2) Our results were issued from children who were clinically referred to our third-level centre for the treatment of primary headache.
Fifty six patients ages 11.0-18.0 (39,3% male and 60,7% female), seen for headache in a third-level centre in Italy, and their 56 mothers were enrolled in this study.
Our sample was relatively modest in size and limited to a specific clinical population, namely children and adolescents with MoA, under observation in a third-level centre, which may increase referral bias.
Our headache centre is a second-level centre with neurologists, experts in headache disorders.
Firstly, being a second-level centre, with high expertise in the treatment of liver diseases, patients are often referred to our department from other hospitals.
A second possible limitation of our study is that being a second-level centre, with a larger number of "complex cases" compared with more general interventional radiology departments, the same analysis performed in a different hospital might lead to different results.
Because of limited evidence of efficacy and the high rate of AEs (Table 3), the use of FBM is controversial and, as reported in NICE guidelines, should be limited to third-level centres in the add-on therapy of primary and secondary GTCS [ 3].
Consecutive IBS outpatients (n = 82, F = 67, mean age 41.6 ± 12.7 years), referred to our third level gastroenterological centre, were recruited.
This finding suggests that a substantial subset of patients of a third level gastroenterological centre with both IBS and FD may benefit from psychological assessment and treatment.
The fact that the third level (health centre organization) was not significant could be due to the characteristics of the selected health centers, all of them located in an urban area and experienced in the use of electronic medical records.
In any case, some bias cannot be ruled out and our third level referral centre sample may not accurately represent the entire population of patients with IBS or with IBS and FD.
