Cardiovascular Reflex Responses During Migraine Attack

Abstract

SYNOPSIS The cardiovascular reflex responses of 10 migraine patients were recorded during both migraine attacks andheadache‐free intervals. Ten healthy subjects of similar age and sex served as a control group.When the results of the measurements for migraine patients performing an isometric work test duringmigraine attacks and during headache‐free intervals were compared, during migraine attacks a statisticallysignificant smaller increase in diastolic B.P. was encountered than interictally (p<0.05).When the results for migraine patients during migraine attack, and controls, were compared, statisticallysignificant differences were encountered in the pulse rate variation in Valsalva manoeuvre, in an orthostatictest, and in the systolic and diastolic blood pressure reactions in an isometric work test. The mean Valsalvaratio and R‐R‐interval ratio during the orthostatic test were lower in migraine patients during migraine attackthan in controls, and the mean blood pressure rise in the isometric work test was also lower in the migrainepatients group during attacks.There were no statistically significant differences between the results of the migraine patients duringheadache‐free intervals and those of the control subjects.

Autonomic Function in Migraine Patients: Ictal and Interictal Pupillometry

“…Associated interictal autonomic abnormalities have been documented in these patients including abnormal cardiovascular reflexes to hemodynamic challenges, altered heart rate variation, vascular reactivity, electrodermal activity, and catecholamine levels . Although the literature is not unequivocal, there is a body of evidence supporting the presence of a subtle, general sympathetic hypofunction in migraine patients …”

“…Another debate in the literature is whether these autonomic dysfunctions are lateralized to the side of the headache. There is very little evidence of a lateralization in the cranial sympathetic dysfunction, and since there is substantial evidence for a general autonomic dysfunction, an isolated cranial lateralization is not expected …”

Autonomic nervous system function in childhood migraine

“…The results of these studies, which have been performed on adult migraine in particular, are controversial. Some studies have reported normal ANS function, 1 , 2 whereas others have reported sympathetic nervous system (SNS) dysfunction 3 –17 or both SNS and parasympathetic nervous system dysfunction 18 –21 . Studies regarding ANS function in childhood migraine are limited 22 .…”

Selected Confirmed, Probable, and Exploratory Migraine Biomarkers

“…The “platelet hypothesis” theory of migraine was first proposed in 1978, and suggested that defective platelet structure and function was the basis for migraine.Elevations in von Willebrand's factorMigraine with and without auraPlasma assayState (during headache) and trait (interictal) 104,105 Elevated interictally, especially in those with prior stroke, and rises during attack.Elevated prothrombin F1.2Migraine with aura, compared with migraine with aura and normal controlsELISATrait (interictal) 106 Found in 50% of migraine with aura subjects. F1.2 is a marker for ongoing thrombin generation and activation of clotting cascade.Autonomic instability, during attack and interictallyMigraineA variety of methods used, including EKG power spectrum analysis, cosinor analysis of heart rate variability, plasma assay for markers of sympathetic activation and direct measurement of cardiovascular reflex responses during a variety of testsTrait (interictally) and state (during headache) 107–114 One study contradicts finding of interictal instabilityAltered platelet serotonin turnover interictally, release of serotonin during a migraine attack, activation of the L‐arginine/NO pathway, especially in migraine with aura. Platelet‐dense bodies (storage organelles for serotonin) increased in both migraine with and without aura, especially in migraine with aura.…”