Biomedical subjects

O Sjaastad

Publications and source records attributed to O Sjaastad.

At least 19 recordsLinked to original sources

PubMed2006

Hydrogen sulphide headache and other rare, global headaches: Vågå study.

One aim of the Vågå study of headache epidemiology was to depict the total panorama of headaches in a small-sized, Norwegian community at the end of the 20th century. In the present part of the study, a search was made for the rare, global headaches. Various, relatively unknown headache categories were observed, such as hydrogen sulphide intoxication (n = 2) after exposure to H(2)S ambient air concentrations of >or=100 p.p.m. In Vågå, nitroglycerine headache ('dynamite headache') proved to be a relatively frequent disorder (n = 13). This represents approximately 0.7% of the study group. A main reason for this, in all probability unusually high frequency is that there previously have been soapstone mines within the precincts of the parish. Another relatively frequently occurring headache followed exposure to wind (n = 7; 0.38%). Ice-cream headache was rare (n = 3; 0.16%), when only the general question was asked: 'other headaches?'. Approximately 7 years later, an ad hoc procedure was adopted: 50 parishioners who did not answer positively concerning ice-cream headache on the first examination were asked specific questions concerning ice-cream headache. Four had had such an experience, i.e. prevalence of 8%, which is 50 times higher than the original result, but still a rather low prevalence when compared with the mean prevalence from other studies: 39%. This demonstrates that the result as regards prevalence, even for a headache such as ice-cream headache, to a large degree depends upon the interview technique used.

Adolescent↗

PubMed2006

Neck-tongue syndrome and related (?) conditions.

A search has been made for the neck-tongue syndrome. It started out with a systematic inquiry during the Vågå study of headache epidemiology during the years 1995-97. Two cases were detected relatively early during the study. This led to a scrutiny of such cases also in our hospital headache practice. The origin - and the basis of the study, nevertheless, was the Vågå study. In the Vågå study, where 1838 18-65-year-old parishioners were examined, there were four neck-tongue syndrome cases (N-TS), i.e. a prevalence of approximately 0.22%. N-TS may be more frequent than hitherto surmised. A variant was observed in one case; a young male: instead of numbness, a 'spasm' seemed to occur in the tongue. None of the four had at any time consulted their physician for their complaints. In our regular headache practice, two new cases were detected. In one of them and in one of the Vågå cases, there was a combination with ipsilateral cervicogenic headache (CEH). In N-TS, there may be both ipsilateral headache and upper extremity sensory phenomena, a constellation reminiscent of CEH. The possible pathogenetic relationship between N-TS and CEH is therefore discussed in some detail.

Adult↗

PubMed2006

Hemicrania with massive autonomic manifestations and circumscribed eyelid erythema.

OBJECTIVES: To describe a unilateral headache that in addition to the typical shortlasting unilateral neuralgiform headache attacks with conjunctival injection, tearing, sweating and rhinorrhea (SUNCT) syndrome - traits with excessive and ipsilateral autonomic phenomena - had circumscribed eyelid erythema and adjacent ocular redness. OBSERVATIONS: A 60-year-old female had excessive, right-sided lacrimation and local pain at 15 years of age. Due to steadily increasing discomfort, with lacrimation and swelling over the outer part of the upper eyelid, the right lacrimal gland was removed at 20 years of age, with a suspicion of lacrimal gland adenoma. Preoperatively, symptomatic side mild-degree eyelid erythema/rhinorrhea were integral parts of the attack. After years with minor complaints, she, in the mid-twenties, experienced more long-lasting pain attacks, and pain soon became the main problem. A marked, distinct erythema on the lateral part of the right-sided eyelids and marked, localized 'eye redness' in the adjacent area were main ingredients of the attacks together with eyelid edema and viscous rhinorrhea. There were visible vessels below the eye, and telangiectasia of the upper eyelid. CONCLUSIONS: This headache has many similarities with SUNCT - but has several, grossly deviating traits: the temporal aspects, excruciatingly intense pain attacks, and above all marked, lateral eye-lid erythema, and adjacent, massive ocular reddening. This constellation probably alienates it from SUNCT.

Anticonvulsants↗

PubMed2006

Neck pain and associated head pain: persistent neck complaint with subsequent, transient, posterior headache.

BACKGROUND: During the Vågå headache epidemiology study, there were indications that various types of work, such as carpentry and hairdressing, frequently seemed to be linked to a combination of neckache and headache. OBJECTIVES: A post hoc study was conducted among 1838, 18- to 65-year-old Vågå citizens, looking for patients with combined neck/headache. DESIGN: Face-to-face interview was conducted. RESULTS: Combined neckache and headache were detected in 121 (6.6%) individuals. The bilateral headache originated in the neck; it was mild/moderate, symptom-poor, and frequently provoked by awkward neck positions. No such headache occurred without a neckache. Headache in this group of patients resembles tractor drivers' headache, except for the provoking factor itself. CONCLUSIONS: This headache is not listed in headache classification systems/textbooks on headache. This headache must be distinguished from the unilateral cervicogenic headache proper because of the different treatment perspectives.

Adult↗

PubMed2005

Single high-dose steroid treatment in episodic cluster headache.

Corticosteroids appear to be the most rapid-acting of the prophylactic drugs used in the treatment of cluster headache (CH). These agents are frequently employed as a short-term regimen to induce clinical remission. In this study, we assessed in an open fashion the effect of high dose methylprednisolone (MPD) in a group of 13 patients with episodic CH (3 females and 10 males). On the 8th day of the active period, MPD was administered intravenously at the dose of 30 mg/kg body weight, as a 3-h infusion in saline. The attack frequency was followed for 7 days. The mean daily attack frequency before MPD administration was statistically different from that reported after treatment (respectively: 1.38 +/- 0.42 and 0.83 +/- 0.78; P = 0.05 Student's t-test). The mean interval between MPD administration and the occurrence of the first subsequent attack was 3.8 +/- 2.2 days (range: 2-7 days). Only 3 (23%) of 13 patients experienced a complete headache remission. No significant side-effects were noted after MPD administration. These data further demonstrate that in most patients with episodic CH, high-dose systemic steroid administration may invariably interrupt attack recurrence for a few days, but is ineffective in maintaining complete clinical remission. This study also suggests that MPD administered as a solitary dose does not provide any advantage above prednisone in CH treatment.

Cluster Headache↗

PubMed2005

Supraorbital neuralgia. Vågå study of headache epidemiology.

In a recent, hospital-based report, we described a small series of 5 patients with unilateral, more or less chronic, severe forehead pain, that could be transitorily abated by anaesthetic blockade of the supraorbital nerve and more permanently abated by 'liberation' operation directed towards the nerve exit area at the supraorbital notch. However, epidemiological data on supraorbital neuralgia are lacking. Among 1838 18-65-year-old inhabitants in Vågå (88.6% of the eligible ones), there were 10 who presented the following clinical picture: (1) Unilateral forehead/ocular pain, not diagnosed or diagnosable as any other, particular, unilateral headache; (2) Steadfast unilaterality; (3) Increased tenderness upon pressure over the exit site of the supraorbital nerve (incisura frontalis) on that side--in those who were in an active phase; (4) Foregoing trauma in the forehead/supraorbital rim area, ipsilaterally. In approximately half the cases, there was a moderate, ipsilateral sensory loss. A striking finding was the occurrence of jabs in the symptomatic area, and in synchrony with the neuralgia pain. These 10 inhabitants correspond to a prevalence of 0.5% (or 0.65% if two nontrauma cases are included).

Adolescent↗

PubMed2005

Long-lasting cephalic jabs (?) The Vågå study of headache epidemiology.

Jabs (stabs) usually last < or = 3 s and are located in the skull area, mostly anteriorly. In many cases, there are only a few jabs during lifetime. With this definition, jabs are frequent, thus at 35.2% in the Vågå study of headache epidemiology. Long-lasting jabs (?), i.e. paroxysms lasting 10-120 s, were present in six out of 1779 parishioners. These pain paroxysms seemed mainly to be side-locked, but could not be provoked. Possibly, these long-lasting jabs after all mainly are regular jabs. To include the < or = 2-minute-long paroxysms among the jabs will necessitate a rather drastic change of criteria. This group of jabs may, nevertheless, be heterogeneous. In two parishioners, the paroxysms were associated with a migraine-like pain. The paroxysms occasionally became most intense (2-10 times the basal pain), and then, and only then, were they combined with stark, visual phenomena: wave-like movements ('undulation'), anopsia, but also: immense dizziness, nausea/vomiting. The nature of the side-locked basal pain, although migraine-like, remains unsolved.

Adolescent↗

PubMed2004

Caffeine-withdrawal headache. The Vågå study of headache epidemiology.

In connection with the Vågå study of headache epidemiology, a search was made for caffeine-withdrawal headache in 1741 parishioners. Female to male ratio 1.05; mean age 44.2 years (range 18-65 years). A face-to-face interview technique was used. The mean consumption of coffee was 4.7 cups a day. Males on an average consumed more coffee (5.1 +/- 3.3 cups/day) than females (4.4 +/- 3.1 cups/day). Neither in those with a high consumption of coffee: > or =10 cups a day (n = 134), nor in those with a considerable variation in consumption: > or =10 cups/day (n = 31) did there seem to be a definite increase in headache resembling caffeine-withdrawal headache, for instance during weekends. In seven parishioners, however, there did seem to be such a headache, and in two of them, the evidence was rather convincing. This headache generally seemed to be mild and global and occurred mainly in the morning hours on weekends. There was no nausea, no throbbing quality of the pain, and no reported use of analgesics. Coffee seemed to abate the headache. This frequency (0.4%) should, clearly, be regarded as a minimum figure. Caffeine-withdrawal headache at the grassroots level may be a rather rare, generally vague, symptom-poor headache.

Adolescent↗

PubMed2003

Extracephalic jabs/idiopathic stabs. Vågå study of headache epidemiology.

Ultrashort cephalic paroxysms are well known. In the parish of Vågå, Norway, 35.2% of the 18-65-year-old subjects (n = 1779) were recently found to have such jabs. In the present work, a search has been made for extracephalic 'jabs'. A questionnaire was in its entirety administered by the same investigator (O.S.) in a 'semistructured' way. Facial jabs were present in three women, and in one of them the pain spread to the head. Four subjects had jabs occurring at random throughout the body, also including the cephalic area. Pure nuchal jabs were present in 12 subjects, 10 of whom were males. This sex preponderance difference differs significantly from that in jabs in general (with 40.2% males). The characteristics of the extracephalic jabs, i.e. the duration and temporal pattern, do not seem to differentiate them essentially from jabs in general. The subjects were not asked specific questions regarding extracranial jabs. Most of the affected individuals gave information spontaneously about their jabs. For these reasons, this study is not a proper prevalence study. It does show, however, that extracranial jabs exist, and it gives some indications as to their frequency.

Adolescent↗

PubMed2003

Parenteral indomethacin (the INDOTEST) in cluster headache.

The interval between indomethacin administration and clinical response may be extremely relevant in the assessment of chronic paroxysmal hemicrania (CPH) and other unilateral headache disorders like cluster headache (CH), with which CPH can be confounded. Indomethacin is inactive in CH; however, in some anecdotal reports in recent years, doubt has been cast on the ineffectiveness of indomethacin in CH. In this study, we have re-assessed the effect of indomethacin treatment in a group of 18 patients with episodic CH (three females and 15 males). From the day 8 of the active period, indomethacin 100 mg i.m. was administered every 12 h, for 2 consecutive days, in an open fashion. The mean daily attack frequency before the test (1.6 +/- 0.6) was not statistically different from that on day 1 (2.1 +/- 0.9) and day 2 (1.9 +/- 0.8) after indomethacin administration. The mean interval between indomethacin injection and the following attack (day 1 and day 2) was 4.6 + 1.1 h. We did not observe any refractory period in any patient after indomethacin. Since the 'expected' attack occurred when there theoretically could have been a protective effect after indomethacin administration, it can be reasonably assumed that there is no such protective effect. The use of a test dose of 100 mg i.m. indomethacin (INDOTEST) appears to provide a clear-cut answer in this situation. It may be a useful tool for a proper clinical assessment of unilateral headache with relatively short-lasting attacks when problems of classification arise. A correct diagnosis of CPH or CH is important, since a CPH diagnosis may imply a lifelong treatment with a potentially noxious drug.

Adult↗

PubMed2003

Cluster headache prevalence. Vågå study of headache epidemiology.

In the Vågå study of headache epidemiology, a search was made also for cluster headache. Of the available 18-65-year-old dalesmen, 1838 (88.6%) could be examined personally (O.S.) - 51.3% females and 48.7% males. Based on current International Headache Society criteria, cluster headache seemed to be present in seven dalesmen, one female and six males (corresponding to a total prevalence of 381 per 100 000; 95% confidence interval (CI) 153-783 per 100 000). Except for the female gender, the female case was fairly typical. In one case, there were short-lasting bouts ('minibouts'). It was felt that this also was a genuine case of cluster headache. If one excluded the latter case, there would be one female and five males [a prevalence of 106 per 100 000 for females, and 558 per 100 000 for males, giving a prevalence in the total population of 326 per 100 000 (95% CI 120-709 per 100 000)]. The confidence interval was considerable. This study therefore does not give a clear indication as to prevalence.

Adult↗

PubMed2003

Exertional headache--II. Clinical features Vågå study of headache epidemiology.

In connection with a large-scale study of headache epidemiology in the parish of Vågå, Norway (n = 1838), a prevalence of exertional headache (EH) of 12.3% was recently reported (n = 202). The principal aim of the present report is to have a closer look at various clinical features: particular attention has been given to the coexistence of EH and migraine. EH seemed to coexist with migraine in 46% of the cases. In spite of that finding, there was generally no plentitude of 'migraine features' in the EH attacks per se. The predominant 'migraine feature' in EH attacks was throbbing. EH attacks were generally more short-lasting and seemed to be more lenient than the corresponding migraine attacks. Nausea/vomiting, and unilaterality of pain were generally not inherent features of EH attacks. EH attacks in all probability are not abortive migraine attacks--rather, they seem to be 'migraine-like'.

Adolescent↗

PubMed2003

Prolonged benign exertional headache. The Vågå Study of headache epidemiology.

OBJECTIVE: To explore in detail the duration of exertional headache attacks and explicitly to identify cases of prolonged exertional headache. BACKGROUND: The prevalence of exertional headache in general population samples may exceed 10%. The prevalence and distinguishing clinical characteristics of prolonged exertional headache are not well delineated. METHODS: One author (O.S.) personally interviewed 1838 parishioners (88.6%) of ages 18 to 65 years living in a southern Norwegian commune. Questions relevant to exertional headache were included. RESULTS: As recently reported elsewhere, exertional headache was present in 12.3% of those questioned. With 1 hour set as a tentative border for short- versus long-duration exertional headache, there were approximately equal numbers with short- and long-lasting attacks; prevalence of short-lasting attacks was 6.3% and long-lasting attack prevalence was 6.0%. In regards to other epidemiologic and clinical features, the long-lasting cases did not seem to deviate from the short-lasting cases; both categories had a moderate female preponderance and similar age of onset. There was a somewhat higher mean number of "migrainelike features" in the long-lasting than in the short-lasting variety of exertional headache. Exertional headache attacks could last up to 24 hours. CONCLUSIONS; There seems to be little reason to subdivide exertional headache into 2 separate varieties according to attack duration. Exertional headache attacks have "migrainelike" features but do not seem to be "form fruste" migraine attacks. The long-lasting variety is not uncommon.

Adolescent↗

PubMed2002

The Vågå study of headache epidemiology II. Jabs: clinical manifestations.

OBJECTIVES: To describe clinical characteristics of cephalic jabs. MATERIAL AND METHODS: In a population study in Vågå, Norway, 1838 18-65-year-old-parishioners (88.6% of the target group) were subjected to a semi-structured interview, based on a headache questionnaire. RESULTS: Of 627 cases of jabs, 68% had single jabs; 4% volleys, and 28% a mixture of volleys and singlets. Most individuals had experienced only few jabs. Exceptionally, there were multiple attacks per day, even per hour. The ratio between an anterior and posterior location was 2.6. Neck movements and Valsalva manoeuvres seemingly occasionally precipitated attacks. Attacks were generally of mild/moderate intensity. Unilaterality prevailed over bilaterality; but unilateral pain might shift side. CONCLUSION: Cephalic jabs are generally solitary paroxysms, with rather long intervals between attacks. Jabs do not only occur in the trigeminal area. Occasionally vocalization and more frequently jolts accompany the paroxysm.

Adolescent↗

PubMed2002

Cervicogenic headache (CEH) after whiplash injury.

The main objective of the present investigation was to search for cervicogenic headache (CEH) after whiplash injury. Whiplash patients (n= 587), were followed for a year after their emergency service consultation. A total of 222 patients with headache after 1 month went through interview and examinations at 6 weeks, 6 months and 1 year. All included persons received a questionnaire after 1 year. De novo CEH seemed to be present in 8% at 6 weeks and in 3% at 1 year. Previous car accidents, pre-existing headache and neck pain were more frequent in chronic CEH individuals than in those in the cohort without CEH. Range of motion in the neck was reduced in 65% of chronic CEH individuals hours after the accident, compared with 41% in the cohort. Cybex inclinometer, at 6 weeks and 1 year, demonstrated reduced extension in the neck. CEH seems to be present after whiplash injury, particularly in the early phase. It seems similar to, but probably not identical to, non-whiplash CEH.

Adolescent↗

PubMed2002

Tractor drivers' head- and neck-ache: Vågå study of headache epidemiology.

The main aim was to study the occurrence of neck- and headache in farmers exposed to seasonal tractor work which involves prolonged, continuous neck rotation. As an integral part of the Vågå study of headache epidemiology, 109 farmers were interviewed according to a set scheme in a 'semistructured' interview, concerning complaints in the wake of tractor work. No appreciable headache/neck-ache was found in 13 farmers; neck-ache alone was present in 66 farmers; headache/neck-ache was present in 15 farmers. For the remaining 15, the information was inadequate. Headache appeared only in connection with neck-ache. Only in those with headache did there seem to be a prevalence of nuchal features (such as reduced range of motion in the neck and positive skin-roll test). In 45% of cases, there was a carry-over effect after the chores, mostly of 1-3 days duration. Head- and neck-pain seem to be frequent in tractor drivers during chores.

Adolescent↗

PubMed2002

Cervicogenic headache: lack of influence of pregnancy.

The influence of pregnancy upon the head pain of cervicogenic headache (CEH) has been studied in 14 patients (number of pregnancies 25). Migraine was used as control group (n = 49; number of pregnancies 116). CEH was diagnosed according to The Cervicogenic Headache International Study Group guidelines. Migraine was diagnosed according to International Headache Society (IHS) guidelines; a further requirement was that at least eight of nine solitary IHS diagnostic requirements of migraine were present. In 79%-or more-of CEH patients, attacks seemed to appear just as usual during pregnancy; in one patient, attacks stopped completely, and in two there may have been a minor reduction of attacks. A significantly lower number of migraine patients (up to 18%) were more or less uninfluenced by pregnancy (CEH vs. migraine P < 0.0001, chi2 test). The lack of response to pregnancy may be a sort of biological marker in CEH. It may also help in clinically distinguishing CEH from migraine when CEH starts early in life, i.e. prior to pregnancies.

Female↗

PubMed2002

Exertional headache. I. Vågå study of headache epidemiology.

The aim was to assess the prevalence ('life-time') and manifestations of exertional headache and to validate some of the clinical diagnostic criteria. This study is part of the Vågå headache epidemiology study, where 1838 18-65-year-old dalesmen were personally examined in a 'semistructured' interview. With the criteria used, the prevalence was 12.3%. There was a slight but significant female preponderance (F/M ratio 1.38). There was a mixture of short- and more long-lasting attacks. Attacks followed long-lasting and strenuous effort/exhaustion. The precipitation mechanisms differed essentially from the cough/sneezing type of provocation. Blinded recheck of records (n = 100) as well as recheck of dalesmen (n = 41) showed high kappa values. The clinical manifestations differed essentially from Rooke's (1968) description (that mainly dealt with the 'cough headache'-type). The present findings were similar to those in Pascual's description of exertional headache from 1996.

Adolescent↗