Spontaneous oscillations in cerebral blood flow velocity give evidence of different autonomic dysfunctions in various types of headache

Objectives.-Our objectives were to determine if: (1) patients with migraine have B wave abnormalities in comparison to normal controls and patients wi th chronic tension headache and (2) patients with chronic tension headache have an imbalance in autonomic activity that is reflected in differences in Mayer wave activity in comparison to normal controls. Background.-B waves and Mayer waves are spontaneous oscillations in cerebra l blood flow velocity with a frequency of 0.5 to 3 or 4 to 7 cycles per min ute, respectively, and can be measured by transcranial Doppler sonography. There is experimental evidence that B waves are generated by certain brain stem nuclei which modulate the lumen of the small intracerebral vessels via monoaminergic nerve endings. In contrast, Mayer waves in cerebral blood no w velocity have no central generator but mirror the Mayer waves in arterial blood pressure which represent peripheral autonomic activity. Migraine may be attributed to a neurotransmitter imbalance in brain stem nuclei. Dysfun ctions of the peripheral autonomic nervous system are known in patients wit h chronic tension headache. Methods.-Using bilateral transcranial Doppler monitoring of the middle cere bral artery B waves and Mayer waves were studied in 30 patients with migrai ne without aura, 28 subjects with tension-type headache, and 30 normal cont rols. Coefficient of variation as a quantitative parameter for amplitude of waves and the mean frequency were calculated from the envelope curves of t he Doppler spectra. Results.-The coefficient of variation of B waves was higher in migrainous p atients compared with patients with tension-type headache and normal contro ls (P<.05), indicating an increase in activity of brain stem nuclei in migr aine only. Patients with chronic tension headaches had lower values for May er wave activity in comparison with normal controls (P<.05), a sign of an i mpairment of sympathetic activity. Conclusions.-Our data support the dysfunction of the brain stem monouminerg ic/serotonergic system in migraine. In contrast, patients with chronic tens ion headache have an autonomic dysfunction of peripheral origin presenting as a decrease of sympathetic activity.