Clinical Autonomic Research

, Volume 22, Issue 1, pp 17–23 | Cite as

Syncopal migraine

  • David Curfman
  • Michael Chilungu
  • Robert B. Daroff
  • Amer Alshekhlee
  • Gisela Chelimsky
  • Thomas C. Chelimsky
Research Article

Abstract

Objective

A subgroup of syncope patients report migraine headaches immediately preceding or following syncope, and some respond to anti-migrainous prophylactic agents. This study aimed to describe the frequency of migrainous features concurrent with episodes of syncope and to propose clinical criteria for assessing whether a migrainous mechanism might underlie syncope.

Methods

This retrospective, questionnaire-based study developed criteria for syncopal migraine based on the International Classification of Headache Disorders II (ICHD-II) migraine criteria. Two hundred and forty-eight recurrent syncope subjects (>3 episodes) were stratified based on the presence (N = 127) or absence (N = 121) of a headache concurrent with syncopal episodes. Syncopal headaches were classified as either syncopal migraine (meeting ICHD-II criteria for migraine or probable migraine, without aura) or nonspecific (not meeting the criteria for syncopal migraine). The syncope groups were then compared to 199 subjects with migraine headaches using chi-square and Cochran-Armitage test for trend.

Results

Nearly one-third of recurrent syncope subjects met criteria for syncopal migraine. This group resembled the migraine headache population more than the syncope population in age, gender, autonomic testing, and comorbid conditions. The syncopal migraine group also reported a longer duration of syncope and a longer recovery time to normal. Finally, anti-migrainous medications reduced syncope in half of the syncopal migraine subjects.

Interpretation

Syncope may have a migrainous basis more commonly than previously suspected, and we suggested criteria to identify these patients. Syncopal migraine appears epidemiologically more closely related to migraine than to reflex syncope.

Keywords

Migraine Syncope Headache disorders Dysautonomias 

Abbreviations

ODYSA

Ohio Dysautonomia Survey

ICHD-II

International Classification of Headache Disorders II

UHCMC

University Hospitals, Case Medical Center

CFS

Chronic fatigue syndrome

CRPS

Complex regional pain syndrome

OH

Orthostatic hypotension

POTS

Postural orthostatic tachycardia syndrome

LOC

Loss of consciousness

QSART

Quantitative sudomotor axon reflex test

Supplementary material

10286_2011_141_MOESM1_ESM.doc (92 kb)
Supplementary material 1 (DOC 92 kb)

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • David Curfman
    • 1
  • Michael Chilungu
    • 2
  • Robert B. Daroff
    • 3
  • Amer Alshekhlee
    • 4
  • Gisela Chelimsky
    • 5
  • Thomas C. Chelimsky
    • 1
  1. 1.The Autonomic Laboratory, Neurological InstituteUniversity Hospitals Case Medical CenterClevelandUSA
  2. 2.School of Medicine and DentistryUniversity of RochesterRochesterUSA
  3. 3.Neurological InstituteUniversity Hospitals Case Medical CenterClevelandUSA
  4. 4.Department of Neurology, Souers Stroke InstituteSaint Louis UniversitySt. LouisUSA
  5. 5.Division of Pediatric GastroenterologyRainbow Babies and Children’s HospitalClevelandUSA

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