Responsiveness of the autonomic nervous system during paced breathing and mental stress in migraine patients

Abstract

BackgroundMigraine is a stress-related disorder, suggesting that there may be sympathetic hyperactivity in migraine patients. However, there are contradictory results concerning general sympathetic activation in migraine patients. To shed more light on the involvement of the autonomic nervous system (ANS) in migraine pathophysiology, we investigated cardiac and cardiovascular reactions during vagal (paced breathing) and sympathetic activation (mental stress test).MethodsHeart rate variability parameters and skin conductance responses were recorded interictally in 22 episodic migraine patients without aura and 25 matched controls during two different test conditions. The paced breathing test consisted of a five-minute baseline, followed by two minutes of paced breathing (6 breathing cycles per minute) and a five-minute recovery phase. The mental stress test consisted of a five-minute baseline, followed by one minute of stress anticipation, three and a half minutes of mental stress and a five-minute recovery phase. Furthermore we measured blood pressure and heart rate once daily over 2 weeks. Subjects rated their individual current stress level and their stress level during paced breathing and during the mental stress test.ResultsThere were no significant differences between migraine patients and controls in any of the heart rate variability parameters in either time domain or frequency domain analysis. However, all parameters showed a non-significant tendency for larger sympathetic activation in migraine patients. Also, no significant differences could be observed in skin conductance responses and average blood pressure. Only heart rates during the 2-week period and stress ratings showed significantly higher values in migraine patients compared to controls.ConclusionsGenerally there were no significant differences between migraine patients and controls concerning the measured autonomic parameters. There was a slight but not significant tendency in the migraine patients to react with less vagal and more sympathetic activation in all these tests, indicating a slightly changed set point of the autonomic system. Heart rate variability and blood pressure in migraine patients should be investigated for longer periods and during more demanding sympathetic activation.

Primary headaches during lifespan

“…Another study based on analysis of the electrocardiogram during sleep described reduced parasympathetic activity with sympathetic predominance [131]. In our own study we saw an exaggerated parasympathetic response to the pupillary reflex after a strong vegetative stimulus (cold water) [132] and a tendency to less parasympathetic and simultaneously more sympathetic activation in the control of the heart rate after mental stress or paced breathing [133]. One possible explanation for these different findings may be that there is a differential effect of migraine on the autonomic control of cranial autonomic reflexes and the cardiovascular system.…”

Heart Rate Variability Analysis in Episodic Migraine: A Cross-Sectional Study

“…At the same time, similar to our results, some studies revealed no difference in migraine. Researchers evaluated the autonomic system function by using HRV and skin conductance responses in EM and controls; no significant differences were found ( 28 ). Researchers used vertical tilt test, Valsalva maneuver, grip test, cold-stress vasoconstriction, BP variability, and arterial baroreflex to examine the autonomic regulation in episodic and chronic forms of migraine.…”

Key role of 5-HT 3 receptors in the nucleus tractus solitarii in cardiovagal stress reactivity

“…These stress responses can be observed, for example, after application of air-jet (2), painful stimuli (130), and also when the animal is placed in a novel and/or noisy environment (73). Similar cardiovascular and respiratory stress responses are observed in humans after application of combined physical and evaluative stressors (18), during mental stress (123), or in response to racially noxious images (28) or fearful faces (46) Various hypothalamic areas were originally defined as hypothalamic defense areas (HDA) because electrical or chemical stimulation of these regions produced characteristic behavioral and physiological defense responses (34,39,49,62,106). Other key regions involved in the defense reaction were subsequently described, such as the PAG (7,24).…”