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Biomedical subjects

O Sjaastad

Publications and source records attributed to O Sjaastad.

At least 55 records · Page 3Linked to original sources
PubMed1997

SUNCT syndrome. Diagnosis morbi. Shortlasting Unilateral Neuralgiform headache attacks, with Conjunctival injection, Tearing and rhinorrhoea.

The present communication represents an updating of the clinical features of SUNCT. The characteristics of SUNCT have been weighed against other orbital/periorbital headache syndromes towards which differential diagnosis is mandatory. In this group, there are various headaches: cluster headache syndrome, first branch trigeminal neuralgia, and idiopathic stabbing headache (jabs and jolts syndrome). SUNCT emerges as a fairly clear-cut, clinical syndrome. A set of diagnostic criteria of SUNCT syndrome is also given.

Adult↗
PubMed1996

Reproducibility of the cold pressor test: studies in normal subjects.

The reproducibility of the cold pressor test was studied in healthy subjects. A non-invasive method was utilized for estimating beat-to-beat arterial blood pressure (BP) and heart rate (HR). The study population of 17 healthy volunteers consisted of two groups. In the first group (Group 1, n = 11), a 1-min test was performed three times during the same day. In the second group (Group 2, n = 6), a 2-min test was repeated at the same time of the day on three consecutive days. In both groups, the test response was defined as the 46- to 60-s mean, minus the prestimulus 15 s baseline mean. In Group 1, a fair test-retest reliability was observed for the systolic BP response (intraclass correlation coefficient R = 0.57). Large intraindividual HR and diastolic BP variabilities were found. The intraindividual testretest difference in Group 1 ranged from -8 to 11 beats/min (SD = 4.3, R = 0.49) for the HR, from -16 to 13 mmHg (SD = 6.3) for systolic BP, and form -21 to 20 mmHg (SD = 9.7, R = 0.23) for diastolic BP. Even larger variability was observed when the test was repeated on different days (Group 2). Thus, the maxim that the response pattern to the cold pressor test is fairly constant for each individual may not be true. It does not seem to be advisable to use the results from one solitary cold pressor test. The use of replicated measurements and large sample sizes in comparative studies to compensate for the low to moderate reliability of the cold pressor test is recommended.

Adolescent↗
PubMed1996

Chronic paroxysmal hemicrania and hemicrania continua. Interval between indomethacin administration and response.

The interval between indomethacin dosage and clinical response was assessed in hemicrania continua (n = 12) and chronic paroxysmal hemicrania (n = 11) sufferers. The number of trials per patient ranged from 1 to 30. At the time of testing, the patients had "considerable" pain after discontinuation of the drug. The dosage used was the usual one for that patient at the given pain level; ie, 25 or 50 mg tid. All the patients had a complete, long-term response to treatment. Nevertheless, the average interval between drug intake and pain relief during the present study ranged between 30 minutes and 48 hours in both disorders. In most patients (10 in both groups), the indomethacin effect was complete within 24 hours, and frequently within 8 hours. It is suggested that interindividual differences in dosage and timing to abolish the headaches may be due to different bioavailability or individual sensitivity. Recommendations on indomethacin testing in unilateral headaches are given.

Administration, Oral↗
PubMed1996

SUNCT syndrome. Atypical temporal patterns.

New clinical features of the SUNCT syndrome are described in a series of 3 men (mean age of 65 years, range 56 to 80). The mean age at the onset of symptoms was 55 years (range 39 to 77). Although in all patients the great majority of attacks were typical, on a few occasions unusual features of the painful attacks were either reported or witnessed by the investigators. We have classified these clinical phenomena as (1) low-grade background pain or discomfort, and (2) relatively long-lasting attacks. Neither neurological examination nor neuroimaging studies revealed structural lesions as responsible for the atypical features. The fact that these atypical attacks occurred in the usual symptomatic area and were accompanied by the usual ipsilateral autonomic signs, suggests that they are an integral part of the clinical picture of SUNCT. The possibility that another, concurrent headache was responsible for the unusual attacks is considered unlikely. These clinical phenomena should, accordingly, provisionally be considered as additional but rare clinical features of the SUNCT syndrome.

Aged↗
PubMed1996

SUNCT syndrome: duration, frequency, and temporal distribution of attacks.

Duration, frequency, and temporal distribution of attacks have been objectively estimated in 11 SUNCT patients (3 women and 8 men). The mean age at the time of the study was 69 years (range 52 to 81). The duration of a total of 348 attacks was measured from videotape records, polygraphic tracings, or by stopwatch. The duration of attacks ranged from 5 to 250 seconds, with an unweighted mean of 61 seconds. Both frequency and exact timing of attacks were assessed in four patients who filled in a time chart with the exact onset of 585 consecutive attacks. The majority of attacks occurred during daytime, with a bimodal distribution; ie, morning and afternoon/evening peaks, and only a few attacks were noted at night (ie, 1.2% of the attacks). The unweighted mean frequency of attacks was 28 per day (range 6 to 77). Duration and timing of attacks in SUNCT syndrome may be of help in the differential diagnosis versus other disorders with the same localization, especially first division trigeminal neuralgia.

Aged↗
PubMed1996

Cervicogenic headache: the influence of mental load on pain level and EMG of shoulder-neck and facial muscles.

The relationship between pain and EMG levels was studied in 17 cervicogenic headache patients and 17 group-matched healthy controls. All subjects performed a 1-hour, complex, two-choice, reaction time test. Every 10 minutes before, during, and also for 20 minutes after the test, they reported pain levels (using visual analogue scales) in the forehead, both temples, neck, and shoulders. Electromyographic activity, using superficial electrodes, was also recorded from the frontal, temporal, neck (splenius), and trapezius muscles. Maximal voluntary contractions were performed in all the muscles. Increased pain levels before, during, and after the test were found on the symptomatic side in the temple, shoulder area, and neck in the patient group compared with nonsymptomatic side and controls (neck only compared with controls). Electromyographic amplitudes from the trapezius muscle on the symptomatic side were significantly higher before and during the test, compared with the nonsymptomatic side, but most markedly during the test. Pretest EMG amplitudes from the frontal muscle on the symptomatic side in patients were also significantly higher than those in controls, but the difference vanished during the test. There are indications that the temporal pain, ie, the headache, is a referred pain. These observations may point to a "muscular" involvement in the pathogenesis of cervicogenic headache, either primarily or, which seems more plausible, secondarily.

Adult↗
PubMed1995

Treatment of cluster headache and its variants.

In cluster headache, subcutaneous administration of sumatriptan has been established as an efficient, safe and well tolerated treatment for acute attacks. For prophylactic treatment, capsaicin (intranasal administration) and leuprolide (a synthetic slow-release gonadotrophin-releasing hormone) seem to be promising. Hyperbaric oxygen therapy seems to be effective in acute attacks, but it is of interest mostly because of its apparent interruption of the cluster period in some patients. In chronic paroxysmal hemicrania, which clinically resembles cluster headache, indomethacin is still necessary for diagnosis, and it is the treatment of choice in most patients. However, because of its potential side effects, alternative treatments should be sought.

Cluster Headache↗
PubMed1995

Headache due to an extra joint between head and neck.

A girl, born in 1973, started having headache in preschool age. After a head trauma in 1985, there was a clear worsening of the headache, and the headache became chronic at around 14 years, making regular school attendance impossible. The headache was "symptom poor," bilateral-occipital, but with a clear left-sided preponderance and occasionally spreading to the forehead. The headache was always worst in the morning hours, easing up by noontime. Neck rotation to the right could provoke long-lasting exacerbations. Neck movement was restricted on rotation to the left. A sore bony structure was discovered on palpation just underneath the mastoid process of the left side. This proved to correspond to a bony "bridge" with an extra joint between the first vertebra on the left side and the skull, medially to the mastoid process that could be demonstrated on x-ray tomography and CT scanning. This bony bridge was removed surgically more than 2 years ago, and the pain disappeared on the day of operation and has not recurred in the intervening time. Such bony bridges have in the past been considered to be innocuous and not symptom producing. Although this may be the general rule, the present case tends to show that even to this rule, there are exceptions.

Adolescent↗
PubMed1995

SUNCT syndrome: trials of drugs and anesthetic blockades.

Nine patients with the SUNCT syndrome (Spanish and Norwegian patients) have, over many years, been given several drugs effective in the cluster headache syndrome, trigeminal neuralgia, and other headaches, as well as drugs not previously used in headache. Various cranial nerves were also anesthetized in an endeavor to ameliorate the suffering of those patients. Although a partial effect was obtained with carbamazepine and corticosteroids in some patients, none of the drugs or anesthetic blockades had consistent, lasting, complete effect on headache paroxysms in SUNCT. The essentially negative outcome of this study aids in further characterizing SUNCT as a separate disorder, and, above all, in distinguishing it from trigeminal neuralgia and the cluster headache syndrome.

Cluster Headache↗
PubMed1995

Respiratory studies in SUNCT syndrome.

Seven SUNCT patients (six men, one woman) took part in this study. In four patients, respiratory variables were compared during and outside attacks. In five patients, peripheral chemosensitivity was tested and compared with a control group matched with respect to age, sex, and smoking habits. The results indicate that SUNCT patients hyperventilate during attacks. Moreover, they appear to hyperventilate slightly under basal conditions. The tests for peripheral chemoreceptor activity indicated no differences between the SUNCT and the control groups except for one variable, namely the mean ventilatory response to a single breath of 13% CO2. It is possible that this indicates a blunted response of the peripheral chemoreceptors. On the other hand, it may also represent a chance finding, since none of the other results presented suggested such a conclusion, and the size of the test group was very small. The results do not indicate that a reduction in oxygen saturation can trigger SUNCT since low levels of oxygen saturation were only rarely accompanied by SUNCT, whereas many attacks were not associated with any appreciable lowering in arterial oxygen saturation.

Aged↗
PubMed1995

CPH and hemicrania continua: requirements of high indomethacin dosages--an ominous sign?

Two female patients, one with chronic paroxysmal hemicrania and one with hemicrania continua, had a continuously high requirement of indomethacin, ie, > or = 225 mg per day, for 4 and 7 years, respectively. In the hemicrania continua patient, a right (symptomatic side) C7 root affection due to disc herniation was demonstrated. Removal of the disc relieved the arm pain completely, and reduced the head pain and indomethacin requirement considerably initially. The other patient suffered from the unremitting form of chronic paroxysmal hemicrania with right-sided attacks from the age of 16. Indomethacin, 200 to 250 mg per day generally kept the headache at bay, but during exacerbations, especially during menstrual periods, the dosage transitorily had to be increased to 250 to 350 mg per day. A CT scan with contrast at aged 18 (1987) was negative. In 1992, she started having new symptoms, including numbness on the ipsilateral side of the face and arm and difficulty swallowing. An MR scan showed a meningioma originating in the roof of the cavernous sinus on the symptomatic side. The meningioma was surgically removed. The postoperative indomethacin requirement was reduced, but only transiently. Patients with chronic paroxysmal hemicrania (CPH) and hemicrania continua (HC) with a continuously high indomethacin requirement may have grave additional disorders and should consequently be followed closely.

Adolescent↗
PubMed1995

Cluster headache: cardiovascular responses to head-up tilt.

Head-up tilt tests were performed in six cluster headache patients in a bout of attacks, but in a pain-free interval at the time of investigation; and in eleven controls matched for age, basal blood pressure, and heart rate. A Doppler servomethod was used for a noninvasive, beat-to-beat blood pressure determination. There were no significant differences between the cluster headache and control groups for heart rate and systolic blood pressure response to the head-up tilt. However, the average diastolic blood pressure seemed to drop more after the tilt in the cluster headache group than in the control group; in particular, in the later part of the test. This might suggest a dysfunction of the baroreflex in cluster headache patients in a bout, also outside of attacks, and most probably of the sympathetically-mediated vasomotor response.

Adult↗
PubMed1995

A piroxicam derivative partly effective in chronic paroxysmal hemicrania and hemicrania continua.

Piroxicam beta-cyclodextrin has recently been observed to be equal to, or even possibly to be superior to, indomethacin (mainly with regard to side effects) in a single case of hemicrania continue. Piroxicam beta-cyclodextrin, 20 to 40 mg per day, was, accordingly, tried in six patients with chronic paroxysmal hemicrania and six patients with hemicrania continua with a previously proven response to indomethacin. The study was conducted over a period of 3 weeks and in an open fashion. A placebo effect is considered to be negligible in these disorders. In such a comparison, piroxicam beta-cyclodextrin seemed inferior to indomethacin, in particular in chronic paroxysmal hemicrania.

Aged↗
PubMed1995

Segmental hyperhidrosis in two siblings with Chiari type I malformation.

A marked, left-sided segmental hyperhidrosis, verified by quantitative evaporimetry, corresponded to an area of dissociated sensory loss in 2 siblings (male 49 years old, female 47 years old). MRI scans of the head and whole cord demonstrated a Chiari type I malformation in both. In the male, there was a syrinx of the neck. The level of this did not correspond to the hyperhidrosis and dissociated sensory loss areas of the trunk and thigh. The female, who had no syrinx, had hyperhidrosis and dissociated sensory loss of the head, neck, upper trunk, and arm, and anisocoria with the larger pupil ipsilateral to the sweating. This rare disorder may be due to a disinhibition of the preganglionic sympathetic neurons caused by cord lesion(s) interrupting inhibitory descending and spinal pathways which are important for the normal thermoregulatory sweating.

Arnold-Chiari Malformation↗
PubMed1994

SUNCT syndrome in the female.

Two female patients suffering from SUNCT syndrome are presented. They are the first female SUNCT cases reported (of a total of 16 cases hitherto seen by us, reported to us, or published). Also some minor modifications of the hitherto known clinical symptomatology of SUNCT syndrome have been observed. Attacks could be triggered in a variety of ways. A short latency between the application of a precipitating stimulus and the onset of pain was noted. An occasional inability of a given precipitating maneuver to activate the pain was also noted. The temporal pattern of pain was partly characterized by the typical, "plateau-like" pattern, but with ultrashort exacerbations. In part, the pain attacks were characterized by steeple or spike-like pain waves, that did not quite subside to the baseline ("repetitive pattern"). Autonomic signs such as lacrimation and conjunctival injection were rather marked, as is generally the case in SUNCT syndrome. Rhinorrhea was present in both patients, and in one patient the rhinorrhea was unusually marked. Carbamazepine treatment seemingly brought about a slight decrease in the frequency of attacks.

Aged↗
PubMed1994

The hereditary syndrome of thrombocytopathia, bleeding tendency, extreme miosis, muscular fatigue, asplenia, headache, etc. ("Stormorken's syndrome"): I. The headache.

A new, autosomal dominantly inherited syndrome with a bleeding disorder was described in 1985 by Stormorken and his co-workers. In this multifaceted syndrome, there were the following integral components: thrombocytopathia, extreme miosis with Argyll Robertson-like traits, muscular fatigue, a tendency to spasms, asplenia, ichthyosis, dyslexia, etc. Headache with migraine traits was also present in the family in all 4 generations in which this syndrome had been observed. Nasal and conjunctival bleeding were part of the headache picture in some of the individuals exhibiting the hemorrhagic syndrome. While the attack-related bleeding disturbances only involved family members who also suffered from the hemorrhagic syndrome, the headache per se may seem to behave differently: The affected son's headache seems to have developed into a headache with tension headache traits, whereas the other, unaffected, son's headache has common migraine traits. The familial headache which in earlier generations clearly had migraine traits, therefore, may be inherited independently from the hemorrhagic disorder. In other words, a migraine or migraine-like headache is most probably not an obligatory integral part of this syndrome. The thrombocytopathia in this disorder comprises abnormal serotonin storage, uptake, and release (Stormorken and co-workers, to be published). The admittedly somewhat farfetched possibility also exists that the headache, although being similar to migraine, differs essentially from it and may be an expression of the serotonin aberration.

Blood Platelet Disorders↗