Perceptions Regarding Daith Piercing in Migraine, A Survey of Pediatric Patients

Round 1

Reviewer 1 Report

In the article: "Perceptions Regarding Daith Piercing in Migraine, a Survey of Pediatric Patients" authors explore daith piercing perception of pediatric patients as a complementary or alternative medicine modality. They used a survey to evaluate pediatric patients knowledge about the daith piercing as well as their willingness to use it in the future as a complementary treatment. In my opinion alternative medicine modalities are surging in the headache field because of the lack of effective treatment options in patients (both adults and pediatric). I agree with the authors that it is important to study these type of treatments to better understand their actual benefit in patients in order to use it as a complementary tool for treatment. 

The manuscript itself is well written and contains appropriate references that support the current study. 

I have some comments regarding the methods and results:

1. The authors used a survey that they designed themselves, it would be very helpful to have a copy of the survey in the manuscript as a figure, so that the readers can get a sense of the survey as a whole and can see what the patients had to fill. 
2. The authors mentioned that the age was not consistently reported by those completing the survey ( 1st paragraph results) but in paragraph four of the results they mentioned that the age was positively correlated with knowing someone with a Daith and with having had a Daith, this is confusing. Authors should mention the age of the participants of the survey in order to make a sense of the second statement. 
3. There is no report of male patients in the whole manuscript, authors should include this numbers in order to discuss gender differences as they do in the results section. 
4. The result section needs to be organize better so it is easier to read, although it contains must of the data, it jumps from what I think is one part of the survey to another (that is why the survey as a figure would make it easier to understand). 
5. Avoid using phrases as "small negative correlation" it should say negative correlation. 
6. Table 2 is difficult to understand because there is a lot of missing information. I believe the authors tried to present the relationship of the variables mentioned in the table that were obtained from the Chi square, but if the authors are showing: Female Sex, Caucasian Race, they should also include the other variables compared to those mentioned in the table, although they might not be significant. For example age is very confusing how a Chi square was done, was the age analyzed in intervals? this should be explain. 
7. It is also not clear enough the number of patients in table 1, 170 all neurology patients, 119 primary headache patients and 1 missing. I understand you wrote that the total was 171 patients, so I assume the 119 are subtracted of those 170 total patients?, I think this is easy to solve if you include a TOTAL column, at the end of the table so it is clearer for the reader. Also you might want to only mention primary headache patients, which are the patients of interest. 
8. In all the chi square analysis made in the results, all variables should be mentioned.

The discussion is based correctly on the results presented, I appreciate the authors mentioned all the limitations of the study and although only a few patients actually had the daith piercing, important information can be obtain even from small n studies such as this. 

The authors can also use the pain gate theory as a way to explain the physiology behind the results observed with the piercing. 

Author Response

Please see attachment

Author Response File: Author Response.docx

Reviewer 2 Report

This work cannot have a sham arm.

Besides, the number of subjects is very low.

Note that: the frequency of migraine fluctuates during the year. The frequency can also decrease spontaneously, without the intervention of the doctor, especially in adolescents.

Author Response

Thank you for your input

Round 2

Reviewer 1 Report

The authors addressed all my comments and change the manuscript accordingly. I don't have any more suggestions.