Burden of cardiovascular risk factors and cardiovascular disease in childhood cancer survivors: data from the German CVSS-study.

Aims: The cardiac and vascular late sequelae in long-term survivors of childhood cancer (CVSS)-study aimed to quantify the prevalence of cardiovascular risk factors (CVRF) and cardiovascular disease (CVD) in German childhood cancer survivors (CCS). Methods and results: In the CVSS-study (NCT02181049), 1002 CCS (age range 23-48 years) diagnosed with neoplasia prior to 15 years of age between 1980 and 1990 prospectively underwent a systematic, standardized clinical and laboratory cardiovascular screening, identical to the population-based Gutenberg Health Study (GHS) cohort. For 951 individuals, prevalences of CVRF and CVD were primarily compared to the GHS sample and to two further German population-based cohorts. Using log-binomial regression models, an increased risk for occurrence of arterial hypertension [relative risk (RR) 1.38, 95% confidence interval (95% CI 1.21-1.57)] and dyslipidaemia [RR 1.26 (95% CI 1.12-1.42)] was found. This indicates a premature occurrence compared to the general population of approximately 6 and 8 years, respectively [rate advancement period estimator, RAPhypertension 5.75 (95% CI 3.5-8.0) and RAPdyslipidaemia 8.16 (95% CI 4.4-11.9)]. Overall, no differences were observed for obesity and diabetes. Overt CVD was present in 4.5% (95% CI 3.0-6.6%) of CCS [RR 1.89 (95% CI 1.34-2.66), RAPCVD 7.9 (95% CI 4.1-11.7)], of which the most frequent entities were congestive heart failure and venous thromboembolism. Prevalences of CVRF and CVD increased with age without reaching a plateau over time. Conclusion: This large CCS screening examination revealed consistently in comparison to three population samples a considerably increased risk for premature CVD. The findings in these young adult CCS indicate a high burden of cardiovascular morbidity and mortality in the long term. Clinicaltrials. gov-Nr: NCT02181049.

[Chronic and vaccine-preventable diseases in children and adolescents in Germany: results of the KiGGS study: first follow up (KiGGS wave 1)]. / Chronische Erkrankungen und impfpräventable Infektionserkrankungen bei Kindern und Jugendlichen in Deutschland : Ergebnisse der KiGGS-Studie - Erste Folgebefragung (KiGGS Welle 1).

The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) 2003-2006 is the first nationwide comprehensive study on the health of children and adolescents living in Germany. The KiGGS first interview follow-up is a telephone interview study that collected, among other things, data on a number of chronic and vaccine-preventable diseases in 2009-2012 and is a combined cross-sectional and longitudinal study based on a population registry sample from the 167 KiGGS study points. The analysis is based on 12,368 respondents (7913 KiGGS follow-up participants aged 7-17 years, response 72 % and 4455 newly recruited 0- to 6-year-olds, response 42 %). Based on parent reports the lifetime prevalence of both chickenpox and pertussis has decreased in the population targeted by recently changed vaccination recommendations. For measles the prevalence remained unsatisfactorily high in each investigated age group. Of the children and adolescents aged 0-17 years 16 % (95 % confidence interval CI 15.2-17.0 %) had a long-standing chronic health condition according to the parents. Of these, however, only one in five was affected in their routine daily activities. The lifetime prevalence in 7- to 17-year-olds was 1.2 % (0.9-1.6) for epilepsy (0.4 % for the past 12 months), 5.0 % (4.4-5.7) for migraine, 0.2 % (0.1-0.3) for diabetes and in 0 to 6-year-olds 2.0 % (1.5-2.6) for heart conditions and 3.1 % (2.5-3.8) for febrile seizures with a -prevalence in 0 to 2-year-olds which are most affected of 1.0 % (0.6-1.6) in the past 12 months. The vast majority of children and adolescents in Germany are in good or very good health as suggested by other results reported in this issue; however, chronic conditions are not rare and need continuous monitoring. These results confirm that implementation of the vaccination recommendations of the German Standing Committee on Vaccination (STIKO) can lead to effective prevention of infectious diseases in Germany.

[Blood pressure in Germany 2008-2011: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Blutdruck in Deutschland 2008-2011 : Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

High blood pressure is one of the most important risk factors for cardiovascular diseases and chronic kidney disease. It is a main determinant of morbidity and mortality in Germany. In the German Health Interview and Examination Survey for Adults (DEGS1) the blood pressure of 7,096 adults aged 18-79 years was measured in a standardised way using oscillometric blood pressure devices (Datascope Accutorr Plus). The average of the second and third measurements was used for analysis. The mean systolic blood pressure was 120.8 mmHg in women and 127.4 mmHg in men, while the mean diastolic blood pressure was 71.2 mmHg in women and 75.3 mmHg in men. Blood pressure values were hypertensive (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg) in 12.7 % of women and in 18.1 % of men. Hypertension (defined as having hypertensive blood pressure or taking antihypertensive medication in known cases of hypertension) was present in 29.9 % of women and 33.3 % of men. Almost 75 % of the survey's highest age group, 70-79, had hypertension. DEGS1 demonstrates that high blood pressure remains a highly prevalent risk factor in the population at large. The methodology employed in measuring blood pressure has been improved as compared to that of the German National Health Interview and Examination Survey 1998 (GNHIES98) and it will be possible to draw comparisons soon, once a procedure for calibrating the 1998 data has been finalised. An English full-text version of this article is available at SpringerLink as supplemental.

Health-related quality of life in subjects with and without Type 2 diabetes: pooled analysis of five population-based surveys in Germany.

AIMS: To estimate population values of health-related quality of life (HRQL) in subjects with and without Type 2 diabetes mellitus across several large population-based survey studies in Germany. Systematic differences in relation to age and sex were of particular interest. METHODS: Individual data from four population-based studies from different regions throughout Germany and the nationwide German National Health Interview and Examination Survey (GNHIES98) were included in a pooled analysis of primary data (N = 9579). HRQL was assessed using the generic index instrument SF-36 (36-item Short Form Health Survey) or its shorter version, the SF-12 (12 items). Regression analysis was carried out to examine the association between Type 2 diabetes and the two component scores derived from the SF-36/SF-12, the physical component summary score (PCS-12) and the mental component summary score (MCS-12), as well as interaction effects with age and sex. RESULTS: The PCS-12 differed significantly by -4.1 points in subjects with Type 2 diabetes in comparison with subjects without Type 2 diabetes. Type 2 diabetes was associated with significantly lower MCS-12 in women only. Higher age was associated with lower PCS-12, but with an increase in MCS-12, for subjects with and without Type 2 diabetes. CONCLUSIONS: Pooled analysis of population-based primary data offers HRQL values for subjects with Type 2 diabetes in Germany, stratified by age and sex. Type 2 diabetes has negative consequences for HRQL, particularly for women. This underlines the burden of disease and the importance of diabetes prevention. Factors that disadvantage women with Type 2 diabetes need to be researched more thoroughly.

Regional differences in the prevalence of known Type 2 diabetes mellitus in 45-74 years old individuals: results from six population-based studies in Germany (DIAB-CORE Consortium).

AIM: In Germany, regional data on the prevalence of Type 2 diabetes mellitus are lacking for health-care planning and detection of risk factors associated with this disease. We analysed regional variations in the prevalence of Type 2 diabetes and treatment with antidiabetic agents. METHODS: Data of subjects aged 45-74 years from five regional population-based studies and one nationwide study conducted between 1997 and 2006 were analysed. Information on self-reported diabetes, treatment, and diagnosis of diabetes were compared. Type 2 diabetes prevalence estimates (95% confidence interval) from regional studies were directly standardized to the German population (31 December 2007). RESULTS: Of the 11,688 participants of the regional studies, 1008 had known Type 2 diabetes, corresponding to a prevalence of 8.6% (8.1-9.1%). For the nationwide study, a prevalence of 8.2% (7.3-9.2%) was estimated. Prevalence was higher in men (9.7%; 8.9-10.4%) than in women (7.6%; 6.9-8.3%). The regional standardized prevalence was highest in the east with 12.0% (10.3-13.7%) and lowest in the south with 5.8% (4.9-6.7%). Among persons with Type 2 diabetes, treatment with oral antidiabetic agents was more frequently reported in the south (56.9%) and less in the northeast (46.0%), whereas treatment with insulin alone was more frequently reported in the northeast (21.6%) than in the south (16.4%). CONCLUSION: The prevalence of known Type 2 diabetes showed a southwest-to-northeast gradient within Germany, which is in accord with regional differences in the distribution of risk factors for Type 2 diabetes. Furthermore, the treatment with antidiabetic agents showed regional differences.

Low rate of self-awareness and medical recognition of migraine in Germany.

OBJECTIVE: The study's objective was to assess self-awareness and medical recognition of migraine and their determinants in Germany. METHODS: We conducted a nationally representative study of the general population of Germany (N = 7341, aged ≥18 years) by means of computer-assisted telephone interviews. Migraine was diagnosed based on the International Classification of Headache Disorders, second edition (ICDH-II). RESULTS: Twelve-month prevalence of ICHD-II-migraine was 10.6% (women 15.6%, men 5.3%). Seventy percent of ICDH-II-migraineurs recognised their headaches as migraine (moderate agreement between ICDH-II and self-diagnosis, κ = 0.46). Only 42% of migraineurs consulted a physician in the previous 12 months. Of those, 63% reported a medical diagnosis of migraine (moderate agreement, κ = 0.40). Women were more likely to be self-aware (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.27-2.60), but the difference was no longer significant when adjusting for migraine features. Physician recognition was more likely in patients with higher educational level (high vs. low education OR 3.90, 95% CI 1.43-10.61 after adjusting for migrainous features). Best predictors for self-awareness and medical recognition of migraine were typical migraine accompaniments and greater headache intensity. CONCLUSION: Self-awareness and physician recognition of migraine are low in Germany. Presence of typical migraine features and greater headache intensity facilitate medical recognition and awareness of migraine, especially in females.

Vascular aging in the young: New carotid stiffness centiles and association with general and abdominal obesity - The KIGGS cohort.

BACKGROUND AND AIMS: The evidence for an association between obesity and increased carotid intima-media thickness (CIMT) and carotid stiffness (CS) in the young has been limited by methodological challenges related to study populations, measurements, methods of percentile derivation and comprehensiveness of obesity markers investigated. This nationwide general population study developed new CS and CIMT centiles in the young and used them to study associations with body mass index, waist circumference, waist-to-height-ratio, bioimpedance-derived absolute and relative fat mass, fat-free mass, subscapular skinfold thickness and blood pressure. METHODS: In its 11-year follow-up, the KiGGS cohort, which is based on a nationally representative sample, included semi-automated state-of-the-art sonographic CIMT and CS measurements in 4,709 participants aged 14 to 28. Distensibility coefficient (DC), stiffness index ß, Young's elastic modulus (YEM) and Peterson's elastic modulus (Ep) centiles were modelled by sex, age and height simultaneously. RESULTS: CS increased with age in both sexes, and young men had stiffer arteries than young women at all ages. All obesity measures at baseline and at follow-up, except for subscapular skinfold thickness, were positively associated with several CS parameters with moderate relative risks (RR), e.g. cross-sectional RR 2.23 (95% CI 1.26-3.93) for DC ≥ 90th percentile when waist circumference ≥90th percentile; RR 5.98 (3.38-10.56) for elevated DC associated with simultaneously elevated waist circumference and BP. CONCLUSIONS: These new state-of-the-art CS percentiles show consistent associations of obesity with CS in the young and support primary prevention efforts starting at a young age.

[Prevalence of helmet use in children and adolescents in Germany and preventable bicycle-related head injuries]. / Helmtragequoten bei Kindern und Jugendlichen in Deutschland und vermeidbare Kopfverletzungen bei Fahrradunfällen.

INTRODUCTION: Head injuries are the main cause of death in bicycle-related accidents among children and adolescents. According to a Cochrane Review, the risk of head injury (OR 0.31; 95% CI 0.26-0.37) or brain injury (OR 0.31; 95% CI 0.23-0.42) decreases by 69% if a helmet is worn. This study presents the prevalence of helmet use in cycling children and adolescents in Germany and the proportion of head injuries that could be prevented by wearing helmets. The potential effects of increased helmet wearing rates on the population attributable risk percentage for head injuries (PAR%) are demonstrated. METHODS: The prevalence of helmet use in children aged 3-17 years was analysed using data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). The percentage of head injuries preventable by helmet use in this group is estimated by calculating PAR%. Prevalence rates of helmet use and odds ratios from a Cochrane Review about the effectiveness of bicycle helmets for the prevention of head injuries were used for analysis. The potential effect of increased helmet use is shown in 3 scenarios by means of differences of PAR% values in the most relevant age groups. RESULTS: The older the children, the less likely they are to wear a helmet: 89.5% (95% CI 88.0%-90.8%) of the 3- to 6-year-old children wear a helmet when cycling but only 11.0% (95% CI 9.3%-12.9%) of 14- to 17-year-old adolescents do. In the youngest group (3-6 years) 19% of bicycle-related head injuries are attributable to the non-use of helmets, but this proportion rises to 67% in the oldest group (14-17 years). The PAR% of head injuries associated with not wearing a helmet may be reduced by more than a third by increasing the helmet wearing rate to 67% (2 out of 3) among adolescents, and may be reduced to half if 75% of adolescents wore a helmet. CONCLUSION: Particularly older children and adolescents hardly use bicycle helmets, hence the rate of preventable head injury is high. Efforts towards increasing helmet use should address all age groups with a particular focus on school-aged children and adolescents.

[Development of mortality and morbidity of vascular diseases: variations between coronary heart disease and stroke]. / Entwicklung von Mortalität und Morbidität vaskulärer Erkrankungen : Unterschiede zwischen koronarer Herzerkrankung und Schlaganfall.

INTRODUCTION: Cardiovascular diseases represent a central challenge for our health care system because of their individual and societal consequences. The manuscript compares the current development of mortality and morbidity of coronary heart disease and stroke in Germany. RESULTS: Coronary heart diseases are one of the leading causes of death and one of the major causes for adult disability. In Germany the average life expectancy has increased by more then 2 years per decade within recent years. The greatest contribution to the increase in life expectancy between 1980 and 2002 in Germany was attributed in previous studies to the decline in mortality rates of cardiovascular diseases; for example in Germany 134,648 persons died in 2008 from coronary heart disease (ICD-10 I20-I25) and 63,060 persons from stroke (ICD-10 I60-I64) compared to 178,759 persons and 90,241 persons in 1998, respectively. Statistical models from other countries estimated that the decrease in coronary heart disease mortality is attributed by about 40% to better treatment and by about 60% to changes in risk factors in the population. Comparable data for stroke are lacking. CONCLUSION: Despite the substantial knowledge on cardiovascular diseases in Germany a continuous and timely documentation of their determinants, time trends of risk factors and impact regarding mortality and morbidity is compulsory to assess the effectiveness of initiated population health measures and to identify future options for improving prevention and treatment of cardiovascular diseases in Germany.

The role of the inflammatory markers ferritin, transferrin and fibrinogen in the relationship between major depression and cardiovascular disorders - The German Health Interview and Examination Survey.

OBJECTIVE: To determine levels of inflammation (ferritin, transferrin and fibrinogen) in major depression (MDD) and comorbid cardiovascular disease (CVD) in an adult population. METHOD: In 4181 participants of the German Health Interview and Examination Survey MDD was assessed through the Composite International Diagnostic Interview (CIDI). Coronary heart disease, stroke, and hypertension were diagnosed by a computer-assisted physician interview. Analyses were performed using anova models stratified for gender. RESULTS: Ferritin, transferrin and fibrinogen levels showed opposing patterns in individuals with either CVD or MDD alone. In comorbidity analyses, male participants with MDD plus comorbid CHD or hypertension had lower levels of ferritin and lower fibrinogen levels in hypertension compared to men without MDD, while in women, results were inconsistent. CONCLUSION: Opposing patterns of inflammatory markers in CVD or MDD alone were reversed when both conditions were present. MDD reduced levels of ferritin, transferrin and fibrinogen in CVD in a gender-specific way.

[Epidemiology of dizziness and vertigo]. / Epidemiologie von Schwindelerkrankungen.

Dizziness and vertigo rank among the most common symptoms in medical practice and belong to the 10 most common reasons for a neurological examination. Epidemiological data on dizziness, vertigo and underlying specific disorders of vestibular origin are useful for clinical decision making, may contribute to a better understanding of disease mechanisms and help evaluate the state of patient care. This article gives an overview on the epidemiology of dizziness/vertigo and of four specific vestibular disorders: benign paroxysmal positional vertigo, vestibular migraine, vestibular neuritis and Menière's disease.

Screening for Menière's disease in the general population - the needle in the haystack.

CONCLUSION: Based on clinical history alone, 98.4% of the population with vestibular vertigo do not qualify for a diagnosis of Menière's disease (MD). Although frequent in dizziness clinics, MD is rare in the general population. OBJECTIVE: To narrow down the prevalence of MD in the general population. SUBJECTS AND METHODS: A representative sample adult population sample (n=4869) was screened for moderate or severe dizziness/vertigo. Subsequently, 1003 participants completed a validated neurotologic telephone interview on vestibular vertigo (VV). Prevalence of MD was determined by stepwise application of clinical criteria according to the AAO (1995): (1) at least two vertigo attacks of > or =20 min duration, (2) unilateral hearing loss, and (3) accompanying cochlear symptoms. RESULTS: Lifetime prevalence of VV was 7.4%. Of 243 participants with VV, 51 (21%) had recurrent vertigo lasting > or =20 min. Of these, nine reported unilateral hearing loss, and four had accompanying cochlear symptoms (1.6% of VV patients, population prevalence 0.12%).

Epidemiology of benign paroxysmal positional vertigo: a population based study.

OBJECTIVES: To examine the prevalence and incidence, clinical presentation, societal impact and comorbid conditions of benign paroxysmal positional vertigo (BPPV) in the general population. METHODS: Cross-sectional, nationally representative neurotological survey of the general adult population in Germany with a two stage sampling design: screening of 4869 participants from the German National Telephone Health Interview Survey 2003 (response rate 52%) for moderate or severe dizziness or vertigo, followed by validated neurotological interviews (n = 1003; response rate 87%). Diagnostic criteria for BPPV were at least five attacks of vestibular vertigo lasting <1 min without concomitant neurological symptoms and invariably provoked by typical changes in head position. In a concurrent validation study (n = 61) conducted in two specialised dizziness clinics, BPPV was detected by our telephone interview with a specificity of 92% and a sensitivity of 88% (positive predictive value 88%, negative predictive value 92%). RESULTS: BPPV accounted for 8% of individuals with moderate or severe dizziness/vertigo. The lifetime prevalence of BPPV was 2.4%, the 1 year prevalence was 1.6% and the 1 year incidence was 0.6%. The median duration of an episode was 2 weeks. In 86% of affected individuals, BPPV led to medical consultation, interruption of daily activities or sick leave. In total, only 8% of affected participants received effective treatment. On multivariate analysis, age, migraine, hypertension, hyperlipidaemia and stroke were independently associated with BPPV. CONCLUSION: BPPV is a common vestibular disorder leading to significant morbidity, psychosocial impact and medical costs.

Short-term efficacy of Epley's manoeuvre: a double-blind randomised trial.

BACKGROUND: Benign paroxysmal positional vertigo of the posterior canal (PC-BPPV) is a common vestibular disorder and can be easily treated with Epley's manoeuvre. Thus far, the short-term efficacy of Epley's manoeuvre for treatment of PC-BPPV is unknown. OBJECTIVES: To evaluate the efficacy of Epley's manoeuvre for treatment of PC-BPPV 24 h after applying the manoeuvre. METHODS: The short-term efficacy of Epley's manoeuvre was compared with a sham procedure in 66 patients with PC-BPPV by using a double-blind randomised study design. RESULTS: 24 h after treatment, 28 of 35 (80%) patients in the Epley's manoeuvre group had neither vertigo nor nystagmus on positional testing compared with 3 of 31 (10%) patients in the sham group (p<0.001). CONCLUSION: Epley's manoeuvre is shown to resolve PC-BPPV both effectively and rapidly.

The epidemiology of dizziness and vertigo.

This chapter gives an overview of the epidemiology of dizziness, vertigo, and imbalance, and of specific vestibular disorders. In the last decade, population-based epidemiologic studies have complemented previous publications from specialized settings and provided evidence for the high burden of dizziness and vertigo in the community. Dizziness (including vertigo) affects about 15% to over 20% of adults yearly in large population-based studies. Vestibular vertigo accounts for about a quarter of dizziness complaints and has a 12-month prevalence of 5% and an annual incidence of 1.4%. Its prevalence rises with age and is about two to three times higher in women than in men. Imbalance has been increasingly studied as a highly prevalent complaint particularly affecting healthy aging. Studies have documented the high prevalence of benign paroxysmal positional vertigo (BPPV) and vestibular migraine (VM), as well as of comorbid anxiety at the population level. BPPV and VM are largely underdiagnosed, while Menière's disease, which is about 10 times less frequent than BPPV, appears to be overdiagnosed. Risk factor research is only at its beginning, but has provided some interesting observations, such as the consistent association of vertigo and migraine, which has greatly contributed to the recognition of VM as a distinct vestibular syndrome.

Hypertension prevalence, awareness, treatment and control in Germany 1998 and 2008-11.

Germany was reported to have higher blood pressure (BP) and lower awareness, treatment and control of BP than other western countries based on 1998 data. BP distribution and hypertension management were examined for 1998 and 2008-11 in 7108 adult participants of the German National Health Interview and Examination Survey 1998 (GNHIES98) and in 7095 adult participants the German Health Interview and Examination Survey for Adults 2008-11 (DEGS1) aged 18-79 years. Age- and sex-standardized mean systolic BP (SBP) dropped from 129.0 to 124.1 mm Hg (women 127.3-120.8, men 130.7-127.4), mean diastolic BP (DBP) from 78.3 to 73.2 mm Hg (women 78.0-71.2, men 78.5-75.3). Mean SBP and DBP decreased most in treated hypertensives but were also lower in participants without hypertension. The overall prevalence of hypertension, including controlled hypertension, remained almost unchanged (30% vs 32%). Uncontrolled hypertension (BP⩾140/90 mm Hg) decreased from 23% to 15% (women 22-13%, men 24-18%). Among hypertensives, awareness increased from 69% to 82% (women 74-87%, men 65-78%), treatment increased from 55% to 72% (women 62-79%, men 48-65%) and control increased from 23% to 51% (women 25-58%, men 20-45%). However, men aged 18-29 years had an opposite trend with 1.5 mm Hg higher SBP and increased prevalence of hypertension, which was mostly uncontrolled. These findings suggest that BP has decreased substantially in Germany, while leaving a persistent gender gap in management and room for further improvement of prevention and treatment, particularly in men.

Health-related quality of life in women and men with type 2 diabetes: a comparison across treatment groups.

AIM: This study compares health-related quality of life (HRQL) in patients with type 2 diabetes (T2DM) across treatment groups and explores gender differences. METHODS: Four regional surveys (KORA, CARLA, SHIP, DHS) and a national survey (GNHIES98) were pooled at individual level. HRQL was assessed with the SF-12/-36v1. Linear regression models were used to assess the effect of T2DM by treatment type (no medication; oral; oral/insulin combination; insulin) on the physical (PCS-12) and mental summary score (MCS-12) and the SF-6D, controlling for age, sex, study and covariates. We also performed an explanatory analysis of single items. RESULTS: PCS-12 scores and treatment type were associated (P-value 0.006), with lowest values for insulin treatment (-4.44 vs. oral; -4.41 vs. combination). MCS-12 scores were associated with treatment type and gender (P-value <0.012), with lower scores for women undergoing oral (-4.25 vs. men) and combination treatment (-6.99 vs. men). Similar results were observed for SF-6D utilities and single items, related to mental health, social functioning, vitality and role limitation (emotional). Comorbidities were predictors of lower PCS-12 and SF-6D scores. CONCLUSIONS: T2DM treatment impacts differently on physical and mental HRQL and on women and men. Further studies of gender-specific perceptions of T2DM treatment regimens are needed.

A modified Epley's procedure for self-treatment of benign paroxysmal positional vertigo.

We compared the efficacy of a modified Epley's procedure (MEP) and Brandt-Daroff exercises (BDE) for self-treatment of benign paroxysmal positional vertigo of the posterior semicircular canal (PC-BPPV) in 54 patients. PC-BPPV resolved within 1 week in 18 of 28 patients (64%) using the MEP and in 6 of 26 patients (23%) performing BDE (p<0.01). Type and adequate performance of the maneuver predicted treatment outcome in the multivariate analysis. The frequency of side effects was not significantly different between the two groups. The MEP is more suitable for self-treatment of PC-BPPV than conventional BDE.

The interrelations of migraine, vertigo, and migrainous vertigo.

OBJECTIVE: To assess the prevalence of migrainous vertigo in patients with migraine and in patients with vertigo according to explicit diagnostic criteria that are presented for discussion. METHODS: The authors prospectively evaluated 200 consecutive patients from a dizziness clinic and 200 patients from a migraine clinic for migrainous vertigo based on the following criteria: 1) recurrent vestibular symptoms (rotatory/positional vertigo, other illusory self or object motion, head motion intolerance); 2) migraine according to the criteria of the International Headache Society (IHS); 3) at least one of the following migrainous symptoms during at least two vertiginous attacks: migrainous headache, photophobia, phonophobia, visual or other auras; and 4) other causes ruled out by appropriate investigations. In addition, the authors compared the prevalence of migraine according to the IHS criteria in the dizziness clinic group with a sex- and age-matched control group of 200 orthopedic patients. RESULTS: The prevalence of migraine according to the IHS criteria was higher in the dizziness clinic group (38%) compared with the age- and sex-matched control group (24%, p < 0.01). The prevalence of migrainous vertigo was 7% in the dizziness clinic group, and 9% in the migraine clinic group. In 15 of 33 patients with migrainous vertigo, vertigo was regularly associated with migrainous headache. In 16 patients, vertigo occurred both with and without headache, and in two patients headache and vertigo never occurred together. The duration of attacks varied from minutes to days. CONCLUSION: These results substantiate the epidemiologic association between migraine and vertigo and indicate that migrainous vertigo affects a significant proportion of patients both in dizziness and headache clinics.

Migraine and Ménière's disease: is there a link?

BACKGROUND: A possible link between Ménière's disease (MD) and migraine was originally suggested by Prosper Ménière. Subsequent studies of the prevalence of migraine in MD produced conflicting results. OBJECTIVE: To determine the lifetime prevalence of migraine in patients with MD compared to sex- and age-matched controls. METHODS: The authors studied 78 patients (40 women, 38 men; age range 29 to 81 years) with idiopathic unilateral or bilateral MD according to the criteria of the American Academy of Otolaryngology. Diagnosis of migraine with and without aura was made via telephone interviews according to the criteria of the International Headache Society. Additional information was obtained concerning the concurrence of vertigo and migrainous symptoms during Ménière attacks. The authors interviewed sex- and age-matched orthopedic patients (n = 78) as controls. RESULTS: The lifetime prevalence of migraine with and without aura was higher in the MD group (56%) compared to controls (25%; p < 0.001). Forty-five percent of the patients with MD always experienced at least one migrainous symptom (migrainous headache, photophobia, aura symptoms) with Ménière attacks. CONCLUSIONS: The lifetime prevalence of migraine is increased in patients with MD when strict diagnostic criteria for both conditions are applied. The frequent occurrence of migrainous symptoms during Ménière attacks suggests a pathophysiologic link between the two diseases. Alternatively, because migraine itself is a frequent cause of audio-vestibular symptoms, current diagnostic criteria may not differentiate between MD and migrainous vertigo.