Unilateral Cranial Autonomic Symptoms in Migraine

Barbanti, Piero; Fabbrini, Giovanni; Pesare, M.; Vanacore, Nicola; Cerbo, R.

doi:10.1046/j.1468-2982.2002.00358.x

Cited by 187 publications

(206 citation statements)

References 9 publications

(12 reference statements)

Supporting

Mentioning

180

Contrasting

Order By: Relevance

“…[3][4][5][6] Recognizing that cranial autonomic symptoms are a common component of migraine is important diagnostically and thus therapeutically. Sinusitis, which also may present with head pain, is one of the most common misdiagnoses given to migraineurs.…”

Section: Discussionmentioning

confidence: 99%

“…4 Similarly, in this pediatric study, only 23% of the cranial autonomic symptoms were strictly unilateral. This tendency for bilaterality may explain why studies that examined only for unilateral cranial autonomic symptoms in adult migraineurs reported a lower prevalence of cranial autonomic symptoms (26.9%-45.8% 3,5 ). The majority of affected patients in this study had more than one cranial autonomic symptom.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Cranial autonomic symptoms in pediatric migraine are the rule, not the exception

2013

View full text Add to dashboard Cite

Objective: The presence of cranial autonomic symptoms often leads to a misdiagnosis of "sinus headache" in adult migraineurs, leading to unnecessary treatments and delaying appropriate migraine therapy. In this study, we examined the frequency of cranial autonomic symptoms in pediatric/adolescent patients with migraine.Methods: This cross-sectional study included all pediatric and adolescent patients with migraine evaluated by a single investigator at 4 different sites over the course of the study period.Results: Of 125 pediatric migraineurs, 62% had at least one cranial autonomic symptom based on current International Classification of Headache Disorders, second edition (ICHD-II) criteria, and 70% based on proposed ICHD-III criteria. The majority had more than one cranial autonomic symptom and the symptoms tended to be bilateral. Age, sex, laterality of headache, presence of aura, and whether migraine was episodic vs chronic did not influence the likelihood of having cranial autonomic symptoms. Conclusions:In pediatric/adolescent migraine, the presence of cranial autonomic symptoms appears to be the rule rather than the exception. Clinicians should be careful to consider migraine when evaluating a child with headache and associated ocular or nasal symptoms so as to avoid giving a misdiagnosis of sinus headache. Cranial autonomic symptoms are typically associated with the trigeminal autonomic cephalalgias, such as cluster headache.1 The anatomy and physiology of these symptoms, consisting of the trigeminal-autonomic reflex, have been described and are well understood.2 However, it is only recently that the implications of the data have been more broadly realized with the relatively high frequency, between 27% and 73%, of cranial autonomic symptoms in adult migraineurs. [3][4][5][6] Recognizing that cranial autonomic symptoms are a common component of migraine is important diagnostically and thus therapeutically. Sinusitis, which also may present with head pain, is one of the most common misdiagnoses given to migraineurs.7-10 In a pediatric study, nearly 40% of pediatric migraineurs were initially mislabeled as having "sinus headache." 11 Misdiagnosis puts these patients at risk of inappropriate treatments and procedures, and delays appropriate treatment of their migraine. In this study, we examined the frequency of cranial autonomic symptoms in pediatric patients with migraine presenting for care.The International Classification of Headache Disorders, second edition (ICHD-II) 12 includes the following cranial autonomic symptoms: 1) conjunctival injection, lacrimation, or both; 2) nasal congestion, rhinorrhea, or both; 3) eyelid edema; 4) forehead and facial sweating; 5) forehead/facial flushing; and 6) miosis, ptosis, or both. In ICHD-III, a sense of aural fullness 13 will be added as a cranial autonomic symptom. 14 METHODS Standard protocol approvals, registrations, and patient consents. This study was approved by the University of California, San Francisco (UCSF) Committee for Human Research (protocol ...

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Cranial autonomic symptoms in pediatric migraine are the rule, not the exception

2013

View full text Add to dashboard Cite

show abstract

“…In addition to the diagnostic criteria specified by the International Headache Society (1), migraine can be associated with cranial autonomic symptoms (CAS) of lacrimation, conjunctival injection, eyelid edema, nasal congestion, and forehead/facial sweating (3,4) in 27% to 73% of cases depending on criteria and study design (3)(4)(5)(6). This correlation is not limited to adults but also includes migraineurs under the age of 18 years, with a recent study showing 62% of children and adolescents complaining of migraine-associated CAS (7).…”

Section: Introductionmentioning

confidence: 99%

Sphenopalatine ganglion neuromodulation in migraine: What is the rationale?

2013

View full text Add to dashboard Cite

Objective: The objective of this article is to review the prospect of treating migraine with sphenopalatine ganglion (SPG) neurostimulation. Background: Fuelled by preliminary studies showing a beneficial effect in cluster headache patients, the potential of treating migraine with neurostimulation has gained increasing interest within recent years, as current treatment strategies often fail to provide adequate relief from this debilitating headache.Common migraine symptoms include lacrimation, nasal congestion, and conjunctival injection, all parasympathetic manifestations. In addition, studies have suggested that parasympathetic activity may also contribute to the pain of migraineurs.The SPG is the largest extracranial parasympathetic ganglion of the head, innervating the meninges, lacrimal gland, nasal mucosa, and conjunctiva, all structures involved in migraine with cephalic autonomic symptoms. Conclusion: We propose two possible mechanisms of action: 1) interrupting the post-ganglionic parasympathetic outflow to inhibit the pain and cephalic autonomic symptoms, and 2) modulating the sensory processing in the trigeminal nucleus caudalis. To further explore SPG stimulation in migraineurs as regards therapeutic potential and mode of action, randomized clinical trials are warranted.

show abstract

“…The presence of autonomic symptoms, restlessness, and the length of the attacks usually distinguishes this from migraine, although a proportion of migraine patients may exhibit cranial autonomic features, [9][10][11] and migraine can coexist with CH by chance. The differential diagnosis for CH includes the other trigeminal autonomic cephalalgias (TACs), which are paroxysmal hemicrania (PH) and SUNCT (shor t-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing), although these dif fer from CH in that the attack lengths are shorter.…”

Section: Diagnosismentioning

confidence: 99%

Prevention and treatment of cluster headache

Cohen¹,

Goadsby²

2009

Prog Neurol Psychiatry

View full text Add to dashboard Cite

CCluster headache (CH) is a stereotypical primar y headache syndrome, characterised by attacks of unilateral excruciating pain usually in the eye, periorbital region and temple, with associated cranial autonomic symptoms such as conjunctival injection, lacrimation, nasal blockage, rhinorrhea, ptosis, and eyelid oedema. Restlessness and agitation also feature prominently. Attacks last for 15-180 minutes, and have a frequency of one every other day up to eight a day. 1 They can be triggered by alcohol, 2 usually in under an hour, in contrast to migraine for which alcohol typically takes longer to trigger an attack. CH attacks often occur with so-called clock-like regularity, and may be precipitated by sleep.CH has a prevalence of 0.1 to 0.3 per cent in the general population, 3 and affects slightly more men than women, with a male: female ratio of 2.5:1 in a recent study. 2 Episodic cluster headache (ECH) is defined as bouts of attacks lasting from seven days up to one year, with breaks of one month or more between bouts. In chronic cluster headache (CCH) attacks occur for more than one year without remission, or with remissions lasting less than one month. In CCH there are micro-periods, and seasonal variation is sometimes seen. Unaware of this, clinicians and patients may feel prophylactics have 'stopped working' although in fact the disorder has changed. Over years this can lead to a creeping upwards of medicine doses and eventual accrual of side-effects. If one is aware of the phenomenon of periodicity even in CCH, the physician can, after a period of increased dosing, revert to the previous dose, or preferably use other strategies for short-term care to avoid changing the baseline preventive dose.CH is probably the most severe pain known to humans, with female patients describing each attack as worse than childbirth. Health-related quality of life is significantly impaired in CH suf ferers. 4,5 Even though it is under-recognised and often suboptimally managed in primary care, 6,7 an early diagnosis and prompt treatment are essential to alleviate the devastating morbidity of these attacks. 8 DiagnosisThe diagnosis is usually clear on taking a thorough history. The presence of autonomic symptoms, restlessness, and the length of the attacks usually distinguishes this from migraine, although a proportion of migraine patients may exhibit cranial autonomic features, 9-11 and migraine can coexist with CH by chance. The differential diagnosis for CH includes the other trigeminal autonomic cephalalgias (TACs), which are paroxysmal hemicrania (PH) and SUNCT (shor t-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing), although these dif fer from CH in that the attack lengths are shorter. 1 There is considerable overlap in attack frequency, such that typical CH patients have one to two attacks a day, typical PH patients 10 and typical SUNCT/SUNA patients 50, there is a marked skew that favours lower attack frequencies. 12 Another useful clinical pointer is the lateralisation of photo...

show abstract

Unilateral Cranial Autonomic Symptoms in Migraine

Cited by 187 publications

References 9 publications

Cranial autonomic symptoms in pediatric migraine are the rule, not the exception

Cranial autonomic symptoms in pediatric migraine are the rule, not the exception

Sphenopalatine ganglion neuromodulation in migraine: What is the rationale?

Prevention and treatment of cluster headache

Contact Info

Product

Resources

About