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December 13, 2017

The headache of terror
A matched cohort study of adolescents from the Utøya and the HUNT Study

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Synne Øien Stensland, MD, PhD, John-Anker Zwart, MD, PhD, Tore Wentzel-Larsen, MSc, and Grete Dyb, MD, PhDAuthors Info & Affiliations
January 9, 2018 issue
90 (2) e111-e118
https://doi.org/10.1212/WNL.0000000000004805
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Abstract

Objective

To elaborate the risk of headache among adolescent survivors exposed to terror.

Methods

On July 22, 2011, a lone man opened gunfire, killing 69 people at a summer camp for adolescents on the Utøya islet in Norway. All 358 adolescent survivors 13 to 20 years of age were invited to participate in the Utøya interview study. Among the 213 (59%) respondents, half (49%) were male, the mean age was 17.7 years, and 13 (6%) were severely injured. For each survivor, 8 matched controls were drawn from the population-based Young-HUNT3 Study, conducted between 2006 and 2008, with a participation rate of 73%. Recurrent migraine and tension-type headache (TTH) over the past 3 months served as main outcomes and were measured 4 to 5 months after the mass shooting with a validated headache interview, in accordance with the International Classification of Headache Disorders.

Results

After exposure to terror, the odds ratio for migraine was 4.27 (95% confidence interval 2.54–7.17) and for TTH was 3.39 (95% confidence interval 2.22–5.18), as estimated in multivariable logistic regression models adjusted for injury, sex, age, family structure and economy, prior exposure to physical or sexual violence, and psychological distress. The observed increased risk of headache in survivors was related largely to an increase in weekly and daily headaches.

Conclusions

Exposure to terror increases risk of persistent weekly and daily migraine and TTH in adolescent survivors, above expected levels. The terrors of other violence may similarly increase the risk of frequent headaches. After severe psychological traumas, interventions may need to address survivors' pain to hinder chronification.

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Information & Authors

Information

Published In

Neurology®
Volume 90 • Number 2 • January 9, 2018
Pages: e111-e118

Copyright

Copyright © 2017 American Academy of Neurology.

Publication History

Received: June 16, 2017
Accepted: September 10, 2017
Published online: December 13, 2017
Published in print: January 9, 2018

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Authors

Affiliations & Disclosures

Synne Øien Stensland, MD, PhD
From the Norwegian Centre for Violence and Traumatic Stress Studies (S.Ø.S., T.W.-L., G.D.); Division of Clinical Neuroscience (S.Ø.S., J.-A.Z.), Oslo University Hospital; Institute of Clinical Medicine (J.-A.Z., G.D.), University of Oslo; and Centre for Child and Adolescent Mental Health (T.W.-L.), Eastern and Southern Norway, Oslo.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
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John-Anker Zwart, MD, PhD
From the Norwegian Centre for Violence and Traumatic Stress Studies (S.Ø.S., T.W.-L., G.D.); Division of Clinical Neuroscience (S.Ø.S., J.-A.Z.), Oslo University Hospital; Institute of Clinical Medicine (J.-A.Z., G.D.), University of Oslo; and Centre for Child and Adolescent Mental Health (T.W.-L.), Eastern and Southern Norway, Oslo.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
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Tore Wentzel-Larsen, MSc
From the Norwegian Centre for Violence and Traumatic Stress Studies (S.Ø.S., T.W.-L., G.D.); Division of Clinical Neuroscience (S.Ø.S., J.-A.Z.), Oslo University Hospital; Institute of Clinical Medicine (J.-A.Z., G.D.), University of Oslo; and Centre for Child and Adolescent Mental Health (T.W.-L.), Eastern and Southern Norway, Oslo.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
European Journal of Psychotraumatology, Statistical advisor (for many years)
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Grete Dyb, MD, PhD
From the Norwegian Centre for Violence and Traumatic Stress Studies (S.Ø.S., T.W.-L., G.D.); Division of Clinical Neuroscience (S.Ø.S., J.-A.Z.), Oslo University Hospital; Institute of Clinical Medicine (J.-A.Z., G.D.), University of Oslo; and Centre for Child and Adolescent Mental Health (T.W.-L.), Eastern and Southern Norway, Oslo.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Korean Society of Traumatic Stress Studies, travel expenses Japanese Society of Traumatic Stress Studies, travel expences
Editorial Boards:
1.
Journal of Traumatic Stress (JTS), member of editorial advisory board
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
(1)The Norwegian Directorate of Health (2)The Norwegian Research Council (3)South-Eastern Health Board Norway (4)Norwegian Extra Foundation for Health and Rehabilitation
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author

Notes

Correspondence Dr. Stensland [email protected]
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Author Contributions

S.Ø.S. carried out the data processing, analyzed the data, performed the statistical analysis, and drafted and revised the paper. She is the guarantor. G.D. and J.-A.Z. contributed to the integration of the headache interview and measures of victimization in the Young-HUNT3 Study. G.D. and S.Ø.S. wrote the original study protocol and further participated in the epidemiologic modeling, analysis and writing of the manuscript. G.D. applied for and received the grant for the study. T.W.-L. contributed to the statistical analysis. J.-A.Z. participated in the design of the study and helped to write the manuscript. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors have read and approved the final version of the manuscript. S.Ø.S. had full access to all the data in the study and had the final responsibility for the decision to submit for publication.

Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

Study Funding

Supported by the Norwegian Directorate of Health and the Norwegian Research Council, project 228917/H10. The funder had no role in study design, data collection and analysis, interpretation, or writing the report.

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