According To Researchers.

NEW ORLEANS—Infants with a maternal history of migraine are more than twice as likely to have colic than infants without such a history, according to a study presented at the 64th Annual Meeting of the American Academy of Neurology. Evidence suggests that infants with a paternal history of migraine also may be more likely to have colic, but the data for this finding are not conclusive.

“Mothers who have a history of migraine can be counseled that their baby may be at higher risk for colic, which may help them prepare better for that possibility,” Amy Gelfand, MD, told Neurology Reviews. “In addition, when evaluating a child with episodic headaches, pediatricians and neurologists can ask about a history of colic during infancy, and this may help lead them toward a diagnosis of migraine sooner, which would allow the child to receive appropriate treatment sooner.” Dr. Gelfand is a pediatric neurologist at the Headache Center of the University of California at San Francisco.

Surveying Parents’ Migraine History
Dr. Gelfand and colleagues sought to determine whether maternal migraine was associated with an increased prevalence of infant colic, or excessive crying in an otherwise healthy infant. To minimize recall bias, Dr. Gelfand assessed colic when babies were six to eight weeks old, when the condition is at its peak.

The investigators administered a one-page survey to mothers who brought their healthy babies to pediatric clinics for two-month checkups. The survey asked the mothers whether their babies had colic according to the modified Wessel criteria (ie, crying for at least three hours a day, for at least three days a week, and for at least one week).

The researchers also asked the mothers (and fathers, when possible) whether a physician had ever diagnosed them with migraine. Because half of migraineurs have not been diagnosed, the investigators incorporated the ID Migraine screener into the survey.

The ID Migraine screener identifies migraineurs based on their responses to three yes-or-no questions. The study’s primary outcome measure was to compare the prevalence of colic among babies with a maternal history of migraine and among babies without this history.

Study Corroborates Previous Estimates of Colic Prevalence
Dr. Gelfand collected 165 surveys and analyzed 154. The prevalence of colic was 14%, which was consistent with previously published estimates. The prevalence of maternal migraine was 18%. Study participants provided paternal data on about 60% of the surveys, and the prevalence of paternal migraine was 10%.

Approximately 29% of infants with a maternal history of migraine had colic, compared with 11% of infants without this history. Dr. Gelfand found no differences in age or sex distribution between babies with and without colic. The magnitude of the effect size was similar to that observed in two previous retrospective studies of children who developed migraine in childhood.

Dr. Gelfand noted that analyzing maternal migraine history instead of following babies to see whether they develop migraine is a limitation of her study. “Ultimately, we do want to follow the babies out, but that takes about a decade to do,” she said.

“As maternal history of migraine was our standard marker for migraine genetics in the baby, I think these results support the hypothesis that infant colic may be an early-life manifestation of migraine genetics in these so-called childhood periodic syndromes,” she added.                   

NEW ORLEANS—Infants with a maternal history of migraine are more than twice as likely to have colic than infants without such a history, according to a study presented at the 64th Annual Meeting of the American Academy of Neurology. Evidence suggests that infants with a paternal history of migraine also may be more likely to have colic, but the data for this finding are not conclusive.

“Mothers who have a history of migraine can be counseled that their baby may be at higher risk for colic, which may help them prepare better for that possibility,” Amy Gelfand, MD, told Neurology Reviews. “In addition, when evaluating a child with episodic headaches, pediatricians and neurologists can ask about a history of colic during infancy, and this may help lead them toward a diagnosis of migraine sooner, which would allow the child to receive appropriate treatment sooner.” Dr. Gelfand is a pediatric neurologist at the Headache Center of the University of California at San Francisco.

Surveying Parents’ Migraine History
Dr. Gelfand and colleagues sought to determine whether maternal migraine was associated with an increased prevalence of infant colic, or excessive crying in an otherwise healthy infant. To minimize recall bias, Dr. Gelfand assessed colic when babies were six to eight weeks old, when the condition is at its peak.

The investigators administered a one-page survey to mothers who brought their healthy babies to pediatric clinics for two-month checkups. The survey asked the mothers whether their babies had colic according to the modified Wessel criteria (ie, crying for at least three hours a day, for at least three days a week, and for at least one week).

The researchers also asked the mothers (and fathers, when possible) whether a physician had ever diagnosed them with migraine. Because half of migraineurs have not been diagnosed, the investigators incorporated the ID Migraine screener into the survey.

The ID Migraine screener identifies migraineurs based on their responses to three yes-or-no questions. The study’s primary outcome measure was to compare the prevalence of colic among babies with a maternal history of migraine and among babies without this history.

Study Corroborates Previous Estimates of Colic Prevalence
Dr. Gelfand collected 165 surveys and analyzed 154. The prevalence of colic was 14%, which was consistent with previously published estimates. The prevalence of maternal migraine was 18%. Study participants provided paternal data on about 60% of the surveys, and the prevalence of paternal migraine was 10%.

Approximately 29% of infants with a maternal history of migraine had colic, compared with 11% of infants without this history. Dr. Gelfand found no differences in age or sex distribution between babies with and without colic. The magnitude of the effect size was similar to that observed in two previous retrospective studies of children who developed migraine in childhood.

Dr. Gelfand noted that analyzing maternal migraine history instead of following babies to see whether they develop migraine is a limitation of her study. “Ultimately, we do want to follow the babies out, but that takes about a decade to do,” she said.

“As maternal history of migraine was our standard marker for migraine genetics in the baby, I think these results support the hypothesis that infant colic may be an early-life manifestation of migraine genetics in these so-called childhood periodic syndromes,” she added.                   

NEW ORLEANS—Infants with a maternal history of migraine are more than twice as likely to have colic than infants without such a history, according to a study presented at the 64th Annual Meeting of the American Academy of Neurology. Evidence suggests that infants with a paternal history of migraine also may be more likely to have colic, but the data for this finding are not conclusive.

“Mothers who have a history of migraine can be counseled that their baby may be at higher risk for colic, which may help them prepare better for that possibility,” Amy Gelfand, MD, told Neurology Reviews. “In addition, when evaluating a child with episodic headaches, pediatricians and neurologists can ask about a history of colic during infancy, and this may help lead them toward a diagnosis of migraine sooner, which would allow the child to receive appropriate treatment sooner.” Dr. Gelfand is a pediatric neurologist at the Headache Center of the University of California at San Francisco.

Surveying Parents’ Migraine History
Dr. Gelfand and colleagues sought to determine whether maternal migraine was associated with an increased prevalence of infant colic, or excessive crying in an otherwise healthy infant. To minimize recall bias, Dr. Gelfand assessed colic when babies were six to eight weeks old, when the condition is at its peak.

The investigators administered a one-page survey to mothers who brought their healthy babies to pediatric clinics for two-month checkups. The survey asked the mothers whether their babies had colic according to the modified Wessel criteria (ie, crying for at least three hours a day, for at least three days a week, and for at least one week).

The researchers also asked the mothers (and fathers, when possible) whether a physician had ever diagnosed them with migraine. Because half of migraineurs have not been diagnosed, the investigators incorporated the ID Migraine screener into the survey.

The ID Migraine screener identifies migraineurs based on their responses to three yes-or-no questions. The study’s primary outcome measure was to compare the prevalence of colic among babies with a maternal history of migraine and among babies without this history.

Study Corroborates Previous Estimates of Colic Prevalence
Dr. Gelfand collected 165 surveys and analyzed 154. The prevalence of colic was 14%, which was consistent with previously published estimates. The prevalence of maternal migraine was 18%. Study participants provided paternal data on about 60% of the surveys, and the prevalence of paternal migraine was 10%.

Approximately 29% of infants with a maternal history of migraine had colic, compared with 11% of infants without this history. Dr. Gelfand found no differences in age or sex distribution between babies with and without colic. The magnitude of the effect size was similar to that observed in two previous retrospective studies of children who developed migraine in childhood.

Dr. Gelfand noted that analyzing maternal migraine history instead of following babies to see whether they develop migraine is a limitation of her study. “Ultimately, we do want to follow the babies out, but that takes about a decade to do,” she said.

“As maternal history of migraine was our standard marker for migraine genetics in the baby, I think these results support the hypothesis that infant colic may be an early-life manifestation of migraine genetics in these so-called childhood periodic syndromes,” she added.                   

NEW ORLEANS—Severe anemia increases a patient’s risk of dying in the hospital following a stroke by approximately three and a half times, researchers reported at the 2012 International Stroke Conference. After discharge following a stroke, a patient with severe anemia is about two and a half times more likely to die within a year than a healthy patient.

“Having a history of severe anemia is a potent predictor of dying anytime throughout the first year—more potent than having heart disease, and more potent than having cancer,” said Jason J. Sico, MD, Assistant Professor of Neurology and Internal Medicine at the Yale School of Medicine in New Haven, Connecticut.

Patients with moderate or mild anemia also have a higher risk of death at six months and one year after a stroke, noted Dr. Sico. In addition, a patient with a high hematocrit value is nearly three times more likely to die in the hospital after a stroke than one with a normal hematocrit level.

Stroke, Anemia, and Mortality
Previous studies revealed a link between anemia and mortality after a stroke, but most did not control for medical comorbidities and stroke severity. Dr. Sico and his colleagues sought to adjust for these variables to gain a clearer understanding of how anemia affects a stroke patient’s survival.

The team conducted a retrospective cohort study using data from more than 3,800 patients with stroke admitted to 131 Veterans’ Health Administration hospitals in 2007. The investigators defined the normal hematocrit range as 37% to 42%. Patients with a hematocrit level between 32% and 37% were considered to have mild anemia, those with a hematocrit value between 27% and 32% were considered to have moderate anemia, and those with a hematocrit level lower than 27% were considered to have severe anemia. A hematocrit value greater than 47% was defined as polycythemia. The researchers used multivariate logistic models to examine patients’ mortality during hospitalization, at 30 days, at six months, and at one year.

Patients With Anemia Should Be Monitored After Stroke
Anemia might reduce survival after a stroke in several ways, according to Dr. Sico. Low hematocrit levels decrease the amount of oxygen that the brain receives, increase heart rate, and sometimes cause high blood pressure. In addition, anemia “impairs the way the blood vessel to the brain can react to having a stroke,” observed Dr. Sico.

Although the large data set is one of the study’s strengths, the patient population included so few women that the investigators decided to exclude them from the analysis. “The results of this current study are applicable only to men. Studies examining how low and high hematocrits influence mortality in women with stroke are needed,” said Dr. Sico.

If a patient with stroke has anemia or polycythemia, a physician should determine whether the latter conditions are reversible and should be treated, said Dr. Sico. “Based on the study that we have available, we can’t say that you should give a blood transfusion to your patients,” he added. Physicians should monitor patients with anemia or polycythemia closely during the period after their strokes, Dr. Sico advised. “We want to be sure that they’re stroke survivors,” he concluded.

NEW ORLEANS—Severe anemia increases a patient’s risk of dying in the hospital following a stroke by approximately three and a half times, researchers reported at the 2012 International Stroke Conference. After discharge following a stroke, a patient with severe anemia is about two and a half times more likely to die within a year than a healthy patient.

“Having a history of severe anemia is a potent predictor of dying anytime throughout the first year—more potent than having heart disease, and more potent than having cancer,” said Jason J. Sico, MD, Assistant Professor of Neurology and Internal Medicine at the Yale School of Medicine in New Haven, Connecticut.

Patients with moderate or mild anemia also have a higher risk of death at six months and one year after a stroke, noted Dr. Sico. In addition, a patient with a high hematocrit value is nearly three times more likely to die in the hospital after a stroke than one with a normal hematocrit level.

Stroke, Anemia, and Mortality
Previous studies revealed a link between anemia and mortality after a stroke, but most did not control for medical comorbidities and stroke severity. Dr. Sico and his colleagues sought to adjust for these variables to gain a clearer understanding of how anemia affects a stroke patient’s survival.

The team conducted a retrospective cohort study using data from more than 3,800 patients with stroke admitted to 131 Veterans’ Health Administration hospitals in 2007. The investigators defined the normal hematocrit range as 37% to 42%. Patients with a hematocrit level between 32% and 37% were considered to have mild anemia, those with a hematocrit value between 27% and 32% were considered to have moderate anemia, and those with a hematocrit level lower than 27% were considered to have severe anemia. A hematocrit value greater than 47% was defined as polycythemia. The researchers used multivariate logistic models to examine patients’ mortality during hospitalization, at 30 days, at six months, and at one year.

Patients With Anemia Should Be Monitored After Stroke
Anemia might reduce survival after a stroke in several ways, according to Dr. Sico. Low hematocrit levels decrease the amount of oxygen that the brain receives, increase heart rate, and sometimes cause high blood pressure. In addition, anemia “impairs the way the blood vessel to the brain can react to having a stroke,” observed Dr. Sico.

Although the large data set is one of the study’s strengths, the patient population included so few women that the investigators decided to exclude them from the analysis. “The results of this current study are applicable only to men. Studies examining how low and high hematocrits influence mortality in women with stroke are needed,” said Dr. Sico.

If a patient with stroke has anemia or polycythemia, a physician should determine whether the latter conditions are reversible and should be treated, said Dr. Sico. “Based on the study that we have available, we can’t say that you should give a blood transfusion to your patients,” he added. Physicians should monitor patients with anemia or polycythemia closely during the period after their strokes, Dr. Sico advised. “We want to be sure that they’re stroke survivors,” he concluded.

NEW ORLEANS—Severe anemia increases a patient’s risk of dying in the hospital following a stroke by approximately three and a half times, researchers reported at the 2012 International Stroke Conference. After discharge following a stroke, a patient with severe anemia is about two and a half times more likely to die within a year than a healthy patient.

“Having a history of severe anemia is a potent predictor of dying anytime throughout the first year—more potent than having heart disease, and more potent than having cancer,” said Jason J. Sico, MD, Assistant Professor of Neurology and Internal Medicine at the Yale School of Medicine in New Haven, Connecticut.

Patients with moderate or mild anemia also have a higher risk of death at six months and one year after a stroke, noted Dr. Sico. In addition, a patient with a high hematocrit value is nearly three times more likely to die in the hospital after a stroke than one with a normal hematocrit level.

Stroke, Anemia, and Mortality
Previous studies revealed a link between anemia and mortality after a stroke, but most did not control for medical comorbidities and stroke severity. Dr. Sico and his colleagues sought to adjust for these variables to gain a clearer understanding of how anemia affects a stroke patient’s survival.

The team conducted a retrospective cohort study using data from more than 3,800 patients with stroke admitted to 131 Veterans’ Health Administration hospitals in 2007. The investigators defined the normal hematocrit range as 37% to 42%. Patients with a hematocrit level between 32% and 37% were considered to have mild anemia, those with a hematocrit value between 27% and 32% were considered to have moderate anemia, and those with a hematocrit level lower than 27% were considered to have severe anemia. A hematocrit value greater than 47% was defined as polycythemia. The researchers used multivariate logistic models to examine patients’ mortality during hospitalization, at 30 days, at six months, and at one year.

Patients With Anemia Should Be Monitored After Stroke
Anemia might reduce survival after a stroke in several ways, according to Dr. Sico. Low hematocrit levels decrease the amount of oxygen that the brain receives, increase heart rate, and sometimes cause high blood pressure. In addition, anemia “impairs the way the blood vessel to the brain can react to having a stroke,” observed Dr. Sico.

Although the large data set is one of the study’s strengths, the patient population included so few women that the investigators decided to exclude them from the analysis. “The results of this current study are applicable only to men. Studies examining how low and high hematocrits influence mortality in women with stroke are needed,” said Dr. Sico.

If a patient with stroke has anemia or polycythemia, a physician should determine whether the latter conditions are reversible and should be treated, said Dr. Sico. “Based on the study that we have available, we can’t say that you should give a blood transfusion to your patients,” he added. Physicians should monitor patients with anemia or polycythemia closely during the period after their strokes, Dr. Sico advised. “We want to be sure that they’re stroke survivors,” he concluded.