No abstract

These results, by using for the first time an easy quantitative scale, confirm that (mild) CAPS are not the exception but the rule in CM patients. The score in this CAPS scale could be of help as a further endpoint in clinical trials or to be correlated with potential biomarkers of parasympathetic activation in primary headaches.

In contrast to VIP, interictal PACAP level measured in peripheral blood does not seem to be a biomarker reflecting parasympathetic activation in CM.

In December 2019, the first cases of atypical pneumonia caused by a new pathogen, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), were detected in Wuhan, China. In March 2020, the World Health Organization declared coronavirus disease-2019 (COVID-19) as a pandemic. 1,2 Manifestations within the respiratory system are dominant in COVID-19. However, other manifestations such as headache, abdominal pain, diarrhea, and loss of taste and smell have been added to the clinical spectrum during the course of the disease, 1,2 and numerous case series and reviews have been published on the neurological manifestations, highlighting the potential neurotropism of the new coronavirus. 3-5 Approximately 40% of patients with COVID-19 have presented with neurological symptoms. 3,4 Headache was reported in 11%-34% of the hospitalized patients, but few studies have carried out a characterization of pain. 5 An observational Spanish study described 112 health professionals who suffered headache during COVID-19. The authors found that headache appeared on the fourth day from the beginning of

Background Cranial autonomic parasympathetic symptoms (CAPS) appear in at least half of migraine patients theoretically as a result of the release of peptides by the trigemino-vascular system (TVS). Cranial pain pathways become sensitised by repeated episodes of TVS activation, leading to migraine chronification. Objective The objective of this article is to correlate the presence of CAPS with serum levels of vasoactive intestinal peptides (VIP) and calcitonin gene-related peptide (CGRP). Patients and methods Patients with chronic migraine (CM) were asked about the presence - during migraine attacks - of five CAPS, which were scored from 0 to 10 by using a quantitative scale. Serum VIP and CGRP levels were determined by ELISA. Results We interviewed 87 CM patients (82 females; mean age 44.7 ± 10.6 years). Seventeen had no CAPS, while 70 reported at least one CAPS. VIP levels ranged from 20.8 to 668.2 pg/ml (mean 154.5 ± 123.2). There was a significant positive correlation between scores in the CAPS scale and VIP levels (Spearman correlation coefficient = 0.227; p = 0.035). VIP levels were significantly higher in CM patients by at least one point in the scale vs those with 0 points ( p = 0.002). Analysing symptoms individually, VIP levels were numerically higher in those patients with symptoms, though they were significantly higher only in those patients with lacrimation vs those without it ( p = 0.013). There was no significant correlation between CGRP levels and the score in the CAPS scale. Conclusions Serum VIP, but not CGRP, levels seem to reflect the rate of activation of the parasympathetic arm of the TVS in migraine.