Skip to main content

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.

This is a preview of subscription content, access via your institution.

References

  1. May A (2009) New insights into headache: an update on functional and structural imaging findings. Nat Rev Neurol 5(4):199–209

    PubMed  Article  Google Scholar 

  2. Sprenger T, Goadsby PJ (2010) What has functional neuroimaging done for primary headache and for the clinical neurologist? J Clin Neurosci 17(5):547–553

    PubMed  Article  Google Scholar 

  3. Obermann M, Yoon MS, Dommes P, Kuznetsova J, Maschke M, Weimar C, Limmroth V, Diener HC, Katsarava Z (2007) Prevalence of trigeminal autonomic symptoms in migraine: a population-based study. Cephalalgia 27(6):504–509

    PubMed  Article  CAS  Google Scholar 

  4. Barbanti P, Fabbrini G, Pesare M, Vanacore N, Cerbo R (2002) Unilateral cranial autonomic symptoms in migraine. Cephalalgia 22(4):256–259

    PubMed  Article  CAS  Google Scholar 

  5. Gupta R, Bhatia MS (2007) A report of cranial autonomic symptoms in migraineurs. Cephalalgia 27(1):22–28

    PubMed  Article  CAS  Google Scholar 

  6. Lai TH, Fuh JL, Wang SJ (2009) Cranial autonomic symptoms in migraine: characteristics and comparison with cluster headache. J Neurol Neurosurg Psychiatry 80(10):1116–1119

    PubMed  Article  Google Scholar 

  7. Rozen TD (2011) A history of cigarette smoking is associated with the development of cranial autonomic symptoms with migraine headaches. Headache 51(1):85–91

    PubMed  Article  Google Scholar 

  8. Kelman L, Tanis D (2006) The relationship between migraine pain and other associated symptoms. Cephalalgia 26(5):548–553

    PubMed  Article  CAS  Google Scholar 

  9. Kaup AO, Mathew NT, Levyman C, Kailasam J, Meadors LA, Villarreal SS (2003) ‘Side locked’ migraine and trigeminal autonomic cephalgias: evidence for clinical overlap. Cephalalgia 23(1):43–49

    PubMed  Article  CAS  Google Scholar 

  10. Rozen TD, Niknam RM, Shechter AL, Young WB, Silberstein SD (2001) Cluster headache in women: clinical characteristics and comparison with cluster headache in men. J Neurol Neurosurg Psychiatry 70(5):613–617

    PubMed  Article  CAS  Google Scholar 

  11. Vingen JV, Pareja JA, Stovner LJ (1998) Quantitative evaluation of photophobia and phonophobia in cluster headache. Cephalalgia 18(5):250–256

    PubMed  Article  CAS  Google Scholar 

  12. Goadsby PJ, Cittadini E, Cohen AS (2010) Trigeminal autonomic cephalalgias: paroxysmal hemicrania, SUNCT/SUNA, and hemicrania continua. Semin Neurol 30(2):186–191

    PubMed  Article  Google Scholar 

  13. Barbanti P, Fabbrini G, Vanacore N, Pesare M, Buzzi MG (2003) Sumatriptan in migraine with unilateral cranial autonomic symptoms: an open study. Headache 43(4):400–403

    PubMed  Article  Google Scholar 

  14. Headache Classification Subcommittee of the International Headache Society (2004) The International Classification of Headache Disorders, 2nd edn. Cephalalgia 24(Suppl 1):9–160

    Google Scholar 

  15. Goadsby PJ, Lipton RB (1997) A review of paroxysmal hemicranias, SUNCT syndrome and other short-lasting headaches with autonomic feature, including new cases. Brain 120(Pt 1):193–209

    PubMed  Article  Google Scholar 

  16. Oppenheimer SM, Kedem G, Martin WM (1996) Left-insular cortex lesions perturb cardiac autonomic tone in humans. Clin Auton Res 6(3):131–140

    PubMed  Article  CAS  Google Scholar 

  17. Hilz MJ, Dütsch M, Perrine K, Nelson PK, Rauhut U, Devinsky O (2001) Hemispheric influence on autonomic modulation and baroreflex sensitivity. Ann Neurol 49(5):575–584

    PubMed  Article  CAS  Google Scholar 

  18. Avnon Y, Nitzan M, Sprecher E, Rogowski Z, Yarnitsky D (2004) Autonomic asymmetry in migraine: augmented parasympathetic activation in left unilateral migraineurs. Brain 127(Pt 9):2099–2108

    PubMed  Article  Google Scholar 

  19. Lieba-Samal D, Wöber C (2011) Sex hormones and primary headaches other than migraine. Curr Pain Headache Rep 15(5):407–414

    PubMed  Article  Google Scholar 

  20. van Vliet JA, Favier I, Helmerhorst FM, Haan J, Ferrari MD (2006) Cluster headache in women: relation with menstruation, use of oral contraceptives, pregnancy, and menopause. J Neurol Neurosurg Psychiatry 77(5):690–692

    PubMed  Article  Google Scholar 

  21. Manzoni GC, Micieli G, Granella F, Martignoni E, Farina S, Nappi G (1988) Cluster headache in women: clinical findings and relationship with reproductive life. Cephalalgia 8(1):37–44

    PubMed  Article  CAS  Google Scholar 

  22. Ekbom K, Waldenlind E (1981) Cluster headache in women: evidence of hypofertility(?) Headaches in relation to menstruation and pregnancy. Cephalalgia 1(3):167–174

    PubMed  Article  CAS  Google Scholar 

  23. Martin VT, Behbehani M (2006) Ovarian hormones and migraine headache: understanding mechanisms and pathogenesis–part I. Headache 46(1):3–23

    PubMed  Article  Google Scholar 

  24. Dodick DW, Rozen TD, Goadsby PJ, Silberstein SD (2000) Cluster headache. Cephalalgia 20(9):787–803

    PubMed  Article  CAS  Google Scholar 

  25. Denuelle M, Fabre N, Payoux P, Chollet F, Geraud G (2007) Hypothalamic activation in spontaneous migraine attacks. Headache 47(10):1418–1426

    PubMed  Google Scholar 

  26. Holle D, Katsarava Z, Obermann M (2011) The hypothalamus: specific or nonspecific role in the pathophysiology of trigeminal autonomic cephalalgias? Curr Pain Headache Rep 15(2):101–107

    PubMed  Article  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hayat Guven.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Guven, H., Çilliler, A.E. & Çomoğlu, S.S. Unilateral cranial autonomic symptoms in patients with migraine. Acta Neurol Belg 113, 237–242 (2013). https://doi.org/10.1007/s13760-012-0164-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13760-012-0164-4

Keywords

  • Migraine
  • Episodic migraine
  • Cranial autonomic symptoms
  • Trigeminal autonomic reflex