Migraine: A Chronic Sympathetic Nervous System Disorder

Abstract

The major finding of the present study is that migraine is a disorder of chronic sympathetic dysfunction, sharing many diagnostic and clinical characteristics with pure autonomic failure and multiple system atrophy. However, the sympathetic nervous system dysfunction in migraine differs from pure autonomic failure and multiple system atrophy in that occurs in an anatomically intact system. It is proposed that the sympathetic dysfunction in migraine relates to an imbalance of sympathetic co-transmitters. Specifically, it is suggested that a migraine attack is characterized by a relative depletion of sympathetic norepinephrine stores in conjunction with an increase in the release of other sympathetic cotransmitters such as dopamine, prostaglandins, adenosine triphosphate, and adenosine. An enhanced understanding of the sympathetic dysfunction in migraine may help to more effectively diagnose, prevent, and/or treat migraine and other types of headache.

Current and prospective pharmacological targets in relation to antimigraine action

“…Although these results suggest that the adrenergic system does not play a significant role in neurogenic dural vasodilatation, the porcine studies mentioned above do suggest that α-adrenoceptor agonists should still be considered for the development of potential antimigraine drugs. Moreover, studies on human subjects suggest that migraineurs have sympathetic hypofunction (Boccuni et al 1989;Peroutka 2004). Accordingly, drugs targeting on subtypes of α 1 -adrenoceptors, which lack systemic vasoconstriction, could hold a promising future in antimigraine therapy.…”

Pathophysiology and Therapeutic Potential of Purinergic Signaling

“…Thus, P2X 3 receptor antagonists may be candidates for antimigraine drug development (Waeber and Moskowitz, 2003). There is also recent evidence that migraine is a chronic sympathetic nervous system disorder, with which there is an increase in release of sympathetic cotransmitters, including ATP (Peroutka, 2004), which may contribute to the initial vasospasm (Macdonald, 2000).…”

Spectral Analyses of Heart Rate Variability by Acceleration Plethysmography for Diagnostic Support of Migraine: Clinical Research

“…Studies have investigated the pathophysiological mechanisms of headache, focusing on the autonomic functions [5,17]. These evaluations of autonomic functions utilized data on blood pressure or pulse rate.…”

“…These symptoms suggest that autonomic dysfunctions are taking place in patients with migraine [4,5]. Reports have been published regarding fluctuation of blood pressure or heart rate variability (HRV) in patients with migraine, but no general agreement has yet been obtained [6].…”