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  • 1.
    Hedborg, Kerstin
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicinvetenskap.
    Migraine and Stress: An Internet administered Multimodal Behavioral Treatment Intervention2011Doktoravhandling, 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.

  • 2.
    Hedborg, Kerstin
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicinvetenskap.
    Muhr, Carin
    Uppsala universitet, Medicin.
    Evaluation of Salivary Cortisol in Adult Migraineurs Participating in an Internet-Administered Multimodal Behavioral Treatment Program2011Manuskript (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.

  • 3.
    Hedborg, Kerstin
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicinvetenskap.
    Muhr, Carin
    Uppsala Universitet.
    The influence of multimodal behavioral treatment on the consumption of acute migraine drugs: a randomized, controlled study2012Inngår i: Cephalalgia, ISSN 0333-1024, E-ISSN 1468-2982, Vol. 32, nr 4, s. 297-307Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To characterize overall drug use in migraine in conjunction with multimodal behavioral treatment (MBT). Methods: Seventy-six adults reporting at least two monthly migraine attacks underwent a randomized, controlled, 24-week MBT intervention. Migraine drugs and symptoms were registered in an Internet-based diary. Results: During 4256 days of baseline registration, 859 drug doses were taken during 655 of the 856 days with migraine headache. Triptans and analgesics constituted 56.7 and 38.3% of all doses with efficacy ratios of 0.41 and 0.20, respectively. Men displayed significantly lower drug efficacy (p = 0.001), and used triptans significantly less (p < 0.001) and analgesics significantly more (p < 0.001) than women. At the end of the MBT, total drug consumption decreased by 22% (p = 0.029), corresponding to 27% fewer days with migraine headache. Drug efficacy increased during MBT from 0.30 to 0.52 (p < 0.001), mainly explained by an increased proportion of mild attacks, which also was the attack category that displayed the largest increase in drug efficacy. Conclusions: Triptans were the most used and efficient drugs. MBT led to decreased and more efficient drug consumption. Men used triptans less frequently.

  • 4.
    Larsson, Ing-Marie
    et al.
    Department of Surgical Sciences, Uppsala University.
    Wallin, Ewa
    Department of Surgical Sciences, Uppsala University.
    Kristofferzon, Marja-Leena
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Vårdvetenskap. Department of Public Health and Caring Sciences, Uppsala University.
    Niessner, Marion
    Roche Diagnostics GmbH, Penzberg, Germany.
    Zetterberg, Henrik
    Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg; UCL Institute of Neurology, Queen Square, London.
    Rubertsson, Sten
    Department of Surgical Sciences, Uppsala University.
    Post-cardiac arrest serum levels of glial fibrillary acidic protein for predicting neurological outcome2014Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, nr 12, s. 1654-1661Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim of the study: To investigate serum levels of glial fibrillary acidic protein (GFAP) for evaluation of neurological outcome in cardiac arrest (CA) patients and compare GFAP sensitivity and specificity to that of more studied biomarkers neuron-specific enolas (NSE) and S100B. Method: A prospective observational study was performed in three hospitals in Sweden during 2008-2012. The participants were 125 CA patients treated with therapeutic hypothermia (TH) to 32-34. °C for 24. hours. Samples were collected from peripheral blood (n. =. 125) and the jugular bulb (n. =. 47) up to 108. hours post-CA. GFAP serum levels were quantified using a novel, fully automated immunochemical method. Other biomarkers investigated were NSE and S100B. Neurological outcome was assessed using the Cerebral Performance Categories scale (CPC) and dichotomized into good and poor outcome. Results: GFAP predicted poor neurological outcome with 100% specificity and 14-23% sensitivity at 24, 48 and 72. hours post-CA. The corresponding values for NSE were 27-50% sensitivity and for S100B 21-30% sensitivity when specificity was set to 100%. A logistic regression with stepwise combination of the investigated biomarkers, GFAP, did not increase the ability to predict neurological outcome. No differences were found in GFAP, NSE and S100B levels when peripheral and jugular bulb blood samples were compared. Conclusion: Serum GFAP increase in patients with poor outcome but did not show sufficient sensitivity to predict neurological outcome after CA. Both NSE and S100B were shown to be better predictors. The ability to predict neurological outcome did not increased when combining the three biomarkers.

  • 5.
    Wiesinger, Birgitta
    et al.
    Umeå University and Västernorrland County Council.
    Häggman-Henriksson, Birgitta
    Umeå University and Malmö University.
    Wänman, Anders
    Umeå University.
    Lindqvist, Mikael
    Umeå University.
    Hellström, Fredrik
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Jaw-opening accuracy is not affected by masseter muscle vibration in healthy men2014Inngår i: Experimental Brain Research, ISSN 0014-4819, E-ISSN 1432-1106, Vol. 232, nr 11, s. 3501-3508Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    There is a functional integration between the jaw and neck regions with head extension–flexion movements during jaw-opening/closing tasks. We recently reported that trigeminal nociceptive input by injection of hypertonic saline into the masseter muscle altered this integrated jaw–neck function during jaw-opening/closing tasks. Thus, in jaw-opening to a predefined position, the head–neck component increased during pain. Previous studies have indicated that muscle spindle stimulation by vibration of the masseter muscle may influence jaw movement amplitudes, but the possible effect on the integrated jaw–neck function is unknown. The aim of this study was to investigate the effect of masseter muscle vibration on jaw–head movements during a continuous jaw-opening/closing task to a target position. Sixteen healthy men performed two trials without vibration (Control) and two trials with bilateral masseter muscle vibration (Vibration). Movements of the mandible and the head were registered with a wireless three-dimensional optoelectronic recording system. Differences in jaw-opening and head movement amplitudes between Control and Vibration, as well as achievement of the predefined jaw-opening target position, were analysed with Wilcoxon’s matched pairs test. No significant group effects from vibration were found for jaw or head movement amplitudes, or in the achievement of the target jaw-opening position. A covariation between the jaw and head movement amplitudes was observed. The results imply a high stability for the jaw motor system in a target jaw-opening task and that this task was achieved with the head–neck and jaw working as an integrated system.

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