Headache disorders are third cause of disability worldwide

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Ansikt til ansikt med historien : identitet og representasjon i portretter fra Christiania 1750-1840

Hva kan portretter fortelle om normer og idealer i samfunnet og oppfatninger av identitet? I denne oppgaven har jeg tatt utgangspunkt i utvalgte portretter fra Christiania fra perioden 1750 til 1840, for å undersøke hva den visuelle presentasjonen av mennesker kan fortelle. Jeg undersøker hvordan klesdrakt, frisyrer, ansiktsuttrykk, positur og eventuelle attributter fremstilles i portrettene, og hvordan denne fremstillingen endret seg over tid. Klesdrakten er en viktig del av presentasjonen i et portrett, og en kulturell praksis som innebærer aktive valg om hvordan man ønsker å utforme sin selvpresentasjon. For å forstå hvilke idealer som kommer til uttrykk i portrettene, er det viktig å sette dem inn i sin kulturelle kontekst. Den historiske og geografiske konteksten er eliten i Christiania og omegn 1750-1840. Denne gruppen hadde nære forbindelser med utlandet, og jeg relaterer derfor også portrettene til de idéstrømningene som fantes i den større konteksten i Europa på denne tiden. I analysen av portrettene benytter jeg den amerikanske kulturhistorikeren Dror Wahrmans teori om endringer i oppfatningen av identitet på slutten av 1700-tallet i England. Ifølge Wahrman var identitet på 1700-tallet først og fremst knyttet til felles kategorier av identitet som kjønn, klasse og rase. Ensformigheten i portrettene i denne perioden henger derfor ikke nødvendigvis bare sammen med en mangel på kunstnerisk kvalitet, men med et syn på identitet som noe som deles av flere. Denne oppfatningen av identitet er også synlig i motebildet, der det var om å gjøre å skjule alle individuelle og karakteristiske trekk, gjennom upersonlig tilbehør som parykken, hårpudder og sminke. Mot slutten av 1700-tallet vokste det imidlertid fram en reaksjon mot dette som en ny trend innenfor europeisk kunst og kultur, blant annet inspirert av tankene til Jean-Jacques Rousseau og opplysningstidens ideer. Rousseau fremhevet naturlighet og følsomhet i kontrast til det sofistikerte og tilgjorte. De nye idealene om naturlighet kom til uttrykk, blant annet i områder knyttet til klesdrakten og kroppen, og i synet på kjønn og familie. Disse endringene henger sammen med et nytt syn på identitet som noe naturlig og medfødt, personlig og indre. De utvalgte portrettene fra Christiania viser en gradvis endring i representasjonen – fra rokokkoens vektlegging av felles kategorier av identitet på midten av 1700-tallet til en mer nyansert og individuell fremstilling på 1800-tallet

Increased water intake to reduce headache: Learning from a critical appraisal

Clinical Bottom Line Water intake is a cost effective, non-invasive and low-risk intervention to reduce or prevent headache pain. Rationale: Chronic mild dehydration may trigger headache. Increased water intake could help. A small trial shows modest benefit; however, a larger methodologically sound randomized controlled trial is needed to confirm efficacy. Critically Appraised Paper Spigt, M., Weerkamp, N., Troost, J., van Schayck, C. P., & Knottnerus, J. A. (2012). ‘A randomized trial on the effects of regular water intake in patients with recurrent headaches.’ Family practice, 29(4), 370–5. Doi: 10.1093/fampra/cmr112 Clinical scenario Patients from primary care registered as ‘headache’, ‘tension headache’ and/or ‘migraine’ for more than one year who suffer at least two episodes of moderately intense headache or more than four mildly intense episodes of headache per month with a daily fluid intake of less than 2.5 litres per day. PICO (M) Patient/Problem = Headache > 1 year with 2 moderately intense or 4 mildly intense episodes per month Intervention = 1.5 litres water per day + stress control and sleep hygiene Comparison/Control = stress control and sleep hygiene Outcome = Reduce or eliminate headache Methodology = Therapy RCT Table 1: Final Search Terms TRIP Data Base: hits = 517 used filter Extended Primary research 4 found 1 paper applicable; 'Water intake '[MeSH Terms] AND 'Headache '[All Fields]'; Best match to PICO, (2012) RCT Selection Criterion and Overall Results 102 headache patients in16 primary care clinics were randomized into control (n = 50) and intervention groups (n = 52) Inclusion criteria = two > episodes of moderately intense headache or five > mildly intense headaches per month and total fluid intake > 2.5 litres per day, Follow-up @ 3 months. 79% intervention and 66% of controls completed RCT. Drinking more water resulted in a statistically significant improvement of 4.5 (confidence interval: 1.3–7.8) points on Migraine-Specific Quality of Life (MSQOL). 47% in the intervention (water) group self-reported improvement (6 > on a 10-point scale) against 25% in controls. Drinking water did not reduce headache days. Comments The transparency from the author of this critically appraised paper enables others to use this study as a teaching tool and to learn from the shortcomings in the trial. The study was underpowered and contains methodological shortcomings. Participants were partially un-blinded during the trial increasing the risk for bias. Only the subjective measures are statistically significant and attrition was significant. The intervention is low risk and of negligible cost. A methodologically sound RCT is recommended to evaluate if the intervention has beneficial effects

Noradrenaline and cortisol changes in response to low-grade cognitive stress differ in migraine and tension-type headache

The goal of this study was to explore the relationship between indicators of sympathoneural, sympathomedullar and hypothalamic-pituitary-adrenocortical (HPA) activity and stress-induced head and shoulder-neck pain in patients with migraine or tension-type headache (TTH). We measured noradrenaline, adrenaline and cortisol levels before and after low-grade cognitive stress in 21 migraineurs, 16 TTH patients and 34 controls. The stressor lasted for 60 min and was followed by 30 min of relaxation. Migraine patients had lower noradrenaline levels in blood platelets compared to controls. Pain responses correlated negatively with noradrenaline levels, and pain recovery correlated negatively with the cortisol change in migraineurs. TTH patients maintained cortisol secretion during the cognitive stress as opposed to the normal circadian decrease seen in controls and migraineurs. There may therefore be abnormal activation of the HPA axis in patients with TTH when coping with mental stress, but no association was found between pain and cortisol. A relationship between HPA activity and stress in TTH patients has to our knowledge not been reported before. In migraine, on the other hand, both sympathoneural activation and HPA activation seem to be linked to stress-induced muscle pain and recovery from pain respectively. The present study suggests that migraineurs and TTH patients cope differently with low-grade cognitive stress

The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates

Background According to the Global Burden of Disease (GBD) study, headache disorders are among the most prevalent and disabling conditions worldwide. GBD builds on epidemiological studies (published and unpublished) which are notable for wide variations in both their methodologies and their prevalence estimates. Our first aim was to update the documentation of headache epidemiological studies, summarizing global prevalence estimates for all headache, migraine, tension-type headache (TTH) and headache on ≥15 days/month (H15+), comparing these with GBD estimates and exploring time trends and geographical variations. Our second aim was to analyse how methodological factors influenced prevalence estimates. Methods In a narrative review, all prevalence studies published until 2020, excluding those of clinic populations, were identified through a literature search. Prevalence data were extracted, along with those related to methodology, world region and publication year. Bivariate analyses (correlations or comparisons of means) and multiple linear regression (MLR) analyses were performed. Results From 357 publications, the vast majority from high-income countries, the estimated global prevalence of active headache disorder was 52.0% (95%CI 48.9–55.4), of migraine 14.0% (12.9–15.2), of TTH 26.0% (22.7–29.5) and of H15+ 4.6% (3.9–5.5). These estimates were comparable with those of migraine and TTH in GBD2019, the most recent iteration, but higher for headache overall. Each day, 15.8% of the world’s population had headache. MLR analyses explained less than 30% of the variation. Methodological factors contributing to variation, were publication year, sample size, inclusion of probable diagnoses, sub-population sampling (e.g., of health-care personnel), sampling method (random or not), screening question (neutral, or qualified in severity or presumed cause) and scope of enquiry (headache disorders only or multiple other conditions). With these taken into account, migraine prevalence estimates increased over the years, while estimates for all headache types varied between world regions. Conclusion The review confirms GBD in finding that headache disorders remain highly prevalent worldwide, and it identifies methodological factors explaining some of the large variation between study findings. These variations render uncertain both the increase in migraine prevalence estimates over time, and the geographical differences. More and better studies are needed in low- and middle-income countries