Purpose:Cranial autonomic symptoms are typically associated with the trigeminal autonomic cephalalgias and also present in substantial cases of migraine. Autonomic nervous system dysfunctions are also been reported in headache disorders and postulated to promote headache attacks. This study was aimed to evaluate the parasympathetic and sympathetic autonomic functions tests in patients with a episodic primary headache and to investigate, if any, electrophysiological abnormalities in the blink reflex test and sympathetic skin response test in these patients.Methods:In this cross-sectional study, a total of 100 patients, 50 patients each of migraine and tension-type headache attending the neurology OPD and fulfilling the diagnostic criteria of headache disorders were enrolled. Autonomic functions tests were performed in the Department of Physiology, whereas electrophysiological tests were powered by the Editorial Manager and ProduXion Manager from Aries Systems Corporation performed in the Department of Neurology.Results:Significant association (P < 0.05) was observed in “blood pressure response to sustained handgrip” (sympathetic activity) and “heart rate response to Valsalva maneuver” (parasympathetic activity) among patients with migraine. Although the mean sympathetic skin response latency of patients with migraine was within the normal range, it was significantly prolonged in comparison with the control group. “Blood pressure response to sustained handgrip” and “heart rate variability” were found to be significantly (P < 0.05) different in patients with a tension-type headache. The blink reflex test was observed to be normal in all patients with a headache. Patients with migraine showed a significant dysautonomia in category three of the Ewing battery for autonomic functional disability.Conclusions:Autonomic functional abnormality, both sympathetic and parasympathetic, does exist in patients with a primary episodic headache.

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Introduction: The presence of cranial autonomic symptoms (CAS) is a hallmark of trigeminal autonomic cephalalgia like cluster headache but their presence in migraine is also not uncommon. Like in trigeminal autonomic cephalalgias, the activation of the trigeminal autonomic reflex pathway is thought to be the possible explanation of the presence of cranial autonomic symptoms in migraine also. Previous studies suggested that around half of the patients of migraine suffer from these symptoms. The aim of our study was to observe the frequency of cranial autonomic symptoms in episodic migraine patients along with their clinical and autonomic characteristics. Methods and Materials: Fifty patients of episodic migraine attending the headache clinic of Dr. RMLIMS, Lucknow and fulfilling the diagnostic criteria of International classification of headache disorder third edition beta were randomly selected and enrolled in the study. The detailed interview regarding presence of cranial autonomic symptoms was recorded along with the clinical characteristics, demographic features and autonomic profile of the migraine patients. Results: About three-fourth (72%) of the patients were females. The mean age of study participants was 27.7±8.3 years. A considerable number of patients (54%) had a long duration (5-10 years) of illness and 70% of patients had severe headaches. Photophobia was the most common (88%) associated clinical symptoms while lacrimation was the most common (56%) cranial autonomic symptom in migraine patients. Among 50 patients of migraine 74% of patients were having at least one cranial autonomic symptoms. Conclusion: Cranial autonomic symptoms are common in patients of episodic migraine. More severe headache is more likely to be associated with the development of cranial autonomic symptoms.

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