SYNOPSIS Common migraine has been related to both dysfunction of the autonomic nervous system (A.N.S.) in the regulation of cerebral vasomotor tonicity and to neurotic and depressive tendencies. In the present study 86 normal healthy controls and 50 patients with common migraine were studied in order to determine whether tonic or phasic central autonomic nervous system dysfunction was concomitant with migraine during a headache‐free, medication‐free interval. pupillometry was employed to measure relevant parameters of sympathetic and parasympathetic activity at rest and during the cold pressor test. Concomitantly, measurements of neuroticism, anxiety and depression were also obtained. Migraineurs were not identifiably different from controls with respect to tonic sympathetic or parasympathetic activity nor were they distinguishable on measures of supranuclear inhibition. However, 70% of migraineurs manifested phasic hyposympathetic activity in response to the cold pressor test. These migraineurs also demonstrated more neurotic and depressive tendencies. The physiological dysfunction was shown to differentiate the groups of migraineurs after personality variables were statistically controlled by a covariance multiple regression analysis. Results of the study are discussed in relationship to cerebral blood flow and permeability of the cerebral vasculature.

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A twelve-year-old girl presented with a history of several weeks of worsening headaches accompanied by flushing and diaphoresis. The discovery of markedly elevated blood pressure and tachycardia led the child's pediatrician to consider the diagnosis of a catecholamine-secreting tumor, and an abdominal CT scan confirmed the presence of a pheochromocytoma. The patient was found to have a mutation in the succinyl dehydrogenase B (SDHB) gene, which is causative for SDHB-related hereditary paraganglioma-pheochromocytoma syndrome. Herein, we describe her presentation and medical management and discuss the clinical implications of SDHB deficiency.