Autonomic Dysfunction in Adult Migraineurs

Abstract

SYNOPSIS The autonomic nervous system (ANS) functions of 60 migraine patients, aged from 23 to 50 years, wereinvestigated during headache‐free intervals by utilizing a number of cardiovascular reflexes as indices.Thirty‐five healthy subjects of similar age served as a control group. The pulse rate (R‐R‐interval) variationwas recorded in normal and deep breathing, in the Valsalva manoeuvre, and in an orthostatic test (a tilttable was used); and the blood pressure reactions were recorded in an orthostatic test and in an isometricwork (hand grip) test.There were significant differences in the results between migraine patients and control subjects in theR‐R‐interval variation ratio, both in normal and deep breathing tests and in the Valsalva manoeuvre. Thedifferences between migraine patients and controls in pulse rate variation in orthostatic test and in bloodpressure reactions in isometric work test were highly significant (p < 0.001 ). There were no statisticallysignificant differences in cardiovascular reflex responses of various subgroups of migraine patients(common‐classic, frequent‐infrequent attacks, normal‐abnormal EEGs). These results suggest mildparasympathetic hypo function, but more definite sympathetic hypofunction (Valsalva manoeuvre,orthostatic test and isometric work test) in adult migraine patients during headache‐free intervals.

Dysfunction of the pupillary light reflex following migraine headache

“…However,the persistence of the sympathetic instability in the migraine free interval was found in previous pupillometric studies [4,8] and in investigations of cardiovascular parameters [3,15,23,33].Therefore we propose an additionally central sympathetic instability that affects the sympathetic innervation of the eye, the arteries and the blood pressure. A sympathetic instability of the blood pressure or the arterial tone might contribute to migraine headache via an excitation of the surrounding trigeminal sensory nerve fibers.…”

“…The latency of the pupillary light reflex was not affected. Previously, mild parasympathetic dysfunction was described by the measurement of cardiovascular reflexes [15,28,29]. Because of the nitric oxide hypersensitivity of the cranial vessels in migraine patients and its release by parasympathetic fibers, the involvement of the parasympathetic nervous system has been discussed [29].…”

“…A sympathetic dysfunction and a mild parasympathetic dysfunction have also been suggested to occur between attacks following examination of cardiovascular reflexes by some authors [15,23]. Others have reported a sympathetic hyperfunction [5], sympathetic and parasympathetic hyperfunction [32] or sympathetic instability [3,33].…”

Syncopal migraine

“…Such brainstem connections involving the central autonomic network [13] may account for the typical autonomic features of migraine [4,14,15]. While studies demonstrate various findings, including both sympathetic and parasympathetic hypofunction and hyperfunction [15][16][17][18][19][20][21][22][23][24], current evidence suggests critical involvement of the parasympathetic system in the pathophysiology of migraine headaches [14], which might ultimately relate to bradycardia and syncope.…”

Sphenopalatine ganglion neuromodulation in migraine: What is the rationale?

“…Though an alleged autonomic dysfunction has been dealt with widely, migraine pathophysiology is complex, and results have advocated both hypo-and hyperfunction of the sympathetic and parasympathetic systems (Table 2) (46)(47)(48)(49)(50)(51)(52)(53)(54).…”