Sneezing in Primary Headaches With Cranial Autonomic Symptoms: Pathophysiological Considerations. A Series of Case Reports

Redon, Sylvain; Donnet, Anne

doi:10.1111/head.13242

Cited by 5 publications

(6 citation statements)

References 17 publications

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“…Despite the most reported symptoms, the phenotype of symptoms likely mediated by cranial autonomic activation has emerged over time. One of these more recently identified symptoms is aural fullness [34][35][36] , a sensation of the ear feeling full and uncomfortable, and sneezing 37,38 . Whilst the majority of cranial vasculature innervation and therefore pain perception comes from V1 23 , we suggest based on previous work, that pain and CAS can be mediated via other divisions of the trigeminal nerve (in the absence of vascular dilatation).…”

Section: Introductionmentioning

confidence: 99%

Cranial autonomic symptoms: prevalence, phenotype and laterality in migraine and two potentially new symptoms

Karsan

Nagaraj

Goadsby

2021

Preprint

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BackgroundWhilst cranial autonomic symptoms (CAS) are typically associated with the trigeminal autonomic cephalalgias (TAC’s), they have also been reported in migraine. Identification and understanding of these symptoms in migraine is important to ensure timely diagnosis and effective management. MethodsMigraineurs seen within our tertiary headache service between 2014-2018 ( n =340): cohort one, and a separate cohort of headache patients seen between 2014-May 2021 reporting voice change and/or throat swelling as CAS were selected ( n =64); cohort two. We examined, as a service evaluation, our records regarding age, sex, diagnosis, headache and CAS frequency and laterality as acquired from the first consultation, during which a detailed headache history is taken by a trained physician. ResultsCohort 1: Mean age 43 (range 14-94, SD 15). The most common diagnosis was chronic migraine (78%). Median monthly headache frequency was 26 days (IQR 15-75). At least one CAS was reported in 74%, with a median of two (IQR 0-3). The most common were nasal congestion (32%), lacrimation (31%) and aural fullness (25%). Most patients reported unilateral headache (80%) and strictly unilateral CAS (64%). There was a positive association between headache and CAS laterality (ꭓ 2 1 = 20.7, P < 0.001), with a positive correlation between baseline headache frequency and number of CAS reported ( r = 0.11, P = 0.047). Cohort two: mean age 49 (range 23-83, SD 14). Diagnoses were chronic migraine (50%), chronic cluster headache (11%), undifferentiated continuous lateralised headache (9%), SUNCT/SUNA (8%), hemicrania continua (8%), episodic migraine (8%), episodic cluster headache (3%) and trigeminal neuropathies (3%). Most (89%) described trigeminal distribution pain; 25% involving all three divisions. Throat swelling was reported by 54, voice change by 17, and both by 7. The most common CAS reported were lacrimation ( n = 47), facial swelling ( n = 45) and rhinorrhoea ( n = 37). There was significant agreement between the co-reporting of throat swelling (ꭓ 2 1 = 7.59, P = 0.013) and voice change (ꭓ 2 1 = 6.49, P = 0.02) with aural fullness. ConclusionsCAS are common in migraine, are associated with increasing headache frequency and tend to co-lateralise with headache. Voice change and throat swelling should be recognized as possible parasympathetically-mediated CAS. They may be co-associated and associated with aural fullness, suggesting a broadly somatotopic endophenotype.

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Section: Introductionmentioning

confidence: 99%

Cranial autonomic symptoms: prevalence, phenotype and laterality in migraine and two potentially new symptoms

Karsan

Nagaraj

Goadsby

2021

Preprint

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“…It has been proposed that this is possible in that it is due to activation of the trigeminal system and that it could also be associated with some visual symptoms in migraine [ 7 ]. Likewise, in relation to the cranial autonomic symptoms, it may activate central mechanisms, mainly in the hypothalamus [ 8 ], although other causes should also be ruled out, such as Chiari malformations, as we did in our patient [ 9 ].…”

Section: Discussionmentioning

confidence: 76%

Atypical Perfusion Manifestation in Migraine with Aura

Lester¹,

Bustamante²,

García-Moreno³

et al. 2021

Case Rep Neurol

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Migraine with aura may be confused with a stroke. Magnetic resonance imaging is an important tool for the differential diagnosis. Cerebral hypoperfusion has been described in classic migraine, mainly during the aura. A 47-year-old male had an unremarkable past medical history. After sneezing, he developed a left hemi hypoesthesia, bitemporal vision loss, photopsia, and some distortion in the position of letters and words. This lasted <1 h, and it was followed by a severe headache. A magnetic resonance angiography was performed during the headache. It showed a left hemispheric hypoperfusion that did not correlate with the symptoms described by the patient. It is believed that during the aura, cerebral blood flow decreases, leading to hypoxia and decreased cellular energy generation, and these metabolic alterations define the symptoms of the patient. In our case, we documented brain hypoperfusion during the headache in the ipsilateral brain hemisphere to the symptoms, which has no clinical correlation. This condition could be due to spasm in the capillary arteries, and it may persist and influence the clinical manifestations during the headache phase in migraine with aura. A state of generalized cerebral hyperperfusion has been suggested, and there may be a coexistence of both phenomena for some period. This may open a new line of research regarding the pathophysiology and vascular changes of migraine with aura.

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“…The phenotype of symptoms likely mediated by cranial autonomic activation has emerged over time. One of these more recently identified symptoms is aural fullness [35][36][37], a sensation of the ear feeling full and uncomfortable, and sneezing [38,39]. Whilst the majority of cranial vasculature innervation and therefore pain perception comes from V1 [24], we suggest based on previous work, that pain and CAS can be mediated via other divisions of the trigeminal nerve (in the absence of vascular dilatation) [30,40].…”

Section: Introductionmentioning

confidence: 85%

Cranial autonomic symptoms: prevalence, phenotype and laterality in migraine and two potentially new symptoms

2022

View full text Add to dashboard Cite

Background Whilst cranial autonomic symptoms (CAS) are typically associated with trigeminal autonomic cephalalgias (TAC’s), they have also been reported in migraine. Identification and understanding of these symptoms in migraine is important to ensure timely diagnosis and effective management. Methods Migraineurs seen in a tertiary headache service between 2014 and 2018 (n = 340): cohort one, and a separate cohort of headache patients seen between 2014-May 2021 reporting voice change, or throat swelling, or both, as CAS were selected (n = 64): cohort two. We performed a service evaluation of our records regarding age, sex, diagnosis, headache and CAS frequency and laterality as acquired from the first consultation, during which a detailed headache history is taken by a headache trained physician. Results Cohort 1: Mean age 43 (range 14–94, SD 15). The most common diagnosis was chronic migraine (78%). Median monthly headache frequency was 26 days (IQR 15–75). At least one CAS was reported in 74%, with a median of two (IQR 0–3). The most common were nasal congestion (32%), lacrimation (31%) and aural fullness (25%). Most patients reported their most common headache as unilateral (80%) and with it strictly unilateral CAS (64%). There was a positive association between headache and CAS laterality (χ21 = 20.7, P < 0.001), with a positive correlation between baseline headache frequency and number of CAS reported (r = 0.11, P = 0.047). Cohort two: mean age 49 (range 23–83, SD 14). Diagnoses were chronic migraine (50%), chronic cluster headache (11%), undifferentiated continuous lateralised headache (9%), SUNCT/SUNA (8%), hemicrania continua (8%), episodic migraine (8%), episodic cluster headache (3%) and trigeminal neuropathies (3%). Most (89%) described trigeminal distribution pain; 25% involving all three divisions. Throat swelling was reported by 54, voice change by 17, and both by 7. The most common CAS reported were lacrimation (n = 47), facial swelling (n = 45) and rhinorrhoea (n = 37). There was significant agreement between the co-reporting of throat swelling (χ21 = 7.59, P = 0.013) and voice change (χ21 = 6.49, P = 0.02) with aural fullness. Conclusions CAS are common in migraine, are associated with increasing headache frequency and tend to lateralise with headache. Voice change and throat swelling should be recognized as possible parasympathetically-mediated CAS. They may be co-associated and associated with aural fullness, suggesting a broadly somatotopic endophenotype.

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Sneezing in Primary Headaches With Cranial Autonomic Symptoms: Pathophysiological Considerations. A Series of Case Reports

Abstract: Sneezing is a symptom associated with primary headaches. The definite place of sneezing in these patients suggests a particular implication of hypothalamus in the pathophysiology of these cases.

Cited by 5 publications

References 17 publications

Cranial autonomic symptoms: prevalence, phenotype and laterality in migraine and two potentially new symptoms

Cranial autonomic symptoms: prevalence, phenotype and laterality in migraine and two potentially new symptoms

Atypical Perfusion Manifestation in Migraine with Aura

Cranial autonomic symptoms: prevalence, phenotype and laterality in migraine and two potentially new symptoms

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