Autonomic Function Tests, Heart Rate Variability, and Electrophysiological Evaluation in Patients With a Primary Episodic Headache: An Observational Study

Abstract

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.

Reconceptualizing autonomic function testing in migraine: a systematic review and meta-analysis

“…Seven of the 109 articles matched our inclusion criteria [ 4 , 51 – 54 , 56 , 57 ]. The articles were published from 1986 to 2023 and included a total of 424 migraine patients and 268 healthy controls.…”

“…Pogacnik and colleagues (1993) studied migraine patients with and without aura interictally (“Testing was carried out during the headache free period”) [ 56 ]. Qavi and colleagues published the latest findings (2023 print), and studied migraine patients at least 7 days post migraine headache and compared the results with tension-type headache patients and healthy controls [ 57 ]. Details on extracted ANS function values and conditions, as well as definitions of the interictal migraine phase, are provided in Table 3 .…”

“…It is relevant to note that the included ANS function values (with one exception [ 57 ]) were initially measured in the late 1980s and early 1990s [ 4 , 51 – 54 , 56 ], when the “autonomic theory” of the pathophysiology of migraine was among the main hypotheses suggested to explain migraine. As the theory was disproven, these ANS function values remained unaccounted for.…”

“…For example, for the isometric challenge, one group reported the mean difference in diastolic blood pressure [ 4 ], the second group reported the maximum change in diastolic blood pressure [ 51 – 54 ], while the third group decided to measure “the average R-R interval during the 15 seconds preceding the contraction … divided by the minimal R-R interval during the contraction period” [ 56 ]. The last group decided to measure BP “before the grip and at the one-minute intervals during handgrip“ [ 57 ]. All four of these variations are correlates of cardiovagal function, but exemplify the inconsistency of autonomic testing at its infancy.…”