The head and neck discomfort of autonomic failure: An unrecognized aetiology of headache

Abstract

Information concerning the frequency, severity, character, location, duration, diurnal pattern of headache and ancillary symptoms were obtained in 25 patients with autonomic failure and 44 control subjects. Precipitating and ameliorating factors were identified. Autonomic failure patients had more head and neck discomfort than controls. Their discomfort was much more likely to localize in the occiput, nape of the neck and shoulder, compared with controls. There was a greater tendency for the discomfort to occur in the morning and after meals. It was sometimes less than 5 min in duration and was often associated with dimming, blurring, or tunnelling of vision. It was provoked by upright posture and relieved by lying down. Patients with severe autonomic failure and orthostatic hypotension often present with a posture-dependent headache or neck pain. Because the relationship of these symptoms to posture is often not recognized, the fact that these findings may signal an underlying autonomic disorder is underappreciated, and the opportunity to consider this aetiology for the headache may be missed.

Influence of age and gender on the occurrence and presentation of reflex syncope

“…Women have a greater decrease of thoracic blood volume compared to men upon standing [11], resulting in lower orthostatic tolerance associated with decreased cardiac filling [12]; this explains the higher number of TLOC episodes in women. Shoulder pain, a clinical feature known to be associated with orthostatic hypotension [10,23], was reported in our study by 11% of women and 4% of men with reflex syncope (P = 0.02). Shoulder pain is most likely due to muscle ischaemia [23].…”

“…Shoulder pain, a clinical feature known to be associated with orthostatic hypotension [10,23], was reported in our study by 11% of women and 4% of men with reflex syncope (P = 0.02). Shoulder pain is most likely due to muscle ischaemia [23]. This muscle ischaemia is thought to result from a (prolonged) impairment of blood flow in orthostatic hypotension.…”

Orthostatic dyspnea: a neglected symptom of orthostatic hypotension

“…The pathophysiological basis of these symptoms is a decrease in cerebral perfusion. Some patients with orthostatic hypotension also report head and neck painthe "coat hanger" headache -due to ischemia of trapezius and the neck extensor muscles [12]. We report an increased prevalence of dyspnea in patients with orthostatic hypotension diagnosed in an autonomic laboratory.…”

“…Common presenting symptoms of patients with orthostatic hypotension include syncope, dizziness, lightheadedness and headache that is postural in nature [12]. Orthostatic dyspnea is not a widely recognized symptom of orthostatic hypotension [10].…”

New trends in the treatment of orthostatic hypotension

“…For example, many patients experience severe neck pain (coat hanger pain) when standing [24]. Others may present with orthostatic angina pectoris.…”