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Evaluation of Salivary Cortisol in Adult Migraineurs Participating in an Internet-Administered Multimodal Behavioral Treatment Program
Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicinvetenskap.
Uppsala universitet, Medicin.
2011 (engelsk)Manuskript (preprint) (Annet vitenskapelig)
Abstract [en]

Objective: To evaluate salivary cortisol as a biological stress marker in migraine and how the different measurements used were affected during the course of a multimodal stress treatment program.

Methods: Saliva samples were collected at four predetermined time points of the day at inclusion, at mid-treatment, and at treatment conclusion during the course of a controlled Internet-administered multimodal behavioral treatment (MBT) intervention focusing on stress. Seventy-six participants (52 women/24 men) reporting at least two migraine attacks a month at inclusion were enrolled. The following four measurements of salivary cortisol as putative stress markers were used: aberrant Awakening Cortisol Response (ACR; < 50% or > 160% or < 2.5 nmol/L), low daytime profiles (all values <13 nmol/L), a low daytime value(s) (< 2.5 nmol/L; excluding the bedtime value), a high bedtime value (> 6 nmol/L), and a summarizing cortisol “index”. In a multivariate model these outcome measurements were compared to the following parameters: MBT treatment time, headache level, gender, stress susceptibility, negative life events, quality of life, depressive mood, physical activity, and body mass index − chosen as independent parameters related to stress.

Results: During the course of the MBT study the rate of aberrant relative ACR (< 50% or > 160%) was high with a range of 59 to 83 percent. No differences in aberrant cortisol profiles (ACR and low daytime profile) were detected as a function of: treatment (vs. control), degree of headache improvement, gender, or body mass index. With regard to single cortisol values (day- or bedtime), the number of high bedtime values increased and the number of low daytime values decreased significantly with time for participants in MBT when compared with controls, thus providing ambiguous data on change in stress responses as a function of the intervention. Low daytime profiles correlated with stress susceptibility. Experience of strongly negative life events during childhood and adolescence correlated with low daytime values and a higher cortisol “index”. However, the inverse relationship was found for strongly negative life events that had occurred during adulthood. Increased depressive mood according to MADRS-S scores was significantly associated with aberrant ACR.

Conclusions: The great variations in salivary cortisol profiles seen here demonstrate the complexity of cortisol regulation and, hence, underscore the difficulty of using measurements of salivary cortisol as stress markers in migraine. Although the intervention showed no consistent effect on cortisol levels, data need to be cautiously interpreted. Cortisol findings relating to stress susceptibility and life events during childhood/adolescence may be of particular interest for further study.

sted, utgiver, år, opplag, sider
2011. , s. 50
Emneord [en]
Salivary cortisol, migraine, stress, behavioral treatment, stress marker, stress susceptibility, awakening cortisol response
HSV kategori
Forskningsprogram
Neurologi
Identifikatorer
URN: urn:nbn:se:hig:diva-12859OAI: oai:DiVA.org:hig-12859DiVA, id: diva2:551786
Tilgjengelig fra: 2011-08-30 Laget: 2012-09-12 Sist oppdatert: 2018-03-13bibliografisk kontrollert
Inngår i avhandling
1. Migraine and Stress: An Internet administered Multimodal Behavioral Treatment Intervention
Åpne denne publikasjonen i ny fane eller vindu >>Migraine and Stress: An Internet administered Multimodal Behavioral Treatment Intervention
2011 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

Migraine is a disabling neurological disorder with high prevalence, the clinical manifestations of which are highly dependent on stress.

The overall theme of the present thesis was to address aspects of stress in migraine. A multimodal behavioral treatment (MBT) program was developed specifically designed for migraine and focusing on stress as a trigger and an intervention was performed using this Internet-administered program. Migraine symptoms were followed via an Internet administered diary and questionnaires were answered at regular intervals during the 11-month study period.

The thesis is based on four papers: In Paper I, life events and current stress, personality traits, and gender were studied cross-sectionally in 106 women and 44 men with migraine, who suffered at least two attacks a month at inclusion. Paper II describes a randomized controlled trial of the MBT program performed on 58 women and 25 men recruited from participants of the study described in Paper I. In the MBT study participants were randomized into one control group and two MBT groups, one of which received hand massage as part of the treatment. In Paper III, complete migraine drug use and changes in use and in drug efficacy during the MBT program were studied. In Paper IV, the salivary cortisol levels of MBT participants were evaluated as a biological stress marker.

The MBT program proved effective in decreasing migraine headache; it was feasible and there was low attrition. Moreover, MBT resulted in decreased migraine drug use and increased drug efficacy, but had no discernible effects on salivary cortisol profiles. No effect of hand massage on migraine headache frequency was seen. Personality trait profiling revealed high scores for the neuroticism factor. Stress susceptibility was the single most aberrant personality trait and correlated highly with the reported level of current stress and with experienced negative life events.

Gender differences included higher scores for women on trait anxiety, negative life events, depressive mood, anxiety, tension type headache, use of triptans, and efficacy of analgesics, whereas men displayed higher use of analgesics.

In conclusion, the efficacy and low attrition associated with the present MBT program appears promising and timely with regard to the development of better and more accessible migraine treatment. Stress susceptibility, gender, negative life events and psychosomatic comorbidity are important factors to consider in relation to the care of persons with migraine.

sted, utgiver, år, opplag, sider
Uppsala: Acta Universitatis Upsaliensis, 2011. s. 73
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 695
Emneord
Awakening Cortisol Response, Cognitive Behavioral Treatment, Gender, Hand Massage, Internet, Life Events, Migraine, Multimodal, Personality, Salivary Cortisol, Stress, Stress Marker, Stress Susceptibility
HSV kategori
Forskningsprogram
Neurologi
Identifikatorer
urn:nbn:se:hig:diva-12847 (URN)978-91-554-8139-1 (ISBN)
Disputas
2011-10-14, Rosénsalen ingång 95, Barnsjukhuset, Akademiska sjukhuset, 09:15 (svensk)
Opponent
Veileder
Tilgjengelig fra: 2012-09-12 Laget: 2012-09-11 Sist oppdatert: 2018-03-13bibliografisk kontrollert

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