Propranolol in the Prophylaxis of Migraine ‐ Evaluation by Spectral Analysis of Beat‐to‐Beat Heart Rate Fluctuations

Abstract

Migraine patients seem to suffer from a continuous autonomic imbalance. Sympathetic instability, expressed by enhanced low frequency fluctuations, which exists during the headache free intervals, was observed in our previous study by spectral analysis of heart rate (HR) fluctuations. Propranolol--a beta adrenoceptor antagonist, is widely used in migraine prophylaxis. In order to specify and quantitate propranolol efficacy in migraine, spectral analysis of heart rate fluctuations was performed on 10 migraine patients before and during the treatment with propranolol. They were compared to 10 healthy control patients and 6 migraine patients who were treated for several months with propranolol and then discontinued the medication. The analysis was carried out on a 24h Holter ECG recording, which was performed for each subject during a headache free interval. Short 256 sec subtraces, taken every 30 min from the 24h ECG signal, were submitted to A/D conversion, R wave detection and computation of heart rate power spectrum. Propranolol achieved a marked effect, when comparing the power spectra of HR fluctuations in treated versus untreated migraine patients. A strong reduction (to normal level) in the low frequency HR fluctuations in the range below 0.1 Hz., was apparent in patients treated with propranolol. Subjects who had received propranolol in the past and discontinued the drug, displayed a carry-over effect of reduced fluctuations even 2-3 months after its discontinuation. It seems that the propranolol efficacy in migraine is associated with the mechanism of stabilizing the fluctuations within the frequency band related to sympathetic activity, hereby moderating the vascular instability in migraine.

The Effect of Verapamil Calcium Antagonist on Autonomic Imbalance in Migraine: Evaluation by Spectral Analysis of Beat‐to‐Beat Heart Rate Fluctuations

“…13,14,28 In our earlier reports on migraine sufferers, 13,14 we found a strong enhancement in LF which reflected increased sympathetic fluctuations (since the respiratory peak was not significantly different). The respiratory peak (HF) is vagally controlled and its power provides a quantifiable measure of parasympathetic activity.…”

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.…”

“…A sympathetic hyperfunction in adults [5] or both sympathetic and parasympathetic hyperfunction in children with migraine [32] have also been reported. It was shown by Zigelman et al that betablockage using propanolol reduced the sympathetic instability (low frequency fluctuations in heart rate) [33].…”

“…Others have reported a sympathetic hyperfunction [5], sympathetic and parasympathetic hyperfunction [32] or sympathetic instability [3,33].…”

Methodology in clinical sleep research

“…The LF range of HRV may difficult to interpret, since both sympathetic and parasympathetic components might be involved. However, it has been accepted that an increase in its power provides insight into the activity of the sympathetic tone, and administration of beta blockers could reduce it [65]. Respiratory patterns may influence the sympathovagal balance and sometimes the LF component to the HF band; therefore the physCell.…”