, the vomiting episode begins between 4 and 6 a.m. "During a spell, a child can vomit every 10-15 minutes, for up to 2 days. There is more vomiting with this syndrome than in any other disease known to man."

Diagnosis can only be made by ruling out every possible physical cause. "Often, the time from the first episode until diagnosis can be 3 or 4 years, which is tragic," he said.

The prospective cohort consisted of 106 consecutive patients seen at the clinic from 2007 to 2010. Most were 8 or 9 years old, male (57%), and white (77%), and "most importantly, 26% had a personal history of migraine, which did not occur during the vomiting."

Most of the children (71%) also had a family history of migraine; 10% had a family history of epilepsy.

The episodes occurred an average every 4 weeks. The mean duration of the acute phase was 25 hours, with a mean of 18 vomits during that time, up to 5 per hour. "There was complete resolution of symptoms between the spells in 88% of these children," Dr. Rothner said.

Most children (73%) had a prodromal phase, usually abdominal pain and nausea. There were some identifiable triggers for 66%, including viral illness, and motion sickness. Along with vomiting, 25% of the children had some autonomic symptom, including fever and hypertension.

Of the 42 patients who underwent magnetic resonance imaging, 57% had normal results. "Some of them already had the abnormalities recognized before the disorder began, but none of them had anything to do with the vomiting," Dr. Rothner said.

He and his team also performed abdominal ultrasound on 41 children during the acute phase to rule out intestinal malrotation or volvulus. There were no gastrointestinal abnormalities related to vomiting. Likewise, esophagogastroduodenoscopies in 27 patients showed no serious issues, other than six cases of gastritis.

The investigators aimed to perform metabolic testing of blood and urine during both the well and ill phase in all children. At least some testing was accomplished in 58. One-third of the children tested during the ill or well phase, or during both, showed some sign of mitochondrial dysfunction or abnormal oxidation of fatty acid.

But the results were very difficult to interpret, Dr. Rothner said. "Of the 16 patients who had testing at both phases, 13 had abnormalities. But three showed mitochondrial dysfunction when well and not when ill, four had abnormalities when ill but not when well, and another three had some combination of mitochondrial and fatty acid dysfunction during both times. When we looked at the metabolic testing based on timing, we expected to find more abnormalities at the time of acute illness, but this was not the case. The results were not consistent."

There is no universally accepted treatment for the disorder. "Nothing controls it or makes it go away," Dr. Rothner said. For prophylactic treatment, about half of the group experienced some benefit from amitriptyline. During the acute phase, 85 children tried high-dose oral ondansetron, which improved or resolved symptoms in 66%.

Now, based on the metabolic testing, some of the children in the group also receive carnitine and coenzyme Q10, which Dr. Rothner said confers at least some benefit to about half the group.

The children are part of a continuous study which Dr. Rothner hopes will shed more light on the disorder’s connection with metabolic dysfunction.

He reported having no financial disclosures.

WASHINGTON – About a third of children with cyclic vomiting syndrome appear to have some metabolic condition, either mitochondrial dysfunction, fatty acid oxidation dysfunction, or a combination of both.

Unfortunately, there seems to be neither rhyme nor reason to the pattern. "Some showed the abnormalities only when well, some showed them only when acutely ill, and some showed them all the time," Dr. David Rothner said at the annual meeting of the American Headache Society.

Dr. Rothner, director of the Pediatric/Adolescent Headache Program at the Cleveland Clinic, and his colleagues presented the largest-to-date case series of metabolic testing in children with cyclic vomiting syndrome. Considered one of the three subtypes of migraine, cyclic vomiting is a debilitating illness with no known etiology and virtually no physical abnormalities that account for its occurrence.

The condition is a chronic disorder characterized by repeated, stereotypical vomiting episodes accompanied by severe nausea and sometimes by headache. The four components to the syndrome include: the prodrome, when severe nausea is present; the severe emetic phase; the postemetic phase; and the time between cycles, during which the patient is entirely well.

Most frequently, the vomiting episode begins between 4 and 6 a.m. "During a spell, a child can vomit every 10-15 minutes, for up to 2 days. There is more vomiting with this syndrome than in any other disease known to man."

Diagnosis can only be made by ruling out every possible physical cause. "Often, the time from the first episode until diagnosis can be 3 or 4 years, which is tragic," he said.

The prospective cohort consisted of 106 consecutive patients seen at the clinic from 2007 to 2010. Most were 8 or 9 years old, male (57%), and white (77%), and "most importantly, 26% had a personal history of migraine, which did not occur during the vomiting."

Most of the children (71%) also had a family history of migraine; 10% had a family history of epilepsy.

The episodes occurred an average every 4 weeks. The mean duration of the acute phase was 25 hours, with a mean of 18 vomits during that time, up to 5 per hour. "There was complete resolution of symptoms between the spells in 88% of these children," Dr. Rothner said.

Most children (73%) had a prodromal phase, usually abdominal pain and nausea. There were some identifiable triggers for 66%, including viral illness, and motion sickness. Along with vomiting, 25% of the children had some autonomic symptom, including fever and hypertension.

Of the 42 patients who underwent magnetic resonance imaging, 57% had normal results. "Some of them already had the abnormalities recognized before the disorder began, but none of them had anything to do with the vomiting," Dr. Rothner said.

He and his team also performed abdominal ultrasound on 41 children during the acute phase to rule out intestinal malrotation or volvulus. There were no gastrointestinal abnormalities related to vomiting. Likewise, esophagogastroduodenoscopies in 27 patients showed no serious issues, other than six cases of gastritis.

The investigators aimed to perform metabolic testing of blood and urine during both the well and ill phase in all children. At least some testing was accomplished in 58. One-third of the children tested during the ill or well phase, or during both, showed some sign of mitochondrial dysfunction or abnormal oxidation of fatty acid.

But the results were very difficult to interpret, Dr. Rothner said. "Of the 16 patients who had testing at both phases, 13 had abnormalities. But three showed mitochondrial dysfunction when well and not when ill, four had abnormalities when ill but not when well, and another three had some combination of mitochondrial and fatty acid dysfunction during both times. When we looked at the metabolic testing based on timing, we expected to find more abnormalities at the time of acute illness, but this was not the case. The results were not consistent."

There is no universally accepted treatment for the disorder. "Nothing controls it or makes it go away," Dr. Rothner said. For prophylactic treatment, about half of the group experienced some benefit from amitriptyline. During the acute phase, 85 children tried high-dose oral ondansetron, which improved or resolved symptoms in 66%.

Now, based on the metabolic testing, some of the children in the group also receive carnitine and coenzyme Q10, which Dr. Rothner said confers at least some benefit to about half the group.

The children are part of a continuous study which Dr. Rothner hopes will shed more light on the disorder’s connection with metabolic dysfunction.

He reported having no financial disclosures.

WASHINGTON – About a third of children with cyclic vomiting syndrome appear to have some metabolic condition, either mitochondrial dysfunction, fatty acid oxidation dysfunction, or a combination of both.

Unfortunately, there seems to be neither rhyme nor reason to the pattern. "Some showed the abnormalities only when well, some showed them only when acutely ill, and some showed them all the time," Dr. David Rothner said at the annual meeting of the American Headache Society.

Dr. Rothner, director of the Pediatric/Adolescent Headache Program at the Cleveland Clinic, and his colleagues presented the largest-to-date case series of metabolic testing in children with cyclic vomiting syndrome. Considered one of the three subtypes of migraine, cyclic vomiting is a debilitating illness with no known etiology and virtually no physical abnormalities that account for its occurrence.

The condition is a chronic disorder characterized by repeated, stereotypical vomiting episodes accompanied by severe nausea and sometimes by headache. The four components to the syndrome include: the prodrome, when severe nausea is present; the severe emetic phase; the postemetic phase; and the time between cycles, during which the patient is entirely well.

Most frequently, the vomiting episode begins between 4 and 6 a.m. "During a spell, a child can vomit every 10-15 minutes, for up to 2 days. There is more vomiting with this syndrome than in any other disease known to man."

Diagnosis can only be made by ruling out every possible physical cause. "Often, the time from the first episode until diagnosis can be 3 or 4 years, which is tragic," he said.

The prospective cohort consisted of 106 consecutive patients seen at the clinic from 2007 to 2010. Most were 8 or 9 years old, male (57%), and white (77%), and "most importantly, 26% had a personal history of migraine, which did not occur during the vomiting."

Most of the children (71%) also had a family history of migraine; 10% had a family history of epilepsy.

The episodes occurred an average every 4 weeks. The mean duration of the acute phase was 25 hours, with a mean of 18 vomits during that time, up to 5 per hour. "There was complete resolution of symptoms between the spells in 88% of these children," Dr. Rothner said.

Most children (73%) had a prodromal phase, usually abdominal pain and nausea. There were some identifiable triggers for 66%, including viral illness, and motion sickness. Along with vomiting, 25% of the children had some autonomic symptom, including fever and hypertension.

Of the 42 patients who underwent magnetic resonance imaging, 57% had normal results. "Some of them already had the abnormalities recognized before the disorder began, but none of them had anything to do with the vomiting," Dr. Rothner said.

He and his team also performed abdominal ultrasound on 41 children during the acute phase to rule out intestinal malrotation or volvulus. There were no gastrointestinal abnormalities related to vomiting. Likewise, esophagogastroduodenoscopies in 27 patients showed no serious issues, other than six cases of gastritis.

The investigators aimed to perform metabolic testing of blood and urine during both the well and ill phase in all children. At least some testing was accomplished in 58. One-third of the children tested during the ill or well phase, or during both, showed some sign of mitochondrial dysfunction or abnormal oxidation of fatty acid.

But the results were very difficult to interpret, Dr. Rothner said. "Of the 16 patients who had testing at both phases, 13 had abnormalities. But three showed mitochondrial dysfunction when well and not when ill, four had abnormalities when ill but not when well, and another three had some combination of mitochondrial and fatty acid dysfunction during both times. When we looked at the metabolic testing based on timing, we expected to find more abnormalities at the time of acute illness, but this was not the case. The results were not consistent."

There is no universally accepted treatment for the disorder. "Nothing controls it or makes it go away," Dr. Rothner said. For prophylactic treatment, about half of the group experienced some benefit from amitriptyline. During the acute phase, 85 children tried high-dose oral ondansetron, which improved or resolved symptoms in 66%.

Now, based on the metabolic testing, some of the children in the group also receive carnitine and coenzyme Q10, which Dr. Rothner said confers at least some benefit to about half the group.

The children are part of a continuous study which Dr. Rothner hopes will shed more light on the disorder’s connection with metabolic dysfunction.

He reported having no financial disclosures.

WASHINGTON – About a third of children with cyclic vomiting syndrome appear to have some metabolic condition, either mitochondrial dysfunction, fatty acid oxidation dysfunction, or a combination of both.

Unfortunately, there seems to be neither rhyme nor reason to the pattern. "Some showed the abnormalities only when well, some showed them only when acutely ill, and some showed them all the time," Dr. David Rothner said at the annual meeting of the American Headache Society.

Dr. Rothner, director of the Pediatric/Adolescent Headache Program at the Cleveland Clinic, and his colleagues presented the largest-to-date case series of metabolic testing in children with cyclic vomiting syndrome. Considered one of the three subtypes of migraine, cyclic vomiting is a debilitating illness with no known etiology and virtually no physical abnormalities that account for its occurrence.

The condition is a chronic disorder characterized by repeated, stereotypical vomiting episodes accompanied by severe nausea and sometimes by headache. The four components to the syndrome include: the prodrome, when severe nausea is present; the severe emetic phase; the postemetic phase; and the time between cycles, during which the patient is entirely well.

Most frequently, the vomiting episode begins between 4 and 6 a.m. "During a spell, a child can vomit every 10-15 minutes, for up to 2 days. There is more vomiting with this syndrome than in any other disease known to man."

Diagnosis can only be made by ruling out every possible physical cause. "Often, the time from the first episode until diagnosis can be 3 or 4 years, which is tragic," he said.

The prospective cohort consisted of 106 consecutive patients seen at the clinic from 2007 to 2010. Most were 8 or 9 years old, male (57%), and white (77%), and "most importantly, 26% had a personal history of migraine, which did not occur during the vomiting."

Most of the children (71%) also had a family history of migraine; 10% had a family history of epilepsy.

The episodes occurred an average every 4 weeks. The mean duration of the acute phase was 25 hours, with a mean of 18 vomits during that time, up to 5 per hour. "There was complete resolution of symptoms between the spells in 88% of these children," Dr. Rothner said.

Most children (73%) had a prodromal phase, usually abdominal pain and nausea. There were some identifiable triggers for 66%, including viral illness, and motion sickness. Along with vomiting, 25% of the children had some autonomic symptom, including fever and hypertension.

Of the 42 patients who underwent magnetic resonance imaging, 57% had normal results. "Some of them already had the abnormalities recognized before the disorder began, but none of them had anything to do with the vomiting," Dr. Rothner said.

He and his team also performed abdominal ultrasound on 41 children during the acute phase to rule out intestinal malrotation or volvulus. There were no gastrointestinal abnormalities related to vomiting. Likewise, esophagogastroduodenoscopies in 27 patients showed no serious issues, other than six cases of gastritis.

The investigators aimed to perform metabolic testing of blood and urine during both the well and ill phase in all children. At least some testing was accomplished in 58. One-third of the children tested during the ill or well phase, or during both, showed some sign of mitochondrial dysfunction or abnormal oxidation of fatty acid.

But the results were very difficult to interpret, Dr. Rothner said. "Of the 16 patients who had testing at both phases, 13 had abnormalities. But three showed mitochondrial dysfunction when well and not when ill, four had abnormalities when ill but not when well, and another three had some combination of mitochondrial and fatty acid dysfunction during both times. When we looked at the metabolic testing based on timing, we expected to find more abnormalities at the time of acute illness, but this was not the case. The results were not consistent."

There is no universally accepted treatment for the disorder. "Nothing controls it or makes it go away," Dr. Rothner said. For prophylactic treatment, about half of the group experienced some benefit from amitriptyline. During the acute phase, 85 children tried high-dose oral ondansetron, which improved or resolved symptoms in 66%.

Now, based on the metabolic testing, some of the children in the group also receive carnitine and coenzyme Q10, which Dr. Rothner said confers at least some benefit to about half the group.

The children are part of a continuous study which Dr. Rothner hopes will shed more light on the disorder’s connection with metabolic dysfunction.

He reported having no financial disclosures.

WASHINGTON – About a third of children with cyclic vomiting syndrome appear to have some metabolic condition, either mitochondrial dysfunction, fatty acid oxidation dysfunction, or a combination of both.

Unfortunately, there seems to be neither rhyme nor reason to the pattern. "Some showed the abnormalities only when well, some showed them only when acutely ill, and some showed them all the time," Dr. David Rothner said at the annual meeting of the American Headache Society.

Dr. Rothner, director of the Pediatric/Adolescent Headache Program at the Cleveland Clinic, and his colleagues presented the largest-to-date case series of metabolic testing in children with cyclic vomiting syndrome. Considered one of the three subtypes of migraine, cyclic vomiting is a debilitating illness with no known etiology and virtually no physical abnormalities that account for its occurrence.

The condition is a chronic disorder characterized by repeated, stereotypical vomiting episodes accompanied by severe nausea and sometimes by headache. The four components to the syndrome include: the prodrome, when severe nausea is present; the severe emetic phase; the postemetic phase; and the time between cycles, during which the patient is entirely well.

Most frequently, the vomiting episode begins between 4 and 6 a.m. "During a spell, a child can vomit every 10-15 minutes, for up to 2 days. There is more vomiting with this syndrome than in any other disease known to man."

Diagnosis can only be made by ruling out every possible physical cause. "Often, the time from the first episode until diagnosis can be 3 or 4 years, which is tragic," he said.

The prospective cohort consisted of 106 consecutive patients seen at the clinic from 2007 to 2010. Most were 8 or 9 years old, male (57%), and white (77%), and "most importantly, 26% had a personal history of migraine, which did not occur during the vomiting."

Most of the children (71%) also had a family history of migraine; 10% had a family history of epilepsy.

The episodes occurred an average every 4 weeks. The mean duration of the acute phase was 25 hours, with a mean of 18 vomits during that time, up to 5 per hour. "There was complete resolution of symptoms between the spells in 88% of these children," Dr. Rothner said.

Most children (73%) had a prodromal phase, usually abdominal pain and nausea. There were some identifiable triggers for 66%, including viral illness, and motion sickness. Along with vomiting, 25% of the children had some autonomic symptom, including fever and hypertension.

Of the 42 patients who underwent magnetic resonance imaging, 57% had normal results. "Some of them already had the abnormalities recognized before the disorder began, but none of them had anything to do with the vomiting," Dr. Rothner said.

He and his team also performed abdominal ultrasound on 41 children during the acute phase to rule out intestinal malrotation or volvulus. There were no gastrointestinal abnormalities related to vomiting. Likewise, esophagogastroduodenoscopies in 27 patients showed no serious issues, other than six cases of gastritis.

The investigators aimed to perform metabolic testing of blood and urine during both the well and ill phase in all children. At least some testing was accomplished in 58. One-third of the children tested during the ill or well phase, or during both, showed some sign of mitochondrial dysfunction or abnormal oxidation of fatty acid.

But the results were very difficult to interpret, Dr. Rothner said. "Of the 16 patients who had testing at both phases, 13 had abnormalities. But three showed mitochondrial dysfunction when well and not when ill, four had abnormalities when ill but not when well, and another three had some combination of mitochondrial and fatty acid dysfunction during both times. When we looked at the metabolic testing based on timing, we expected to find more abnormalities at the time of acute illness, but this was not the case. The results were not consistent."

There is no universally accepted treatment for the disorder. "Nothing controls it or makes it go away," Dr. Rothner said. For prophylactic treatment, about half of the group experienced some benefit from amitriptyline. During the acute phase, 85 children tried high-dose oral ondansetron, which improved or resolved symptoms in 66%.

Now, based on the metabolic testing, some of the children in the group also receive carnitine and coenzyme Q10, which Dr. Rothner said confers at least some benefit to about half the group.

The children are part of a continuous study which Dr. Rothner hopes will shed more light on the disorder’s connection with metabolic dysfunction.

He reported having no financial disclosures.