Ben Abramoff

LOS ANGELES – New daily persistent headache in children and adolescents appeared to be most often caused by a physical stress, viral illness, or minor head trauma, according to study findings reported by Dr. Kenneth Mack at the annual meeting of the American Headache Society.

Illnesses preceded the onset of new daily persistent headache (NDPH) in 43% of the 40 patients studied (range 12–18 years). Most common was infection with the Epstein Barr virus, accounting for more than half of those illnesses, said Dr. Mack, a neurologist at the Mayo Clinic, Rochester, Minn.

Minor head trauma accounted for 23%, while head surgery and idiopathic intracranial hypertension each was associated with 10% of the cases.

The onset of NDPH followed an appendectomy in one patient and high altitude climbing in another. Five patients had no identifiable inciting events.

Dr. Mack compared his results from this study with a follow-up study of 94 children (aged 7–18 years) who had a history of episodic migraines that evolved into transformed migraines.

He found that the transformed migraines that were abruptly triggered followed an illness 46% of the time and were triggered by minor head trauma 18% of the time, while individual cases were triggered by idiopathic intracranial hypertension or developed after surgery. In 25% of cases there were no identifiable preceding events.

Other etiologies that have been proposed for the onset of daily headache include analgesic overuse, psychological stress, caffeine, alcohol, and hypothyroidism, but Dr. Mack found no evidence of these in his study.

Dr. Mack noted that the onset of symptoms of NDPH and transformed migraines are very similar, as are the comorbid symptoms. He proposed that this may indicate that NDPH may be one of the first signs of transformed migraine in some patients.

LOS ANGELES – New daily persistent headache in children and adolescents appeared to be most often caused by a physical stress, viral illness, or minor head trauma, according to study findings reported by Dr. Kenneth Mack at the annual meeting of the American Headache Society.

Illnesses preceded the onset of new daily persistent headache (NDPH) in 43% of the 40 patients studied (range 12–18 years). Most common was infection with the Epstein Barr virus, accounting for more than half of those illnesses, said Dr. Mack, a neurologist at the Mayo Clinic, Rochester, Minn.

Minor head trauma accounted for 23%, while head surgery and idiopathic intracranial hypertension each was associated with 10% of the cases.

The onset of NDPH followed an appendectomy in one patient and high altitude climbing in another. Five patients had no identifiable inciting events.

Dr. Mack compared his results from this study with a follow-up study of 94 children (aged 7–18 years) who had a history of episodic migraines that evolved into transformed migraines.

He found that the transformed migraines that were abruptly triggered followed an illness 46% of the time and were triggered by minor head trauma 18% of the time, while individual cases were triggered by idiopathic intracranial hypertension or developed after surgery. In 25% of cases there were no identifiable preceding events.

Other etiologies that have been proposed for the onset of daily headache include analgesic overuse, psychological stress, caffeine, alcohol, and hypothyroidism, but Dr. Mack found no evidence of these in his study.

Dr. Mack noted that the onset of symptoms of NDPH and transformed migraines are very similar, as are the comorbid symptoms. He proposed that this may indicate that NDPH may be one of the first signs of transformed migraine in some patients.

LOS ANGELES – New daily persistent headache in children and adolescents appeared to be most often caused by a physical stress, viral illness, or minor head trauma, according to study findings reported by Dr. Kenneth Mack at the annual meeting of the American Headache Society.

Illnesses preceded the onset of new daily persistent headache (NDPH) in 43% of the 40 patients studied (range 12–18 years). Most common was infection with the Epstein Barr virus, accounting for more than half of those illnesses, said Dr. Mack, a neurologist at the Mayo Clinic, Rochester, Minn.

Minor head trauma accounted for 23%, while head surgery and idiopathic intracranial hypertension each was associated with 10% of the cases.

The onset of NDPH followed an appendectomy in one patient and high altitude climbing in another. Five patients had no identifiable inciting events.

Dr. Mack compared his results from this study with a follow-up study of 94 children (aged 7–18 years) who had a history of episodic migraines that evolved into transformed migraines.

He found that the transformed migraines that were abruptly triggered followed an illness 46% of the time and were triggered by minor head trauma 18% of the time, while individual cases were triggered by idiopathic intracranial hypertension or developed after surgery. In 25% of cases there were no identifiable preceding events.

Other etiologies that have been proposed for the onset of daily headache include analgesic overuse, psychological stress, caffeine, alcohol, and hypothyroidism, but Dr. Mack found no evidence of these in his study.

Dr. Mack noted that the onset of symptoms of NDPH and transformed migraines are very similar, as are the comorbid symptoms. He proposed that this may indicate that NDPH may be one of the first signs of transformed migraine in some patients.

LOS ANGELES – An over-the-counter herbal supplement touted for headache relief proved reasonably effective in treating migraines, Dr. Sheena Aurora reported at the annual meeting of the American Headache Society.

Dr. Aurora, of the Swedish Headache Center in Seattle, conducted a randomized, placebo-controlled study in which 26 patients were randomized to take GelStat Migraine or a placebo at the onset of an acute migraine headache.

Among 13 patients receiving GelStat Migraine, 8 reported headache relief after 2 hours, compared with 5 placebo patients, a statistically significant result, the investigator reported.

GelStat Migraine, a combination of ginger extract (12.5 mg) and feverfew (2.0 mg), is available in a gel-filled liquid capsule that is held under the tongue for 5–10 minutes and then swallowed.

“We think for a short benefit for somebody who's having a lot of headaches this is a safe and effective therapy,” Dr. Aurora said. “Say someone doesn't have their triptan with them. It probably gives them enough time and it doesn't have any interactions, so conceivably they could take the GelStat so they can get home.”

Although the mechanism of GelStat Migraine is not completely understood, feverfew seems to be a very nonspecific blocker of the transcription of inflammatory proteins, the investigator concluded.

Dr. Aurora's study was funded by GelStat Corp.

LOS ANGELES – An over-the-counter herbal supplement touted for headache relief proved reasonably effective in treating migraines, Dr. Sheena Aurora reported at the annual meeting of the American Headache Society.

Dr. Aurora, of the Swedish Headache Center in Seattle, conducted a randomized, placebo-controlled study in which 26 patients were randomized to take GelStat Migraine or a placebo at the onset of an acute migraine headache.

Among 13 patients receiving GelStat Migraine, 8 reported headache relief after 2 hours, compared with 5 placebo patients, a statistically significant result, the investigator reported.

GelStat Migraine, a combination of ginger extract (12.5 mg) and feverfew (2.0 mg), is available in a gel-filled liquid capsule that is held under the tongue for 5–10 minutes and then swallowed.

“We think for a short benefit for somebody who's having a lot of headaches this is a safe and effective therapy,” Dr. Aurora said. “Say someone doesn't have their triptan with them. It probably gives them enough time and it doesn't have any interactions, so conceivably they could take the GelStat so they can get home.”

Although the mechanism of GelStat Migraine is not completely understood, feverfew seems to be a very nonspecific blocker of the transcription of inflammatory proteins, the investigator concluded.

Dr. Aurora's study was funded by GelStat Corp.

LOS ANGELES – An over-the-counter herbal supplement touted for headache relief proved reasonably effective in treating migraines, Dr. Sheena Aurora reported at the annual meeting of the American Headache Society.

Dr. Aurora, of the Swedish Headache Center in Seattle, conducted a randomized, placebo-controlled study in which 26 patients were randomized to take GelStat Migraine or a placebo at the onset of an acute migraine headache.

Among 13 patients receiving GelStat Migraine, 8 reported headache relief after 2 hours, compared with 5 placebo patients, a statistically significant result, the investigator reported.

GelStat Migraine, a combination of ginger extract (12.5 mg) and feverfew (2.0 mg), is available in a gel-filled liquid capsule that is held under the tongue for 5–10 minutes and then swallowed.

“We think for a short benefit for somebody who's having a lot of headaches this is a safe and effective therapy,” Dr. Aurora said. “Say someone doesn't have their triptan with them. It probably gives them enough time and it doesn't have any interactions, so conceivably they could take the GelStat so they can get home.”

Although the mechanism of GelStat Migraine is not completely understood, feverfew seems to be a very nonspecific blocker of the transcription of inflammatory proteins, the investigator concluded.

Dr. Aurora's study was funded by GelStat Corp.

LOS ANGELES – Nearly 40% of soldiers had migraines or probable migraines during their tours of duty in Iraq, but few had a history of migraines before their deployments, Capt. Brett Theeler, MC, USA, reported at the annual meeting of the American Headache Society.

Nineteen percent of the 2,687 soldiers surveyed upon their return met the criteria for definite migraines, 18% had probable migraines, and 11%, nonmigraine- type headaches. Those with definite migraines had an average of 3.5 migraine days/month, reported Capt. Theeler, of the Madigan Army Medical Center, Tacoma, Wash., who collaborated on the research.

Just 5% of the soldiers had a history of migraine headaches prior to their deployments to Iraq.

After returning home from Iraq, soldiers are sent through a medical processing site. Members of one brigade completed a validated 17-question survey about headaches. Based on their survey responses, soldiers were divided three groups: definite migraines, probable migraines, or nonmigraine headaches, a system of classification similar to that used in the American Migraine Study.

The mean age of respondents was 27. The group was 95% male and 5% female

Capt. Theeler deemed the results “very surprising.” He noted that soldiers rated their migraine headaches as a mean 6.5 on a 10-point severity scale, lasting an average of 5.2 hours. Yet only 2% received triptans, the standard of care for the treatment of acute migraines.

Over a 3-month period in Iraq, soldiers made 603 headache-related sick call visits, with most being due to definite migraines.

Some of the causes of headaches among soldiers in Iraq are similar to “common migraine triggers for the general population: stress, heat, irregular diets. All those things are, of course, present in Iraq,” Capt. Theeler noted in an interview.

Findings from a 3-month follow-up survey indicate that many soldiers continue to have elevated rates of migraines after their return stateside.

“Now that we've recognized the problem, we need to go forward with treatments and proven study protocols to figure out why this is going on, and especially, what we can do,” Capt. Theeler said.

“We've already started educating troop commanders and troop medical providers, and our goal is to actually educate soldiers to help them get better treatment … while they're deployed and when they come home.”

LOS ANGELES – Nearly 40% of soldiers had migraines or probable migraines during their tours of duty in Iraq, but few had a history of migraines before their deployments, Capt. Brett Theeler, MC, USA, reported at the annual meeting of the American Headache Society.

Nineteen percent of the 2,687 soldiers surveyed upon their return met the criteria for definite migraines, 18% had probable migraines, and 11%, nonmigraine- type headaches. Those with definite migraines had an average of 3.5 migraine days/month, reported Capt. Theeler, of the Madigan Army Medical Center, Tacoma, Wash., who collaborated on the research.

Just 5% of the soldiers had a history of migraine headaches prior to their deployments to Iraq.

After returning home from Iraq, soldiers are sent through a medical processing site. Members of one brigade completed a validated 17-question survey about headaches. Based on their survey responses, soldiers were divided three groups: definite migraines, probable migraines, or nonmigraine headaches, a system of classification similar to that used in the American Migraine Study.

The mean age of respondents was 27. The group was 95% male and 5% female

Capt. Theeler deemed the results “very surprising.” He noted that soldiers rated their migraine headaches as a mean 6.5 on a 10-point severity scale, lasting an average of 5.2 hours. Yet only 2% received triptans, the standard of care for the treatment of acute migraines.

Over a 3-month period in Iraq, soldiers made 603 headache-related sick call visits, with most being due to definite migraines.

Some of the causes of headaches among soldiers in Iraq are similar to “common migraine triggers for the general population: stress, heat, irregular diets. All those things are, of course, present in Iraq,” Capt. Theeler noted in an interview.

Findings from a 3-month follow-up survey indicate that many soldiers continue to have elevated rates of migraines after their return stateside.

“Now that we've recognized the problem, we need to go forward with treatments and proven study protocols to figure out why this is going on, and especially, what we can do,” Capt. Theeler said.

“We've already started educating troop commanders and troop medical providers, and our goal is to actually educate soldiers to help them get better treatment … while they're deployed and when they come home.”

LOS ANGELES – Nearly 40% of soldiers had migraines or probable migraines during their tours of duty in Iraq, but few had a history of migraines before their deployments, Capt. Brett Theeler, MC, USA, reported at the annual meeting of the American Headache Society.

Nineteen percent of the 2,687 soldiers surveyed upon their return met the criteria for definite migraines, 18% had probable migraines, and 11%, nonmigraine- type headaches. Those with definite migraines had an average of 3.5 migraine days/month, reported Capt. Theeler, of the Madigan Army Medical Center, Tacoma, Wash., who collaborated on the research.

Just 5% of the soldiers had a history of migraine headaches prior to their deployments to Iraq.

After returning home from Iraq, soldiers are sent through a medical processing site. Members of one brigade completed a validated 17-question survey about headaches. Based on their survey responses, soldiers were divided three groups: definite migraines, probable migraines, or nonmigraine headaches, a system of classification similar to that used in the American Migraine Study.

The mean age of respondents was 27. The group was 95% male and 5% female

Capt. Theeler deemed the results “very surprising.” He noted that soldiers rated their migraine headaches as a mean 6.5 on a 10-point severity scale, lasting an average of 5.2 hours. Yet only 2% received triptans, the standard of care for the treatment of acute migraines.

Over a 3-month period in Iraq, soldiers made 603 headache-related sick call visits, with most being due to definite migraines.

Some of the causes of headaches among soldiers in Iraq are similar to “common migraine triggers for the general population: stress, heat, irregular diets. All those things are, of course, present in Iraq,” Capt. Theeler noted in an interview.

Findings from a 3-month follow-up survey indicate that many soldiers continue to have elevated rates of migraines after their return stateside.

“Now that we've recognized the problem, we need to go forward with treatments and proven study protocols to figure out why this is going on, and especially, what we can do,” Capt. Theeler said.

“We've already started educating troop commanders and troop medical providers, and our goal is to actually educate soldiers to help them get better treatment … while they're deployed and when they come home.”