Abstract
The journal Cephalalgia was founded in 1980 and was first published in 1981. The foundation was mainly laid by Ottar Sjaastad who also served as the first Editor-in-Chief. In the early years, Cephalalgia was published in Scandinavia and was owned by the Norwegian Migraine Society. It became the official journal of the International Headache Society in 1984 and in 1993 ownership of Cephalalgia was transferred to International Headache Society. The publisher changed in 2000 and then again in 2009. The success of Cephalalgia can be seen by the almost continuous rising of its impact factor and by the increasing number of issues including supplements and special issues. In the future, Cephalagia will become more digital and open access.
Keywords
Introduction
This article is based on a manuscript by Ottar Sjaastad (Figure 1) and on two interviews and discussions held between the author and Ottar Sjaastad in the last years in his home in Trondheim, Norway. Ottar Sjaastad was the founder and first Editor-in-Chief of Cephalalgia. After he died in August 2022, the text files were edited and composed to create this article.
Ottar Sjaastad (1928–2022).
The article represents the memories and the opinions of Ottar Sjaastad of the first years of the journal. The author tried to keep the wording and the comments of Ottar Sjaastad as close to the original as possible, however, dates, figures etc. were checked for correctness. The article is dedicated to Ottar Sjaastad personally to remember his achievements in headache science and headache medicine. The article should be viewed in context with other articles Ottar Sjaastad published on the history of the International Headache Society (IHS) (1,2).
Background
This story begins in Scandinavia. It is probably correct to say that interest in headaches was not particularly profound among Scandinavian neurologists in the early post-war period, not even at an academic level. Around the mid-60 s, the first, firm steps into academic headache medicine were taken, almost simultaneously, in the different Scandinavian countries. It was, nevertheless, a major step forward when a group of senior headache-interested Scandinavian neurologists, under the leadership of Torvald Dalsgaard-Nielsen from Copenhagen founded the Scandinavian Migraine Society in 1968. In the wake of this event, there was a burgeoning interest in headache among the younger generation neurologists in Scandinavia. Annual meetings were arranged on a rotating basis in the Scandinavian countries.
Linked to the Society, there was even a journal called Proceedings of the (annual meetings of the) Scandinavian Migraine Society. It summarized the lectures given at the annual meetings, but the name varied. This was not ideal, but the situation was considered satisfactory during the first years. At that time, there was one single journal devoted to headache worldwide: the official journal of the American Association for the Study of Headache, appropriately named Headache, started in 1960. One did not need to be a great soothsayer to foresee that rather soon more headache journals would be needed.
In the late 70 s, a younger generation of Scandinavian neurologists led the Society, in each of the Scandinavian countries, and ambitions grew. Why should we not go for a regular headache journal, originating in Scandinavia and linked to an international headache society, hopefully when such an organization was founded? So, when Norway had the next presidency, Ottar Sjaastad proposed a new headache journal at a business meeting in 1979. The proposal was well received and he was unanimously chosen as the Editor-in-Chief. The first business meetings took place in 1980 together with Bayard T Horton and John R Graham.
A new headache journal
Right from the start some issues had to be attended to. What should it be named? There were a lot of proposals: Headache? The appellation headache had already been used by the Americans. The Headache Journal or Headache and Neck Pain? Headache was hardly applicable anymore, even if used combination. What about Migraine? That would probably be too narrow a field. There are many headaches beside migraine. Migraine and other Headaches? Was it too wordy? Another alternative was: World Headache Journal. At that stage, it would be premature and probably also presumptuous, since it was ahead of the creation of the International Headache Society (IHS). It might also offend the Americans. Bayard T Horton, a friend of Ottar Sjaastadt, suggested: Cephalgia. This was not a bad idea at all. Horton had even used the term himself for Histaminic Cephalgia. Another Greek name for headache is cephalalgia. Would the word be too strange, even for neurologists? After a few rounds, this proposal was accepted.
The list of Editorial Board members (N = 51; two of whom were female) followed. The founding Editorial board list consisted mainly of headache specialists and specialists from closely related fields (see Table 1). There was also an Advisory Board (N = 33) whose members mainly were specialists from neighboring branches. There were three senior editors and two associate editors. In 1986, two additional associate editors were included, Karl Ekbom and Egilius Spierings. Almost invariably, these collaborators were selected by Ottar Sjaastad; they belonged to his network.
Members of the first Editorial Board of Cephalalgia.
Which printing company should be used? There was one natural and obvious choice: Universitetsforlaget in Oslo (Oslo University Press). The leader of the journals’ section, Terje Sørlie, was the counterpart in the negotiations. Sørlie needed a reference or two, someone with personal knowledge of Ottar Sjaasted, so Sjaastad referred him to his own previous chief, Professor Sigvald Refsum, the Professor of Neurology, at Rikshospitalet, Oslo. After the meeting, Terje Sørlie announced he needed no more references.
One serious consideration was: could it be assured that the journal would survive economically? Universitetsforlaget was naturally even more worried than the Editors were, as the whole project could go down the drain, and Sørlie felt that he ought to have some sort of guarantee in case things should go awry. Precautionary measures were taken: The Norwegian Migraine Society had – not long before these events – inherited a considerable sum of money. In order to obviate all doubt, the whole sum was staked to shore up Cephalalgia. This guarantee actually moved the risk from the Oslo University Press to Cephalalgia itself. All the Scandinavian national migraine societies stood behind Cephalalgia, but it was owned by the Norwegian Migraine Society which only had 15 to 20 members at that time. The cooperation with Universitetsforlaget was most satisfactory in all respects, from linguistic scrutiny to delivery precision.
The collection of manuscripts started right away. The first issue was completed in late autumn of 1980 and appeared in print in March 1981, the cover of the second issue in 1981 is presented in Figure 2. Cephalalgia was thus established in Scandinavia, printed in Scandinavia and with an Editor-in-Chief from Scandinavia. In Norway, a country with relatively few inhabitants, one tends to be happy for all positive events, however small, that occur in the country. A small province added to the country, as the Norwegian Nobel Prize laureate Bjørnstjerne Bjørnson puts it in one of his poems. This admittedly was an extremely small one but Ottar Sjaastad was nevertheless strongly urged that above all he should not let the ownership and responsibility go to English or to American colleagues. In retrospect, it is remarkable that that is exactly what happened.
Cover of the second issue of Cephalalgia in 1981.
Beside the economic situation, there was also another scenario that caused considerable worry: How could future access to high-quality manuscripts be guaranteed? The worst-case scenario would be that the journal would suffocate, due to lack of articles that were worthy of being printed.
Realistically, one could not expect an abundance of manuscripts from the beginning. The journal was new and relatively unknown and would probably have a small readership. Furthermore, the American journal Headache had been on the market for several years. Perhaps, the Americans would act jointly and support their journal, not reading Cephalalgia and not publishing in it. Hopefully, it would not go that far, but, at least one could foresee a conflict of interest and a competition with regard to manuscripts. During the first year or so, there was some comprehensible apprehension that the fortune had been wasted. Ottar Sjaastad and collaborators tried to fortify the economic status of Cephalalgia in various ways:
Advertisements. There were approximately 10 adverts per issue and four issues per year. Ottar Sjaastad provided all the adverts. Pharmaceutical industry officials not infrequently committed themselves to prolonged periods of advertisement. There apparently was a common interest between the journal and the pharmaceutical industry at that time. For instance, new drugs were in the pipeline, such as the triptans. Clinical studies concerning such drugs could be printed. And the pharmaceutical industry could get closer to those who in the future possibly were to prescribe the drug. Needless to say, there were no pledges attached in such situations. Subscriptions. Initially, there were very few subscribers, maybe around 100. Later, there was a considerable increase in the number, as revealed in the annual reports from Universitetsforlaget. In Norway, there was a special arrangement. All members of the Norwegian Neurology Society were offered a free membership in the Norwegian Migraine Society, and membership automatically included subscription of Cephalalgia. As expected, almost everyone accepted this offer. When, at a later point of time, it was announced that membership would not be free anymore, most of them wanted Cephalalgia on a permanent basis and paid for it. They had become accustomed to Cephalalgia and would miss it if it did not appear on their doorstep anymore. Supplements. Supplements mainly stemmed from various types of headache meetings, in particular from the biannual International Headache Congress.
In the early phase, advertisements were a significant factor in Cephalalgia economy. Those intimately connected with Cephalalgia, were all prepared for a major budget deficit for the first couple years, at least. To their surprise, there was already a positive balance sheet from the first year. This tendency continued. Nevertheless, the situation around Cephalalgia was never quite rosy. Advertisements could be time-limited, and some could be discontinued. New discussions with the pharmaceutical industry would inevitably appear. In the long run, it would be better to base the business, or at least the major part of it, on a stable number of subscribers and a stable readership. There was some distance to cover before the editors could feel safe.
Immediate future and IHS
The journal was established, but as of yet there was no IHS. From the first issue of Cephalalgia, there was a subtitle on the front page, listing it as “An International Journal of Headache”. The ultimate goal was to link the journal to an international headache society, and this was never hidden. IHS was founded in London in September 1982, but there was no economic basis in the IHS for taking over Cephalalgia at that time. The IHS announced in an advertisement in December 1984 that Cephalalgia was the official organ of the IHS. However, it was still owned by the Norwegian Migraine Society, and there was not going to be any change in ownership for many years. It was still printed by Oslo University Press but in 1986, the name of the publisher was changed to Norwegian University Press, and this was the name until 1992. Then, Norwegian University Press acquired the Swedish printing company Almquist and Wiksell and changed its name to Scandinavian University Press. In the mid-80s, the journal was approached by the Danish publishing company Munksgaard. They claimed that there would be many advantages to transferring the activities to them. Cephalalgia found the service of Norwegian University Press entirely satisfactory, however, and had no interest in severing that liaison.
From the beginning, it was stated that: It is our intention to be receptive and not forbidding in our approach. Yet, it was also desirable to try to enhance the quality of scientific work in this field. Another aim was expressed: It is our hope and intention that there will be some sort of connection between Cephalalgia and a prospective International Headache Association.
This was written almost two years ahead of the London meeting in September 1982 where IHS was founded. The two first aims were hard to harmonize, but a serious attempt was made to live up to both. The initial access to manuscripts was limited and if it were to be at that level continuously, the journal could suffer. It was later learned that the journal Headache also had had similar problems at this time. They feared that Cephalalgia would take everything, but it turned out that Cephalalgia had printed articles that were previously refused by Headache. The reverse story is that Headache had printed articles that Cephalalgia had rejected.
With time, the flow of articles increased. As a consequence, the rejection rate also started to increase. It was 42% in 1984. There were other considerations. Colleagues eager to publish articles about migraine and headache, could come from a country without any tradition for headache medicine. One could flatly reject articles of this type, or, one could help educate colleagues interested in headache and give them a chance. In one case from the latter category, for example, the first version was sent to one of the prominent headache researchers, who stated that this article would never reach the stage of being publishable. Then came the revision, after which it was sent back to the same referee. He wrote that this must be a new article which he had not seen before and that he had no problems with accepting it.
What was the publishing policy of the Editor-in Chief and his group during this period? The majority of submitted papers were published in Cephalalgia. The reasoning behind this was as follows: If the members of this group did not systematically publish their papers in Cephalalgia, could one really expect that other headache research groups would publish their articles in Cephalalgia? This publishing policy was discontinued at the end of the editorship of Ottar Sjaastad.
Some years after the start of Cephalalgia, Ottar Sjaastad was approached by a professor of considerable renown in his own country, in one of the closely related clinical disciplines. Ottar Sjaastad knew him only by reputation. He said that he had found the story of Cephalalgia interesting, with its cradle and continued existence up north. He had, therefore, taken it as a personal challenge to go through all the issues of Cephalalgia to make up his own, totally independent, opinion about the quality of the journal. He gave a detailed review. All in all, he was impressed. This was, of course, an enormous encouragement. There were several others along the route, from inside and outside the boards, who spontaneously expressed their satisfaction with the journal.
Cephalalgia had, since the early days, been indexed in Current Contents, Index Medicus, and Excerpta Medica. There had not been much time to think about Citation Index, Life Sciences, and Impact Factor, as the focus was on survival. The journal did survive and could even be reasonably satisfied with its standard at least. The thought that the journal would survive, even in the long run, started to prevail and that was the time for Ottar Sjaastad to leave the office. The ground had to be prepared for the successor and Karl Ekbom from Stockholm was the personal favorite of Ottar Sjaastad. It was also time for renewal as there were still only four issues per year and a restricted number of pages per issue. There would probably be room for six issues per year or even more, both with regard to economy and to high-quality manuscripts, but such changes would be left for the next editor to work out. The change-over was planned for early 1987. These plans were well known to the inner circle of Cephalalgia.
There were originally two associate editors. From the beginning of 1986, two new associate editors were added, with the intention that, within a year, the new ones should replace the original ones. When this shift first was announced, noise came up in a letter from 1985. It was said that Cephalalgia was badly edited and that reviews of papers were manipulated by the Editor-in-Chief. It was feared that Cephalalgia would be run over by its competitors. This criticism came in two phases, the second in July 1988. It was claimed that too many articles by Ottar Sjaastad and his group were published in Cephalalgia and that many articles in the journal were of low quality. Further criticism was that too many articles were published on those topics Ottar Sjaastad was working on such as paroxysmal hemicrania and hemicrania continua. Further, it was argued that manuscripts by Ottar Sjaastad and his group were not peer-reviewed. The role of Ottar Sjaastad as Editor-in-Chief was questioned. It was a comfort for him when Professor James W Lance, after having been oriented about the re-arrangement in the editorship, wrote the following: ‘The development and success of the journal is a great credit to Ottar Sjaastad’ (letter, 4 October 1988).
Friends and colleagues of Cephalalgia maintained that under such circumstances, Ottar Sjaastad had to stay in office for another two years. So, this interlude led to a prolongation of his editorship instead of the discontinuation that was planned. Sometime later, there was a business meeting of the IHS and one of the issues was the election of a new Editor-in-Chief of Cephalalgia. However, it was disclosed at the meeting that the Norwegian Migraine Society had decided that there would be no election by IHS, the reason simply being that the Norwegian Migraine Society owned the journal. On the other side, it was at that meeting that Cephalalgia also became the official journal of the IHS.
The change of Editor-in-Chief took place at the end of 1989 when Cephalalgia had about 800 subscribers. Karl Ekbom had in the meantime claimed health problems and was no longer a candidate. In the new situation, Michael Welch from the US became a front contender. He had, however, been elected president of the IHS at that time and felt that these two positions together represented too much power. He wanted Marcia Wilkinson from the UK as a substitute during his presidential period. This was a gentlemen’s agreement: the editorship of Marcia Wilkinson was to end as soon as Michael Welch’s presidency was over. However, at that time, Michael Welch and others wanted her to continue so that she could get enough editor time, whatever that was supposed to mean. She did not continue, and the reason for that was that the Norwegian Migraine Society insisted that the gentlemen’s agreement should be kept and The Norwegian Migraine Society was still the owner of Cephalalgia.
The ownership was transferred to the IHS during the first part of Michael Welch’s editorship, which began in 1993. During one of his visits to Trondheim, he and Ottar Sjaastad together arranged the transfer. The strategy was that of a gradual transfer of ownership to IHS. The Norwegian Migraine Society still pledged itself to a time-limited, financial support in case of economic hardship (Cephalalgia was actually transferred to IHS for a symbolic price only).
It was deplorable that Cephalalgia ultimately was printed outside of Scandinavia, according to many of those originally intimately connected with the journal. However, the two main aims were achieved: Cephalalgia seemed to be a viable publication, and it was now the official journal of the IHS.
In 2000, Blackwell took over from Scandinavian University Press. That was not an entirely successful take-over; there were some complaints, e. g. concerning lack of regularity of the issues. For those who had followed Cephalalgia closely, the necessity of this shift was hard to understand. One might wonder about the motives. We had a well-functioning printing system and got a less appropriate one. Was it a resolute demonstration to get rid of the last traces of Scandinavia? This possibility has been hinted at over and over again.
Cephalalgia until now and in the future
This article does not intend to describe the history of Cephalalgia after 1990 in detail. However, a brief overview of that period shall be given in order to understand how the first years have stimulated an international, widely accepted, highly scientific journal.
Over time, the Editor-in-Chief changed from one period to the next, their names and years are given in Table 2. The Editor-in-Chief of Cephalalgia is nowadays elected by the IHS Board of Trustees for a period of four years and can be re-elected once. The Editorial Board itself is now smaller than in the beginning of Cephalalgia although the number of manuscripts has increased substantially. Today, the members of the Editorial Board are responsible for the review process of single articles but the review itself is done by external experts. Several new positions for Cephalalgia have been created such as an Ombudsman, junior editors, and section editors (e. g., book reviews, historical section).
The Editors-in-Chief of Cephalalgia and their years in office.
The increasing importance of Cephalalgia can also be seen by the increasing number of manuscripts and the increasing ranking according to the Impact Factor. In Table 3, the annual two-year-Impact Factor of Cephalalgia is presented together with the ranking of the journal within the section Clinical Neurology. On average, the Impact Factor is rising over the time, the fluctuations in this rise are mainly due to the publication of the International Classification of Headache Disorders which is frequently cited worldwide. There is also an increase in the number of issues per year. The maximum number of issues per year was reached in 2011 to 2013 because of a congestion of good manuscripts waiting for being published. The supplements of Cephalalgia consist nearly exclusively of the contributions to the International Headache Congress or to other congresses; these contributions were published in the beginning as short full papers and later as abstracts. A new format is the special issue which are published since 2013. Special issues are collections of authoritative review articles on a specific topic. They are intended to inform the reader about the most recent advances of knowledge in a specific field of headache medicine.
Two-year-Impact Factor, ranking in the section Clinical Neurology, and number of different issues for the journal Cephalalgia.
The dashes mean not available (i.e. not listed).
The journal Cephalalgia is still owned by the IHS, the publisher however changed. The list of publishers and their time periods are given in Table 4. In cooperation with the actual publisher, Cephalalgia is on its way into the future which will be digital. In 2018, the new journal Cephalalgia Reports started. This is an online journal with open access publications only, it aimed to publish more clinical papers, case reports, and focused reviews. The Editor-in-Chief and the Editorial Board for Cephalalgia Reports are the same as for Cephalalgia. Cephalalgia itself will become an exclusively open access journal from 2023 onwards.
List of publishers of Cephalalgia and the term of contract.
Conclusion
The turbulent years around 1980 with the development of a new headache journal, Cephalalgia, have laid the foundation of a highly successful and respected scientific journal which is now ranked in the top quarter of all journals in clinical neurology and in neuroscience. This story of success is, initially, due mainly to Ottar Sjaastad who worked with several others on the scientific and economic foundation of Cephalalgia.
Footnotes
Acknowledgement
The author is grateful to Paolo Martelletti, Italy, for making available the figures.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
