Cranial autonomic symptoms in episodic and chronic migraine: a cross sectional study in Iran

Abstract

Background Cranial autonomic symptoms are common in migraine, with eye redness and tearing being the most common ones. Their identification can help to avoid misdiagnosis, predict the disease course, and select the appropriate treatment. Methods This was a cross-sectional study of 904 patients who presented with migraine to a headache referral clinic. The participants filled out a questionnaire about their headache characteristics, as well as the presence of cranial autonomic symptoms. A total of 904 patients, 698 women (77.2%) and 206 men (22.8%), were included in the study, with a mean (SD) age of 38.05 (11.76) years. Results About 70% of subjects with chronic migraine and 56.2% of those with episodic migraine reported one or more cranial autonomic symptoms. The two most commonly reported autonomic symptoms were eye redness (36.06%) and tearing (21.02%). Chronic migraine (43.4% vs. 29.5%), unilateral headache (56.8% vs. 48.7%), and blurred vision (20% vs. 14.7%) were significantly more frequent in migraineurs with cranial autonomic symptoms. Headache intensity and frequency in subjects with cranial autonomic symptoms were significantly higher than in those without cranial autonomic symptoms. Conclusion We found higher percentages of cranial autonomic symptoms in patients with unilateral headaches, frequent and severe attacks and blurred vision. A diagnosis of cranial autonomic symptoms accompanying migraine may predict more severe disease and the possibility of evolution into chronic migraine.

Population-based prevalence of cranial autonomic symptoms in migraine and proposed diagnostic appendix criteria

“…On the one hand, Togha et al. (19) found a significantly higher proportion of CM among participants with CAS compared with participants without CAS. On the other hand, Ceylan et al.…”

“…We have included the symptom eyelid oedema in the proposed diagnostic criteria based on the literature, since eyelid oedema is a well described autonomic symptom among patients with migraine (Supplementary Table 3) (3 –5,7,10,15 –23), although, we did not have data on this symptom in our cohort. We believe that the diagnostic criteria suggested here are valid and useful.…”

“…To identify dominant patterns of clusters, we performed the clustering analysis 50 times. We identified 15 studies on migraine with CAS, which included a population prevalence of migraine with CAS (3 –7,10,15 –23). Data on the population prevalence of having one or more CAS and the population prevalence of individual CAS items were extracted from the articles and reported in this study for comparison with the population prevalences in this study.…”

“…The correlation between chronicity of migraine and high prevalence of CAS is not clear from the current literature. On the one hand, Togha et al (19) found a significantly higher proportion of CM among participants with CAS compared with participants without CAS. On the other hand, Ceylan et al (15) examined CAS prevalence separately in patients with episodic migraine (EM) and CM and found no significant difference.…”

“…Preictal CAS have been reported in 175/ 500 attacks, ictal CAS have been reported in 408/500 attacks, and postictal CAS have been reported in 204/ 500 attacks (24). In migraine, CAS are in general thought to occur at the peak of pain intensity and not before the pain (16,26), and the presence of CAS is associated with more severe headache pain (3)(4)(5)10,19). Nevertheless, CAS have also been reported as premonitory symptoms in provoked attacks of migraine and CH (27)(28)(29)(30), suggesting that pain may not be necessary for their presence.…”