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Background: Burden of headache has been assessed in adults in countries worldwide, and is high, but data for children and adolescents are sparse. The objectives of this study were o develop a questionnaire and methodology for the global estimation of burden of headache in children and adolescents, to test these in use and to present preliminary data., Methods: We designed structured questionnaires for mediated-group self-administration in schools by children aged 6-11 years and adolescents aged 12-17 years. In two pilot studies, we offered the questionnaires to pupils in Vienna and Istanbul. We performed face-to-face interviews in a randomly selected subsample of 199 pupils to validate the headache diagnostic questions., Results: Data were collected from 1,202 pupils (mean 13.9 ± 2.4 years; 621 female, 581 male). The participation rate was 81.1% in Istanbul, 67.2% in Vienna. The questionnaire proved acceptable: ≤5% of participants disagreed partially or totally with its length, comprehensibility or simplicity. The sensitivity, specificity, positive and negative predictive values ranged between 0.71 and 0.76 for migraine and between 0.61 and 0.85 for tension-type headache (TTH). Cronbach's alpha was 0.83. The 1-year prevalence of headache was 89.3%, of migraine 39.3% and of TTH 37.9%. The prevalence of headache on ≥15 days/month was 4.5%. One fifth (20.7%) of pupils with headache lost ≥1 day of school during the preceding 4 weeks and nearly half (48.8%) reported ≥1 day when they could not do activities they had wanted to. The vast majority of pupils with headache experienced difficulties in coping with headache and in concentrating during headache. Quality of life was poorer in pupils with headache than in those without., Conclusion: These pilot studies demonstrate the usefulness of the questionnaires and feasibility of the methodology for assessing the global burden of headache in children and adolescents, and predict substantial impact of headache in these age groups.

Background: The supportive clinical and pathophysiological data about the correlation between migraine and atopic disorders are far from a coincidence. In order to determine and investigate the correlates of atopic disorders in a specific dataset, we performed this retrospective cross-sectional clinical-based study., Methods: The dataset was composed from three tertiary center web-based databases (http://www.childhoodheadache.org). Headache diagnosis and differential diagnosis were made according to the International Classification of Headache Disorders, 2nd version and the Diagnostic Statistical Manual of Mental Disorders, 5th edition. Migraine with aura, migraine without aura, chronic migraine and episodic and chronic tension type headache (TTH) patients were included. All other causes of headache disorders, including comorbid headache disorders like migraine plus TTH or "possible" causes of headache, were excluded., Results: The study included 438 patients with migraine and 357 patients with TTH, whose age and sex distribution were identical. After descriptive statistics accordingly, 80 migraine (18.2%) and 23 TTH (6.4%) patients were found to have specific atopic disorders (P < 0.001). Atopic disorders are more commonly reported in patients with migraine with aura (21.6%) than those with migraine without aura and TTH (P < 0.001). The most common atopic disorders were seasonal rhinitis, conjunctivitis and asthma. There was also a close correlation between TTH with atopic disorders and psychiatric comorbid disorders of the patients., Conclusions: Although the International Classification of Headache Disorders, 2nd version, does not specify, atopic disorders should be suspected in all migraine patients and their relatives, not only for accurate diagnosis but also for planning prophylactic medications, such as β-blockers., (© 2014 Japan Pediatric Society.)

Objectives: To assess the presence, prevalence and clinical characteristics of primary headaches in pediatric patients with chronic rheumatic diseases such as juvenile idiopathic arthritis (JIA) and familial Mediterranean fever (FMF), and to analyze the common pathophysiological mechanisms., Study Design: In this noncontrolled, cross-sectional study, a semi-structured 53 item headache questionnaire was administered to subjects with FMF and JIA, and interviewed a total sample size of 601 patients younger than16years of age. The questionnaires were then analyzed according to the International Headache Society's diagnostic criteria., Results: Children with FMF (n=378) and JIA (n=223) were studied. Each group was then divided into two subgroups according to whether the subjects reported headache or not. 29.5% of subjects with FMF reported having migraine, 37.6% probable migraine and 32.9% tension type headache (TTH). In JIA group 28.2% were diagnosed with migraine; 41.2% with probable migraine and 30.6% with TTH. No significant difference was found between all subjects with (n=258) and without (n=343) headache for variables such as living in a crowded family (p=0.95), being the first child in the family (p=0.63), academic achievement of the child (p=0.63), high education level (higher than high school) of the mother (p=0.52) and father (p=0.46). The presence of systemic disease was reported not to be effecting the daily life at the time of evaluation by 90.2% of the children with headache and 91.0% of the children without headache (p=0.94). 81.4% of the children reported their headaches were not aggravating with the exacerbation periods of their systemic disease. Family history of hypertension was reported higher by the subjects with headache (13.5% with headache and 4.0% without headache p=0.001). Diabetes mellitus was also reported higher (5.8% with headache; 0.5% without headache; p=0.006). Family history of headache was reported in 28.2% of the patients with headache whereas it was 17.4% of the patients without headache (p<0.001). Family history of headache was reported in 28.2% of the FMF subjects with headache whereas it was 17.4% of the patients without headache (p<0.001). For JIA patients a positive family history for headache was obtained in 25.9% of children with headache notably in migraineurs (81.8%)., Conclusion: Patients with JIA and FMF should be asked specifically about accompanying primary headaches particularly migraine headaches as they may be additional disabilities for these patients., (Copyright © 2014 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)

Background and Purpose: An inverse association between 25-hydroxyvitamin D (25[OH]D) levels and stroke was emphasized in recent studies. Our objective was to determine the rate of Vitamin D deficiency and risk of associated osteoporosis among stroke survivors in a nationally representative population., Methods: Participants from the National Health and Nutritional Examination Survey (NHANES) from 2001 to 2006 were included. Stroke survivors were then divided into two groups depending on serum 25(OH)D levels: <30 ng/dl as Vitamin D deficiency and ≥30 ng/dl as normal. Comparisons of demographics and risk factors between two groups were performed using SAS software. Multivariate analysis was performed to determine the association between Vitamin D deficiency and osteopororis in stroke survivors after adjusting for potential confounding factors., Results: There were 415 (4.0%) stroke survivors among 10,255 participants in NHANES. The mean age (±SD) of stroke survivors was 67.6 (±17.3) years and 211 (50.8%) were men. Mean 25(OH)D concentrations were not significantly different in patients with stroke (20.3 versus 21.8 ng/ml, p = 0.65) although the rate of osteoporosis was significantly higher among stroke survivors (17.9% versus 6.9%, p < 0.0001). Out of 415 stroke patients, Vitamin D deficiency was seen in 71.0% of patients. The rates of osteoporosis were similar between patients with or without Vitamin D deficiency. After adjusting for potential confounders, there was no association between Vitamin D deficiency and osteoporosis., Conclusions: Vitamin D deficiency and osteoporosis are highly prevalent among stroke survivors; however, there does not appear to be a relationship between the two entities.

Background: Comorbidity of migraine with anxiety and depression may play a role in the link between migraine and obesity. We examined the moderating and mediating roles of ghrelin in the relationship between depression (and anxiety) and body weight in newly diagnosed migraineurs., Methods: Participants were 63 newly diagnosed migraine patients (using the ICHD-II criteria) and 42 healthy volunteers. Body mass index (BMI) was calculated by measuring height and weight. Ghrelin was assessed at fasting. Depression was assessed with the Hamilton Depression scale, and anxiety with the Hamilton Anxiety scale., Results: The data did not support the mediating role of ghrelin in the relationship between depression (or anxiety) and BMI for either the migraine or the control group. The interaction between ghrelin and depression as well as anxiety was significant for the migraine group, but not for the control group. Depressed (or anxious) migraineurs had a positive association between ghrelin and BMI, whereas for the non-depressed (or non-anxious) migraineurs this association was negative., Conclusions: Depression and anxiety moderated the effect of ghrelin on BMI for migraineurs. Management of anxiety and depression might be regarded as part of migraine treatment.

Objectives: To determine neuropathy frequency with electromyography (EMG) in asymptomatic diabetic children, and to demonstrate whether the electromyographical abnormalities noted improve after L-carnitine treatment., Patients and Methods: This study was carried out on 51 type 1 diabetes mellitus patients (of whom, 26 were female; average age 12) and 21 healthy children as the control group. Thirty four patients, whose nerve conduction velocity (NCS) was diagnosed as pathological, were treated with L-carnitine (dosage: 2 g/m2/day) for two months and their NCS checked at the end of the treatment period., Results: At least one electrophysiological parameter was abnormal in 38 out of 51 patients (74.6%). At the end of the treatment, Stage 1 a patients (NCS pathologic and neurologic examination normal) demonstrated a 44% improvement in all pathologic NCS parameters and a 50% improvement in sympathetic skin responses (SSR), while in Stage 1 b patients (NCS and neurologic examination pathologic) a matching ratio of improvement was detected in SSR but no definite improvement was noted in the all pathologic NCS parameters., Conclusion: Starting carnitine treatment in the early stages may be more effective in the treatment of sub-clinical neuropathy. A two-month treatment period may not be sufficient in detecting an electrophysiological improvement in cases where neurological deficits had been determined