Self-Reported Patient Compliance With Physician Advised Lifestyle Behavior Changes Among Adults With Musculoskeletal Conditions.

Introduction: Approximately half of adult Americans suffer from musculoskeletal disorders (MSD). Significant risk factors for musculoskeletal disorders include poor diet, obesity, and insufficient physical activity. Studies show that lifestyle change education and interventions reduce MSD risk factors. However, little is known about the relationship between physician advice for behavior change and reported behavior change by MSD patients. This study explored the association between physician advice for lifestyle change and reported change in MSD patients, as well as the effects that patient education levels have on compliance. Methods: This study used data from the 2017 National Health Interview Survey, a nationally representative cross-sectional survey of non-institutionalized US adults. The research team limited analysis to adults who reported a limitation due to musculoskeletal problems (n = 2,672). Outcomes included physician recommendations to increase physical activity, reduce fat/calories, or lose weight, and whether they enacted these behavioral changes. Adjusted logistic regression models examined whether compliance with doctor's instructions differed by education level. Results: Adjusted models show patients advised to change physical activity, diet, and weight were more likely to report attempted behavior change. Education was positively associated with likelihood of complying with physician advice to increase physical activity. Among patients not advised to change behaviors by a physician, education was positively associated with current behavior change attempts. Conclusion: This study suggests that physician recommendations are relevant predictors of reported behavior change in individuals with MSD. Although education plays an important role in this association, the relationship is complex and multifaceted. Future studies should explore how compliance may be impacted by other factors, such as physician message type.

Comparison of 30-day mortality and readmission frequency in women versus men with acute myocardial infarction.

This study aimed to assess gender differences in hospitalization incidence, 30-day mortality, and 30-day readmission rates for acute myocardial infarction (AMI) in a Southwestern US medical center. Hospital billing records for AMI admissions were compiled from January 2013 to June 2019, resulting in a sample size of 2394. Billing data included gender, age, principal procedure, insurance status, principal diagnosis, and race/ethnicity. Multivariate logistic regression was used to estimate gender differences in mortality after adjustment for the aforementioned factors. Men were hospitalized for AMI over twice as frequently, yet women had higher AMI mortality than men (9.3% vs. 6.1%, P < 0.01). Female AMI patients were older on average and slightly less likely to undergo percutaneous transluminal coronary angioplasty than men. Thirty-day readmission rates did not differ by gender. In absolute terms, AMI hospitalizations and deaths are larger in number in men, but AMI hospitalizations more frequently end in death in women.

Assessment and Diagnosis of Mental Illness in EDs Among Individuals Without a Home: Findings from the National Hospital Ambulatory Care Survey.

INTRODUCTION: Homeless individuals lack resources for primary healthcare and as a result use the emergency department (ED) as a social safety net. Our primary objective in this study was to identify the differences between features of visits to United States (US) EDs made by patients without a home and patients who live in a private residence presenting with mental health symptoms or no mental health symptoms at triage. METHODS: Data for this study come from the 2009-2017 National Health and Ambulatory Medical Care Survey, a nationally representative cross-sectional survey of ED visits in the US. We examined differences in waiting time, length of visit, and triage score among homeless patients, and privately housed and nursing home residents. We used logistic regression to determine the odds of receiving a mental health diagnosis. Residence, age, gender, race, urgency, and whether the person was seen in the ED in the previous 72 hours were controlled. RESULTS: Homeless individuals made up less than 1% of all ED visits during this period. Of these visits, 47.2% resulted in a mental health diagnosis compared to those who live in a private residence. Adjusting for age, race, gender, triage score, and whether the person had been seen in the prior 72 hours, homeless individuals were still six times more likely to receive a mental health diagnosis despite reporting no mental health symptoms compared to individuals who lived in a private residence. Homeless individuals reporting mental health symptoms were two times more likely to receive a mental health diagnosis compared to privately housed and nursing home residents. CONCLUSIONS: Homeless individuals are more likely to receive a mental health diagnosis in the ED whether or not they present with mental health symptoms at triage. This study suggests that homelessness as a status impacts how these individuals receive care in the ED. Community coordination is needed to expand treatment options for individuals experiencing emergent mental health symptoms.

Increasing Trend of Yoga Practice Among U.S. Adults From 2002 to 2017.

Introduction: Benefits, risks, and the increasing popularity of yoga use warrant assessing yoga practice prevalence and users' profiles. This study describes trends in yoga practice exclusively among American adults from 2002 to 2017, compares the profile of yoga users, and identifies factors related to yoga use over time. Materials and Methods: This study is a secondary analysis done in 2019 and 2020 using the National Health Interview Survey (NHIS) 2002, 2007, 2012, and 2017 data. Population weights were used to obtain statistically accurate estimates of yoga use prevalence for the U.S. population. Descriptive statistics were used to profile the sociodemographic and health-related characteristics of yoga users. Multivariable logistic regression was used to identify factors associated with yoga use in each cohort defined by the NHIS year. Results: Yoga practice prevalence nearly tripled from 5.1% in 2002 to 13.7% in 2017 (weighted estimate 10,386,456 and 32,761,194 American adults, respectively). Typical yoga users were young non-Hispanic single white female adults with bachelor or higher education and health insurance, and resided in the west region of the United States. Yoga use pattern change over time was significantly related to only younger age (p < 0.001) but not to other sociodemographic or health-related factors. Conclusions: Yoga has gained increasing popularity in the past two decades among American adults, with younger adults being the driving force. Yoga appears to be adopted for general well-being or prevention more than for specific disease treatment. Future research should evaluate how yoga can be effectively and safely integrated into preventive medicine strategies.

Sex Differences in Stroke Hospitalization Incidence, 30-Day Mortality, and Readmission in a Regional Medical Center in the Southwestern United States.

OBJECTIVES: This study explores sex differences in ischemic stroke hospitalization incidence, 30-day mortality, and 30-day readmission in a southwestern US medical center. METHODS: Ischemic stroke admissions in a regional medical center in the southwestern United States were obtained for a 6.5-year time frame (N = 1968). Logistic regression models examine the adjusted effects of sex on 30-day mortality and 30-day readmission outcomes among individuals hospitalized for ischemic stroke. RESULTS: Findings confirm that although women experience higher mortality than men (9.1% vs 6.7%), the sex disparity in mortality is explained by the age distribution of strokes. Women experience far more strokes and deaths because of stroke at older ages. No differences in principal procedure or 30-day readmission emerged. CONCLUSIONS: Men experienced higher stroke hospitalization incidence, although women exhibited higher 30-day mortality. Age composition explained sex differences in mortality, but higher male stroke hospitalization incidence represents a larger public health issue that suggests the need for behavioral change at the population level. No meaningful sex differences emerged in treatment, mortality, or readmission.

Racial/Ethnic Disparities in Triage Scores Among Pediatric Emergency Department Fever Patients.

OBJECTIVES: Emergency department (ED) triage scores are assigned to patients in a short period based on assessment of need for lifesaving measures, risk and pain levels, resource needs, and vital signs. Racial/ethnic disparities have been found across a number of outcomes but are not consistent across all studies. This study examines pediatric ED cases reporting fever, a commonly reported triage symptom, to explore racial/ethnic and age disparities in triage score assignment. METHODS: This study uses the 2009-2015 National Hospital Ambulatory Medical Care Survey, an annual national sample of ED visits in the United States. Pediatric cases where fever is the sole reported reason for visit are analyzed for racial/ethnic disparities, controlling for sex, age, insurance status, body temperature, region, and hospital type. RESULTS: Among all pediatric fever cases, temperature is the sole significant predictor of triage scores. However, non-Hispanic (NH) black pediatric patients older than 1 year have approximately 22% greater risk of being given a less urgent triage score relative to NH white patients. CONCLUSIONS: Findings suggest racial disparities in the triage of NH black pediatric patients older than 1 year for fever. Although fever is a single and often non-life-threatening condition, especially after infancy, findings of racial disparities in triage scores suggests a need for further evaluation of the assignment of patient urgency in emergency medicine.

Hypertension and Hyperthyroidism: Association and Pathogenesis.

Hypertension can cause significant morbidity and reduced life expectancy. Most patients with hypertension have primary hypertension; however, 10 to 15% of patients have secondary hypertension. Endocrine disorders explain approximately 10% of hypertension in all patients, and thyroid disorders account for approximately 1% of cases with hypertension. Hyperthyroidism can cause increased cardiac output, increased systolic blood pressures, and increased levels of renin, angiotensin, and aldosterone. Treatment of hyperthyroidism can cure hypertension in some patients. Consequently, identification of patients with secondary hypertension potentially has important benefits, and understanding secondary hypertension provides a framework for investigating the pathophysiology of hypertension. Clinicians should consider the possibility of hyperthyroidism in patients with hypertension, even in those of more advanced age.

Characteristics of U.S. adults taking prescription antipsychotic medications, National Health and Nutrition Examination Survey 2013-2018.

BACKGROUND: Global 12-month psychosis prevalence is estimated at roughly 0.4%, although prevalence of antipsychotic use in the U.S. is estimated at roughly 1.7%. Antipsychotics are frequently prescribed for off label uses, but have also been shown to carry risk factors for certain comorbid conditions and with other prescription medications. The study aims to describe the socio-demographic and health characteristics of U.S. adults taking prescription antipsychotic medications, and to better understand the association of antipsychotic medications and comorbid chronic diseases. METHODS: The study pools 2013-2018 data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative cross-sectional survey of non-institutionalized U.S. residents (n = 17,691). Survey staff record prescription medications taken within the past 30 days for each respondent, from which typical and atypical antipsychotic medications were identified. RESULTS: Prevalence of antipsychotic use among U.S. adults was 1.6% (n = 320). Over 90% of individuals taking antipsychotics reported having health insurance and a usual place for care, significantly more than their counterparts not taking antipsychotics. Further, those taking antipsychotics reported higher prevalence of comorbid chronic diseases and took an average of 2.3 prescription medications more than individuals not taking antipsychotics. Individuals taking antipsychotics were more likely to sleep 9 or more hours per night, be a current smoker, and have a body mass index greater than 30 kg/m2. CONCLUSIONS: U.S. adults who take antipsychotic medications report more consistent health care access and higher prevalence of comorbid chronic diseases compared to those not taking antipsychotics. The higher comorbidity prevalence and number of total prescriptions highlight the need for careful assessment and monitoring of existing comorbidities and potential drug-drug interactions among adults taking antipsychotics in the U.S.

Conventional and Complementary Health Care Approaches Used by American Adults Reporting Joint Pain: Patterns from the National Health Interview Survey 2012.

Objective: To describe patterns of conventional health care (CH) and complementary and alternative medicine (CAM) use among U.S. adults reporting recent joint symptoms in a nationally representative sample. Design: This study uses the adult alternative medicine supplement from the 2012 National Health Interview Survey (NHIS). Location: United States. Subjects: Nationally representative cross-sectional sample of non-institutionalized U.S. residents. Of 34,525 respondents who answered the alternative medicine supplement, approximately 30% (n = 10,964) reported recent pain symptoms (pain, aching, stiffness). Outcome measures: Among adults reporting joint symptoms, we examine reported use of CH, CAM, both CH and CAM, or neither specifically for joint symptoms or joint condition. Results: Among adults reporting joint symptoms in the past 30 days, 64% reported using only CH for their joint pain, whereas ∼10% reported using CAM. Among those using CAM for their joint symptoms, 83% also sought help from a CH practitioner. CAM-only users comprised only 1.6% of the sample of joint pain sufferers. Those who reported using both CH and CAM for joint pain were more likely to report a diagnosis of a joint condition compared with CAM-only users, but also reported higher comorbidities and worse self-reported health. Conclusion: Most U.S. adults reporting recent joint pain seek care only from a CH practitioner, although among the 10% who report CAM use for joint conditions, a strong majority also report seeking care from a CH practitioner. CH and CAM providers should consistently inquire about other forms of treatment their patients are using for specific symptoms to provide effective integrative health care management.

Electronic cigarette survey characteristics.

INTRODUCTION: Electronic cigarettes (EC) remain a controversial topic with uncertainty about harm reduction in current smokers, their efficacy in smoking cessation, their potential for addiction, the need for regulation, and the type of information needed to educate the public about the benefits and hazards of EC. Multiple medical institutions and organizations have conducted surveys to investigate the demographics and perceptions of EC consumers in adult and youth populations. However, it is unknown whether these surveys use consistent, reliable, or accurate measures for EC use. METHODS: We analyzed 13 survey articles identified during a review of the use of EC during smoking cessation programs to determine the characteristic features of the surveys and to determine how frequently they satisfied the measurement of important core items suggested by recent articles. RESULTS: Our analysis focused on 13 studies. These studies represented the work of 13 separate research groups and were published in 10 different biomedical journals with a median impact factor score of 4.1. The median number of participants in the studies was 2,624 (Q1-Q3: 662-6,356); the number of participants ranged from 179 to 19,414. The median number of e-cigarette users in the surveys was 840 (Q1-Q3: 256-3,849). All studies provided clear study goals in their introduction. Five surveys used on-line methods to collect information; four studies provided limited information about the reliability of their data. All studies reported study outcomes and considered limitations. Five studies had limited external validity. None of the surveys collected a complete set of core information recommended by recent authorities on survey methodology for EC. CONCLUSIONS: The surveys reviewed in this project had significant variability in study design, survey population, and study goals. Consequently, comparisons across studies become difficult and limit the external validity of survey studies on EC.

Relation between mean platelet volume and C-reactive protein.

Mean platelet volume (MPV) is a measure of platelet activation, and C-reactive protein (CRP) is an established marker of inflammation. Studies on the correlation between MPV and CRP have produced ambiguous results. We undertook a population study with the National Health and Nutrition Examination Survey (NHANES) data (2005-2010) to investigate the relationship between CRP and MPV. CRP was analyzed both as a continuous variable and as a categorical variable (low, intermediate, or high). Multivariate ordinary least squares regression analysis was used to predict the association. Statistical analyses were performed with Stata MP 15.1. In 16,329 participants, mean MPV was 7.9 fL (standard deviation 0.87). Overall mean CRP in the population was 0.4 mg/dL (standard deviation 0.78). In adjusted regression models with CRP as a continuous measure, individuals with high CRP had significantly lower MPV (b = -0.04; standard error 0.01; 95% confidence interval -0.06 to -0.01; P = 0.002). In adjusted regression models using CRP categories, participants with high CRP (>3 mg/dL) had significantly lower MPV compared with the low CRP group (b = -0.20; standard error 0.09; 95% confidence interval -0.38 to -0.01; P = 0.035). Our study revealed a significant inverse correlation between MPV and CRP in NHANES participants.

Relation of hematologic inflammatory markers and obesity in otherwise healthy participants in the National Health and Nutrition Examination Survey, 2011-2016.

This study investigated the association between hematologic inflammatory markers derived from complete blood counts and obesity. We undertook a cross-sectional study that included self-reported healthy subjects above the age of 18 years from the 2011-2016 National Health and Nutrition Examination Survey, a US population database. Study parameters included mean corpuscular volume, red cell distribution width, mean platelet volume, total platelet count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammation index. Body mass index was used as an index of obesity and was correlated with each hematologic inflammatory marker. Our analysis found a statistically significant association between each inflammatory parameter and higher body mass indices. We demonstrated an association between complete blood count-derived indices of inflammation and obesity, and these results provide the basis for future studies using complete blood count-derived variables and outcomes in patients with some chronic diseases.

Hypothyroidism and Its Association With Sleep Apnea Among Adults in the United States: NHANES 2007-2008.

CONTEXT: The association between hypothyroidism and sleep apnea (SA) has been studied, but results are conflicting and based mostly on small studies. OBJECTIVE: To determine whether there is a positive association between hypothyroidism and SA in the US population. DESIGN: Cross-sectional study. SETTING: US National Health and Nutrition Examination Survey, 2007-2008. PARTICIPANTS: We included all subjects ≥18 years old who met inclusion criteria. Participants not on antithyroid medication with a TSH >5.6 mIU/L and those on thyroid hormone replacement regardless of TSH were categorized as hypothyroid. Participants not on thyroid hormone replacement or antithyroid medication who had a TSH ≥0.34 and ≤5.6 mIU/L were categorized as euthyroid. The diagnosis of SA was based on participants' response when asked whether they had been diagnosed with SA by their doctors. MAIN OUTCOME MEASURES: Multivariate logistic regression analyses were performed to determine the association between hypothyroidism and SA. RESULTS: A total of 5515 adults were included for data analysis. The prevalence of hypothyroidism and hyperthyroidism was calculated at 9.47% and 1.19%, respectively. Multivariate logistic regression analysis adjusted for demographics, health care access, body mass index, socioeconomic factors, alcohol use, smoking, and other comorbidities demonstrated a significant association between hypothyroidism and SA (OR = 1.88, 95% CI, 1.24 to 2.84, P < 0.01). CONCLUSION: Hypothyroidism is associated with SA after adjustment for potential confounding variables.

Implications of mean platelet volume in health and disease: A large population study on data from National Health and Nutrition Examination Survey.

INTRODUCTION: Mean platelet volume (MPV) is a measure of platelet size and activity. We conducted a population study with National Health and Nutrition Examination Survey (NHANES) data to understand the relationship of MPV with health and diseases. MATERIALS AND METHODS: The NHANES is a cross-sectional survey of non-institutionalized adult population, administered every 2 years by the Centers for Disease Control and Prevention. Participants answer a questionnaire, receive a physical examination, and undergo laboratory tests. Values of MPV were collected over 6 years (2011-2016). Logistic regression was used to predict likelihood of being in categories with MPV < 10th percentile or >90th percentile. Statistical analysis was performed using Stata/SE 15.1. RESULTS: In our study with 17,969 individuals, the mean MPV was 8.40 [SD = 0.92] femtoliter. Individuals with male sex, age 45-64 years, and recent hospital-stay were more likely to have MPV < 10th percentile. Obese, Blacks and Mexican Americans had higher odds of having MPV > 90th percentile. Individuals with emphysema had significantly higher adjusted Odds [OR 1.92, 95% CI: 1.11-3.31, p = 0.021] of MPV < 10th percentile. Individuals with cancer were less likely to have MPV > 90th percentile [OR 0.74, 95% CI: 0.55-0.99, p = 0.042]. A diagnosis of coronary artery disease, asthma, and chronic obstructive pulmonary disease did not have significant associations with MPV. CONCLUSIONS: Obese individuals are more likely to have higher MPV. Individuals with emphysema had higher odds of having MPV < 10th percentile and those with cancer were less likely to have MPV > 90th percentile.

Complementary and Alternative Medicine Use by U.S. Adults with Self-Reported Doctor-Diagnosed Arthritis: Results from the 2012 National Health Interview Survey.

BACKGROUND: The use of complementary and alternative medicine (CAM) therapies have been reported for the management of arthritis. However, little is known about CAM use among adults with self-reported doctor-diagnosed arthritis. OBJECTIVES: To determine (1) the prevalence and type of CAM use, (2) the difference in characteristics between CAM users and non-CAM users, and (3) the factors related to CAM use, among U.S. adults with self-reported doctor-diagnosed arthritis. DESIGN: Secondary analysis of the 2012 National Health Interview Survey (NHIS) data. SETTING: The NHIS is a cross-sectional survey that gathers health-related data on the civilian, noninstitutionalized U.S. PARTICIPANTS: The NHIS 2012 uses a complex, multistage sampling design and oversamples minorities to achieve population representation; it included 34 525 adults, with 7179 adults having arthritis. METHODS: Data were analyzed using Stata 15.1 survey syntax. The potential factors related to CAM use included sociodemographics and health-related characteristics. MAIN OUTCOME MEASUREMENTS: CAM modalities were categorized into six groups: natural products, manipulative therapies, mind-body therapies, special diets, movement therapies, and other practitioner-based CAM modalities. RESULTS: Of the adults with arthritis, 2428 (weighted estimate of 36.2% of U.S. adult population) had used CAM within the last year. Adults with arthritis reported greater use of CAM than those without, particularly the use of natural products, manipulative therapies and other practitioner-based CAM modalities. Factors associated with higher CAM use included being female, residing in regions other than the U.S. South, having a college degree or higher, reporting very good/excellent self-rated health status, and having current symptoms of joint stiffness/pain. CONCLUSION: As more than one-third of U.S. adults with arthritis seek CAM therapies, open and nonjudgmental conversations between conventional medicine providers, CAM providers, and patients should be encouraged to ensure patient health care needs are being met. LEVEL OF EVIDENCE: III.

Birth weight and maternal age among American Indian/Alaska Native mothers: A test of the weathering hypothesis.

Substantial research has examined birth outcomes by race/ethnicity, noting not only disparities by race/ethnicity, but different maternal age patterns in low birth weight (LBW) prevalence. Few studies have examined these disparities among American Indian/Alaska Native (AI/AN) mothers, whose LBW prevalence is below the national average, despite substantial socioeconomic disadvantage among the population. Prior work has hypothesized that AI/AN mothers should exhibit LBW age patterns similar to those seen in NH black mothers as a result of exposure to cumulative stress, trauma, and socioeconomic disadvantage, but this has not been empirically tested. This paper uses data from the 2014-2016 U.S. Birth File, which contains records of all U.S. births for those years to examine maternal age patterns in birth weight among AI/AN mothers. Importantly, this study also considers high birth weight (HBW) births, given higher prevalence of diabetes in the AI/AN population, and proposes that if "weathering" is occurring in this population, HBW prevalence likely will influence the observed maternal age patterns in birth weight, such that prevalence of births in normal range may resemble NH blacks, even if LBW prevalence does not. Findings suggest modest evidence of weathering in AI/AN populations for LBW. Examination of normal birth weight births suggests that inclusion of HBW to the risk profile of AI/AN births better defines birth outcome risk in this population relative to white mothers. Smoking during pregnancy and gestational diabetes were particularly prevalent among AI/AN mothers and present reason for concern in spite of relatively favorable birth outcomes.

The Association of Unreported Sleep Disturbances and Systemic Inflammation: Findings from the 2005-2008 NHANES.

BACKGROUND/OBJECTIVE: Sleep apnea is associated with elevated inflammatory markers. A subgroup of patients never report sleep disturbances to their physician. The inflammatory status of this subgroup is not known. The present study aims to evaluate two inflammatory markers, C-reactive protein (CRP) and red cell distribution width (RDW), in those with unreported sleep disturbances and compares these findings to those with and without reported sleep disorders. We also investigate the utility of RDW as an inflammatory marker in sleep disorders. METHODS: Sample includes 9,901 noninstitutionalized, civilian, nonpregnant adults from the 2005-2008 National Health and Nutrition Examination Survey, a nationally representative, cross-sectional U.S. study. Sleep questionnaire and laboratory data were used to compare inflammatory markers (CRP and RDW) in five subgroups of individuals: reporting physician-diagnosed sleep apnea, reporting another physician-diagnosed sleep disorder, reported sleep disturbance to physician with no resulting diagnosis, unreported sleep disturbance (poor sleep quality not reported to physician), and no diagnosed sleep disorder or sleep disturbance. RESULTS: Individuals with unreported sleep disturbance had significantly higher odds of elevated RDW (>13.6%) when compared to those without a sleep disturbance in adjusted models (OR=1.33). Those with unreported sleep disturbance had significantly higher odds of elevated CRP levels (>1 mg/L) than those without sleep disturbances (OR 1.34), although the association was not significant when adjusted for obesity and other controls. CONCLUSION: Self-identified unreported sleep disturbances are associated with significantly higher odds of elevated RDW than those without sleep disturbances. RDW may serve as a valuable indicator in identifying individuals at higher risk for sleep apnea and other sleep disorders.

Complementary and Alternative Medicine Use Among US Adults With Headache or Migraine: Results from the 2012 National Health Interview Survey.

BACKGROUND: Given the safety concerns regarding pharmacological agents, and the considerable impact of headache and migraine on the sufferer's quality of life, many people seek other treatment options beyond conventional medication and care to address their symptoms; this includes complementary and alternative medicine (CAM). Some CAM interventions have shown promising results in clinical trials of headache and migraine management. Nonetheless, there has been little research exploring the reasons for using CAM, and the types of CAM used, among this population. OBJECTIVE: The study aimed to answer the following questions: (1) Which CAM modalities are used most frequently among migraine/headache sufferers? and (2) What are the self-reported reasons for CAM use among migraine/headache sufferers? METHODS: This secondary analysis of data from the 2012 U.S. NHIS (a national cross-sectional survey) examined the use of CAM among migraine/headache sufferers, including the main reasons related to CAM use. Data were weighted and analyzed using STATA 14.0. RESULTS: The sample of 34,525 adults included 6558 (18.7%) headache/migraine sufferers. Of the headache/migraine sufferers, a substantial proportion (37.6%, n = 2427) used CAM for various conditions; however, CAM use specifically for headache/migraine was much less prevalent (3.3%, n = 216). Of those who used CAM for headache/migraine, about half used CAM in conjunction with prescription (47.8%, n = 100) or over-the-counter medication (55.1%, n = 113). As severity of headache/migraine increased so did the likelihood of using CAM (severe migraine odds ratio [OR] = 2.32; 95% confidence interval [CI]: 1.41, 3.82; both recurring headache/severe migraine OR = 3.36; 95% CI: 2.08, 5.43; when compared to those with recurring headache only). The most frequently used CAM modality among all headache/migraine sufferers (N = 6558) was manipulative therapy (22.0%, n = 1317), herbal supplementation (21.7%, n = 1389) and mind-body therapy (17.9%, n = 1100). The top 3 reasons for using CAM for headache were general wellness (28.7%, n = 60/209), improving overall health (26.8%, n = 56/209), and reducing stress (16.7%, n = 35/209). CONCLUSIONS: Although CAM is used by many sufferers of headache/migraine, the use of CAM specifically for the treatment of headache/migraine is relatively low in the United States. The study also assesses the key differences of CAM use among headache/migraine sufferers in NHIS 2012 compared with those in NHIS 2007, and identifies shortfalls in the evidence-base of several CAM modalities used by U.S. adults for headache/migraine. This information may assist health providers and consumers in making informed decisions about the safest and most appropriate approach to managing headache/migraine.