Unilateral cranial autonomic symptoms in patients with migraine

Abstract

The aim of this study is to investigate the frequency of unilateral cranial autonomic symptoms during migraine attacks, and to compare the clinical characteristics of migraine patients with and without unilateral cranial autonomic symptoms. One hundred and eighty-six consecutive patients with episodic migraine attacks were prospectively included. Cranial autonomic symptoms of the patients occurred during headache, frequency, duration, severity and character of headache, disease duration, presence of aura, laterality of headache, accompanying symptoms, relation of migraine attacks with menstruation, lesions detected on magnetic resonance images, and family history of migraine were recorded. The patients with and without unilateral cranial autonomic symptoms during headache were compared in terms of above-mentioned parameters. Seventy-seven (41.4 %) patients were observed to develop unilateral cranial autonomic symptoms during migraine attack. Disease duration was longer in the patients with unilateral cranial autonomic symptoms than in those without (p = 0.045). Headache was unilateral in 83.1 % of the patients with unilateral cranial autonomic symptoms (p = 0.001). Pure menstrual or menstrually related migraine attacks were more common in the patients with unilateral cranial autonomic symptoms (p = 0.043) and is thought that menstruation-related hormonal factors might have a triggering role on the trigeminal-autonomic reflex pathway. The longer disease duration in patients with unilateral cranial autonomic symptoms might be associated with the activation of pathophysiological mechanisms that cause cranial autonomic symptoms in time. Frequent unilateral pain in migraine patients with unilateral cranial autonomic symptoms is likely to indicate that the development of autonomic symptoms may share common mechanisms with the pathogenesis of trigeminal autonomic cephalalgias.

Errors in Recognition and Management are Still Frequent in Patients with Cluster Headache

“…The very different temporal patterns and duration of attacks in migraine and CH are key factors on distinguishing between these two conditions, as it is true that other features of these headaches can overlap. These overlapping features include the development of aura (known to occur in up to 20% of CH cases) [14], the pain intensity (2/3 of migraine patients also have severe pain), the existence of cranial autonomic symptoms (at least one of these symptoms is known to occur in about half of migraine patients) [15,16,17,18,19,20,21,22] or the presence of associated ‘migraine' features in CH attacks (in a large German cohort CH attacks associated photo/phonofobia in 61% and nausea and vomiting in 28% of cases) [13]. The IHS criteria of ‘strictly unilateral pain' may also cause confusion as switching attack sides has been reported in at least 10% of CH cases [23] and also in up to 10% of cases migraine attacks are strictly unilateral for years [24].…”

Relationship between serum levels of VIP, but not of CGRP, and cranial autonomic parasympathetic symptoms: A study in chronic migraine patients

“…Cranial parasympathetic autonomic symptoms (CAPS) appear in more than half of migraine patients (15)(16)(17)(18)(19)(20)(21)(22). Using a quantitative scale we were able to show that CAPS are not the exception but the rule in CM patients (23).…”

No Change in Interictal PACAP Levels in Peripheral Blood in Women With Chronic Migraine

“…Our results are surprising considering the proposed involvement of PACAP in migraine and in CM pathophysiology. Cranial autonomic parasympathetic symptoms do appear, depending on criteria and study design, in 27% to 73% of migraine patients, [6][7][8][9][10][11][12][13][14][15][16] and a recent study using an ICHD-IIIb based scale has shown that around 80% of CM patients show an average of two cranial parasympathetic autonomic symptoms. 30 Meningeal vessels receive dense parasympathetic innervation.…”

“…The autonomic nervous system is involved in migraine as reflected by the “general” (nausea, vomiting, diarrhea or polyuria) and “cranial” (conjunctival injection, lacrimation, nasal congestion, etc) symptoms appearing with attacks. Cranial autonomic parasympathetic symptoms have been shown to appear in up to three quarters of migraine patients . Vasoactive intestinal peptide (VIP) release has been classically invoked as the explanation for the appearance of cranial parasympathetic symptoms in migraine and cluster headache .…”

“…Cranial autonomic parasympathetic symptoms have been shown to appear in up to three quarters of migraine patients. [9][10][11][12][13][14][15][16] Vasoactive intestinal peptide (VIP) release has been classically invoked as the explanation for the appearance of cranial parasympathetic symptoms in migraine and cluster headache. 17,18 Recent evidence, however, indicates that the release of pituitary adenylate cyclase activating polypeptide (PACAP) by the efferent arm of the TVS might also be implicated in the appearance of cranial parasympathetic symptoms and in the development of migraine headache.…”