Autonomic Dysfunction in Interictal Period in Patients with Migraine

Abstract

Background: migraine is a chronic neurovascular disorder characterized by intermittent attacks of sever headache with or without aura that can include various combinations of neurological, gastrointestinal tract (G.I.T), and autonomic changes, without evidence of primary structural abnormalities. The Autonomic nervous system involvement suggested by many symptoms and signs including nausea, diarrhea, constipation, coldness in the extremities, paroxysmal tachycardia and chest pain.
Objectives: To evaluate autonomic functions in patients with migraine and to clarify the autonomic dysfunction weather its sympathetic, parasympathetic, or combined. Also to assess the severity of this dysfunction and its relation to age, gender and type of migraine.
Methods: This study enrolled 60 patients with migraine, 42 females and 18 males with an age range between 14-45 y. with 30 healthy volunteer as control group, The using of a questionnaire paper, autonomic nervous system disability scale and set of autonomic cardiovascular reflexes test were also applied .
Results: The migraineurs with disabling attack may be prone to autonomic nervous system hypofunction which may be either a risk factor for migraine headache, or be a consequence of frequent disabling attacks, moreover autonomic nervous system dysfunction and migraine may share a common neural substrate. The Parasympathetic part of autonomic nervous system is affected more than sympathetic according to Ewing classification of autonomic function tests which is significant statistically in comparison to control, and 16(26.7%) of patients showed definite dysautonomia(score >2) while 44(73.3%) of patients were normal. Palpitation and postural dizziness are the most frequent symptoms in patients with migraine . Autonomic dysfunction among migraineurs is not rare also prolong course of illness is strongly correlated with autonomic dysfunction which is affect parasympathetic part more than sympathetic, for this reason the clinician should look carefully for the autonomic symptoms when they assess patient with migraine because most of those symptoms were disabling
Conclusions: The assessment of autonomic function tests should be a routine work in patient with migraine. The heart rate response to deep breath and valsalva are simple informative and beside to evaluate the parasympathetic part of autonomic nervous system