Methods: Children ages 2–17 who were within the KPNC health care system for  6 months during the study period (1997–2007) constituted the study cohort. Stroke outcomes had been identified as part of the Kaiser Pediatric Stroke Study. Children with migraine met at least one of the follow- ing criteria: 1) had  1 ICD-9 visit code for migraine, 2) had migraine listed on their significant health problem list, or 3) had a prescription for a migraine specific medication. Those migraineurs whose stroke occurred before evidence of head- ache were excluded. We calculated stroke incidence rates stratified by the presence or absence of migraine and inci- dence rate ratios (IR) as a measure of relative risk. In order to minimize the presence of undiagnosed migraineurs in the comparison group, we excluded from this group anyone with evidence of headache. Results: Of approximately 1.6 million eligible children within KPNC during the study period, 88,139 had migraine, and 1,323,062 had no evidence of headache. Of the migraineurs, 8 had a stroke during the study period (3 hemorrhagic, 5 ischemic). There were 80 strokes in chil- dren without headache, (66% hemorrhagic, 34% ischemic). The ischemic stroke incidence rate was 0.9/100,000 person-years in migraineurs vs. 0.4/100,000 person-years in those without headache; IR 2.0 (95% CI 0.8–5.2). The hemorrhagic stroke incidence rate was 0.5/100,000 person-years in migraineurs and 0.9/100,000 person- years in those without headache; IR 0.6 (95% CI 0.2–2.0). Conclusions: Pediatric migraine was not statistically sig- nificantly associated with an increased rate of pediatric stroke in this study. However, the two-fold increase in the estimate of ischemic stroke rate is similar to that reported in adults, suggesting the negative finding in this study may be the result of underpowering. Further research is needed, with particular focus on aura status as migraine aura mediates stroke risk in adults. LBP21 Occipital Nerve Block for the Preventive Treatment of Migraine: A Randomized, Double-Blinded, Placebo Controlled Study E. Dilli 1 , R. Halker 2 , J. Hentz 2 , R. Rogers 2 , B. Vargas 2 , A. Starling 2 , T. Radam 2 , D. Dodick 2 1 Neurology, University of British Columbia, Vancouver, BC, Canada; 2 Neurology, Mayo Clinic, Scottsdale, AZ, USA. Objectives: To determine the efficacy of occipital nerve block (ONB) with local anesthetic and corticosteroid for the preventive treatment of migraine. Background: Occipital nerve (ON) injections with cor- ticosteroids and/or local anesthetics have been employed for the acute and preventive treatment of migraine for decades. However, to date there is no randomized, pla- cebo-controlled evidence to support the use of ONB for the preventive treatment of migraine. Methods: Subjects between 18–75 years old with ICHD-II defined episodic (>1 attack per week) or chronic migraine were randomized to receive either 2.5 ml 0.5% bupivicaine plus 0.5 ml 20 mg methylprednisolone over the ipsilateral (uni- lateral headache) or bilateral (bilateral headache) ON or 2.75 ml normal saline plus 0.25 ml 1% lidocaine without epinephrine (placebo). Key exclusion criteria included subjects with con- tinuous headache, use of maintenance opioid medication, or the initiation of a medication with preventive efficacy for migraine within 2 months prior to screening. Patients com- pleted a 1-month diary both at baseline and after the double- blind injection. The primary outcome measure was defined as a 50% or greater reduction in the frequency of days with mod- erate or severe headache in the 4-week post-injection com- pared to the 4 week pre-injection baseline period. Results: Thirty-four patients received active and 35 patients received placebo treatment. Because of missing data, 33 patients in the Active and 30 patients in the placebo group were analyzed for efficacy. In the active and placebo groups respective, the mean frequency of at least moderate (mean 9.8 vs 9.5) and severe (3.6 vs 4.3) headache days and acute medi- cation days (7.9 vs 10.0) was not substantially different at base- line. The percentage of patients with at least a 50% reduction in the frequency of moderate or severe headache days was 30% for both groups (Á 0.00, 95% CI -0.22 to 0.23). There were also no significant between-group differences in the con- sumption of acute medications or post-injection ON tender- ness. The treatment was generally well tolerated with injection site pain noted for 4 patients in the active and 2 patients in placebo group. Conclusions: Greater occipital nerve block does not reduce the frequency of moderate to severe migraine days in patients with episodic or chronic migraine. LBP22 Reliability and Validity of Malaysian Language Translated Version of Migraine Disability Assessment (MIDAS) Questionnaire M.M. Shaik 1 , N.B. Hassan 2 , H.L. Tan 1 , S. Bhaskar 3 , S.H. Gan 1 1 Human Genome Centre, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; 2 Department of Pharmacology, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; 3 Department of Medicine, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. 970 Cephalalgia 33(11)