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Migraine and autonomic nervous system function

A population-based, case-control study

From the Department of Epidemiology (Dr. Stewart and A. Shechter), the Johns Hopkins School of Hygiene and Public Health, Baltimore, MD; Jefferson Headache Center (Dr. Silberstein and A. Shecter), Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA; Department of Neurology, Epidemiology, and Social Medicine (Drs. Stewart and Lipton), Albert Einstein College of Medicine and Headache Unit, Montefiore Medical Center, Bronx, NY; and Innovative Medical Research (Dr. Lipton), Towson, MD, and Stamford, CT.

Address correspondence and reprint requests to A. Shechter, Jefferson Headache Center, Department of Neurology, Thomas Jefferson University Hospital, 111 S. 11th Street, Suite 8130, Philadelphia, PA 19107; e-mail: ashechter{at}hotmail.com

Objective: This study determines if measures of the function of the autonomic nervous system (ANS) differ in a population study of 80 migraine cases vs 85 controls matched for age, race, and sex.

Background: The authors sought to confirm clinic-based studies suggesting that migraine is associated with abnormal ANS function.

Methods: Resting systolic and diastolic blood pressure, Valsalva maneuver, heart rate variability (pulse rate [RR] variation) during deep breathing, and cardiovascular reactivity were measured during headache-free intervals. Migraineurs were subdivided into those with (n = 28) and without (n = 52) disabling headaches.

Results: Resting diastolic, but not systolic, blood pressure was elevated in disabled (73.2 mm) compared with nondisabled cases (71.6 mm; p < 0.10) and controls (69.8 mm; p < 0.096). RR variation also was significantly different among the three groups. Disabled migraine cases (1.19) had significantly lower RR variation compared with nondisabled migraine cases (1.26; p < 0.001) and controls (1.26; p < 0.001). The Valsalva ratio and mean circular resultant were lower in disabled cases compared with other migraine cases and with controls, but the differences were not statistically significant. No differences were found between the three groups when comparing blood pressure response to a psychological stressor.

Conclusions: Migraineurs with disabling attacks may be prone to ANS hypofunction. These findings may suggest that ANS dysfunction either may be a risk factor for migraine headaches or be a consequence of frequent disabling attacks. Moreover, ANS dysfunction and migraine may share a common neural substrate.

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