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. 2022 Jul-Aug;25(4):654-659.
doi: 10.4103/aian.aian_948_21. Epub 2022 May 12.

Cranial Autonomic Symptoms in Migraine: An Observational Study

Ashutosh Tiwari  1 , Pradeep K Maurya  2 , Abdul Qavi  2 , Dinkar Kulshreshtha  2 , Anup K Thacker  2 , Ajai K Singh  2
Affiliations

Cranial Autonomic Symptoms in Migraine: An Observational Study

Ashutosh Tiwari et al. Ann Indian Acad Neurol. 2022 Jul-Aug.

Abstract

Objective: Our aim was to observe frequency of cranial autonomic symptoms (CAS) in migraineurs (primary) and its relation with laterality of headache or other factors, if any.

Background: Migraine episodes have headaches with or without aura, and sometimes associated with systemic autonomic nervous system symptoms. Primarily presence of cranial autonomic symptoms suggests diagnosis of TACs. But many studies reported cranial autonomic symptoms (CAS) ranging from 26% to 80% in migraine patients.

Material and methods: Consecutive patients of migraine attending our headache clinic were included in our study. Presence of CAS was recorded with respect to ocular, nasal, facial and aural symptoms along with headache characteristics and laterality information. Detailed clinical examination was performed. We used ICHD 3 (beta version) criteria.

Results: Our study cohort comprised of 200 patients having mean (± SD) age 31.12 (± 10.67) years. There were 157 (78.5%), females. Out of 200 patients, 148 (74%) were having at least one CAS, of which 70% were having 2 or more CAS. Frequency of CAS was lacrimation (45.5%), conjunctival injection (34.5%), eyelid edema (34%), aural fullness (27.5%), facial sweating (25%), facial flushing (17.5%), nasal congestion (9%), rhinorrhea (5%) and ptosis (4%). Bilateral CAS was present in 129 (87%) and unilateral CAS in 19 (13%) (OR 35.31; 95% CI 9.19 to 135.7), (P < 0.0001). Sunlight as a trigger was present in all 148 (100%) patients.

Conclusion: Our study showed that CASs in migraine is common and bilateral. Sunlight triggers headache in almost all CAS positive patients.

Keywords: Autonomic symptoms; CAS; migraine and CAS; parasympathetic cranial autonomic symptoms; sympathetic cranial autonomic symptoms; trigeminal autonomic reflex.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Frequency of cranial autonomic symptoms (%)
Figure 2
Figure 2
Migraineurs (in percentage) and number of cranial autonomic symptoms present
See this image and copyright information in PMC

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