Sweating and vascular responses in the face: Normal regulation and dysfunction in migraine, cluster headache and harlequin syndrome

Drummond, Peter D.

doi:10.1007/bf01827433

Cited by 59 publications

(37 citation statements)

References 110 publications

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“…Because of the nitric oxide hypersensitivity of the cranial vessels in migraine patients and its release by parasympathetic fibers, the involvement of the parasympathetic nervous system has been discussed [29]. Drummond supposed that the dilatation of the dermal vessels during and after a migraine attack is caused by an increase of parasympathetic tone, due to trigeminal-parasympathetic vasodilator reflexes [9]. This parasympathetic hyperfunction during the attack may lead to a parasympathetic dysfunction immediately following the attack.…”

Section: Discussion S Sympathetic Parameters Of the Pupillary Light Rmentioning

confidence: 98%

Dysfunction of the pupillary light reflex following migraine headache

Mylius¹,

Braune²,

Schepelmann³

2003

Clinical Autonomic Research

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Using pupillometry and sympathetic skin responses we compared the changes in local and systemic autonomic function within one week of a migraine attack. We investigated whether the measurement of the pupillary light reflex provides further information on the pathophysiology of migraine.Forty-two migraine patients and forty-two healthy age-matched controls were included. The parameters that were measured were the amplitude of the pupillary light reflex, the pupil size at the beginning of the measurement, the latency, the velocity of constriction and the velocity at the end of the dilatation. The average pupil size was 6.43 mm in the migraine group and 6.7 mm in the control group (p < 0.01). Reduced velocity of constriction and smaller amplitude of constriction in migraine patients within two days of an attack were signs of a parasympathetic dysfunction (p < 0.05). The sympathetic skin response did not differ significantly between migraine sufferers and controls. These findings indicate that both parasympathetic and sympathetic nerves supplying the eye are involved in migraine headache presumably due to effects on the pericarotid sympathetic fibers and involvement of trigeminal-parasympathetic reflexes.

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Section: Discussion S Sympathetic Parameters Of the Pupillary Light Rmentioning

confidence: 98%

Dysfunction of the pupillary light reflex following migraine headache

Mylius¹,

Braune²,

Schepelmann³

2003

Clinical Autonomic Research

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“…Parasympathetic activation. Both the secretory and vasomotor parasympathetic innervation originate in the salivatory nuclei of the brainstem [2], but preganglionic secretory fibres travel through the greater superficial petrosal nerve and vasomotor fibres through the facial and glossopharyngeal nerves [2]. They synapse at the sphenopalatine ganglion and postganglionic fibres are then distributed to the lacrimal glands and nasal mucosal (causing lacrimation, rhinorrhoea and nasal congestion) and to various structures in the eye (explaining conjunctival injection).…”

Section: Discussionmentioning

confidence: 99%

“…Oculomotor, vasomotor and sudomotor neurons from the cervical sympathetic pathway descend trough the medulla and spinal cord and leave the spinal cord in slightly different levels [2]. The preganglionic sympathetic fibres synapse in the superior cervical ganglion maintaining somatotopic organisation, in which fibres from the rostral end of the ganglion project into the internal carotid nerve plexus and innervate the eyes (explaining ptosis and miosis) and forehead (explaining forehead sweating) [2]. 3.…”

Section: Discussionmentioning

confidence: 99%

“…Autonomic disturbances in cluster headache (CH) are thought to result from parasympathetic stimulation [1] and from ocular sympathetic deficit [2] with expression of a Horner-like syndrome. Forehead sweating is though to be a consequence of a postganglionic lesion in sympathetic sudomotor fibres [3], with adaptive supersensitivity of the forehead sweat glands [4].…”

Section: Introductionmentioning

confidence: 99%

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Autonomic features in cluster headache. Exploratory factor analysis

2005

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IntroductionAutonomic disturbances in cluster headache (CH) are thought to result from parasympathetic stimulation [1] and from ocular sympathetic deficit [2] with expression of a Horner-like syndrome. Forehead sweating is though to be a consequence of a postganglionic lesion in sympathetic sudomotor fibres [3], with adaptive supersensitivity of the forehead sweat glands [4]. Facial flushing could result from a unilateral increase in extracranial blood flow, demonstrated during cluster attacks [5,6] as a consequence of trigeminal nociceptive activation [6,7].Principal component analysis is a data reduction method that explores correlations among the variables of a problem, producing a set of independent factors that resume the relation within the original variables -the principal components. We applied this deductive statistical method to the autonomic manifestations of a series of CH patients, trying to elucidate the relationships between these symptoms. MethodsThe Cluster Headache Outpatient database of Santa Maria's Hospital in Lisbon was used to select ICHD-II [8] CH patients. All patients included in this database was observed by neurologists with experience in headache. Clinical data were analysed, including age at first consultation, gender, duration of illness, follow-up time, pattern (episodic/chronic), presence of autonomic symptoms and number and type of autonomic symptoms (mio- Raquel Gil Gouveia Elsa Parreira Isabel Pavão MartinsAbstract The objective is to identify the pathogenesis of each autonomic manifestation in cluster headache (CH). Through a deductive statistics method (factor analysis) we analysed the type of autonomic symptoms reported by 157 CH patients. Three principal components were identified in the analysis: parasympathetic activation (lacrimation, conjunctival injection and rhinorrhoea), sympathetic defect (miosis and ptosis) and parasympathetic mediated effect (nasal congestion, eyelid oedema and forehead sweating). This work suggests that there are three different mechanisms underlying autonomic manifestations in CH.

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“…The importance of specifically monitoring cutaneous circulation at the forehead is emphasized by the peculiar neural control of this area, which is profoundly affected by cognitive and emotional aspects (13,50,53). These factors are experimentally difficult to control and are likely to account for the observed variability of responses in the extracranial compartments.…”

Section: General Considerationsmentioning

confidence: 99%

Inconsistent detection of changes in cerebral blood volume by near infrared spectroscopy in standard clinical tests

Canova

Roatta

Bosone³

et al. 2011

Journal of Applied Physiology

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The attractive possibility of near infrared spectroscopy (NIRS) to noninvasively assess cerebral blood volume and oxygenation is challenged by the possible interference from extracranial tissues. However, to what extent this may affect cerebral NIRS monitoring during standard clinical tests is ignored. To address this issue, 29 healthy subjects underwent a randomized sequence of three maneuvers that differently affect intra- and extracranial circulation: Valsalva maneuver (VM), hyperventilation (HV), and head-up tilt (HUT). Putative intracranial (“i”) and extracranial (“e”) NIRS signals were collected from the forehead and from the cheek, respectively, and acquired together with cutaneous plethysmography at the forehead (PPG), cerebral blood velocity from the middle cerebral artery, and arterial blood pressure. Extracranial contribution to cerebral NIRS monitoring was investigated by comparing Beer-Lambert (BL) and spatially resolved spectroscopy (SRS) blood volume indicators [the total hemoglobin concentration (tHb) and the total hemoglobin index, (THI)] and by correlating their changes with changes in extracranial circulation. While THIe and tHbe generally provided concordant indications, tHbi and THIi exhibited opposite-sign changes in a high percentage of cases (VM: 46%; HV: 31%; HUT: 40%). Moreover, tHbi was correlated with THIi only during HV ( P < 0.05), not during VM and HUT, while it correlated with PPG in all three maneuvers ( P < 0.01). These results evidence that extracranial circulation may markedly affect BL parameters in a high percentage of cases, even during standard clinical tests. Surface plethysmography at the forehead is suggested as complementary monitoring helpful in the interpretation of cerebral NIRS parameters.

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Sweating and vascular responses in the face: Normal regulation and dysfunction in migraine, cluster headache and harlequin syndrome

Cited by 59 publications

References 110 publications

Dysfunction of the pupillary light reflex following migraine headache

Dysfunction of the pupillary light reflex following migraine headache

Autonomic features in cluster headache. Exploratory factor analysis

Inconsistent detection of changes in cerebral blood volume by near infrared spectroscopy in standard clinical tests

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