Autonomic dysfunction in migraineurs

Objective.-To evaluate autonomic function and sympathovagal balance in migr aineurs and healthy controls. Background.-The pathophysiology of migraine i s still Largely unknown. An imbalance of the autonomic nervous system could explain many of the clinical manifestations of the disorder. Materials and Methods.-We undertook autonomic function tests in 17 women su ffering from migraine (8 with aura) (average age 36 +/- years) and 16 healt hy women (average age 34 +/- 7 years), Autonomic nervous system studies con sisted of tests of sympathetic function (the quantitative sudomotor axon re flex test, heat-to-heat blood pressure responses to the Valsalva maneuver, sustained handgrip, cold presser test, and head-up tilt and tests of parasy mpathetic function (heart rate responses to deep breathing and the Valsalva maneuver), The data from the tilt test were further evaluated by time-freq uency analysis (Wigner distribution). Results.-Subjects with migraine with aura had a smaller increase of mean bl ood pressure during phase IV of the Valsalva maneuver (P<0.05) and a lower blood pressure increment during the handgrip test (P=0.08); their time-freq uency distribution showed reduced power at the nonrespiratory frequencies i n the X-R interval at both minutes 1 (P<0.03) and 5 (P<0.04) of head-up til t. Sympathovagal balance (a ratio of spectral power of nonrespiratory frequ ency variations in blood pressure to that at respiratory frequency variatio ns in the R-R interval) was significantly increased in migraineurs, both wi th and without aura, by 10 minutes of head-up tilt. Conclusion.-Subjects with migraine with aura had resting supine sympathetic hypofunction and intact parasympathetic function. With head-up tilt, sympa thovagal balance is increased. The dynamic alterations in autonomic nervous system function may contribute to the development of aura in patients with migraine.