Evaluation of Autonomic Dysfunction in Pediatric Migraine Patients

Abstract

Objective: Headache during childhood is a common condition. Although recent studies have shown that the autonomic nervous system (ANS) in adult migraine patients is affected, there are few studies evaluating this relationship in children. Adult migraine patients demonstrate no abnormal ANS function in either the sympathetic or parasympathetic nervous system but there can be sympathetic/parasympathetic hypofunction/hyperfunction. The aim of this study is to investigate autonomic dysfunction in pediatric migraine patients. Method: The study evaluated tests for autonomic functions such as the orthostatic test, 30: 15 ratio, cold-pressor test, heart-rate responses to deep and normal breathing, valsalva ratio (VR), blink reflex (BR), and sympatheticskin-response with thirty pediatric migraine patients in interictal period. Patients in control group were selected from children that had not any other disease or headhache. Results: Consistent with sympathetic hypofunction, there was more frequent orthostatic hypotension in migraine group (p=0.019) and negative correlation between average disease duration, migraine attack duration and orthostatic tests results. Consistent with parasympathetic hyperfunction, the migraine group had higher VRs (p=0.035). There was a negative correlation between analgesic use rate and normal respiratory-RR-interval variability and between attack rate and deep and normal-R-R interval (R-wave peak to R-wave peak in electrocardiograms) variability. There was a positive correlation between average disease duration and BR R2 and R2’ latency in migraine group (p=0.028 and p=0.027). Conclusion: Our study revealed that ANS functions are affected in pediatric migraine and balance between sympathetic and parasympathetic nervous system is distrupted.Our study demonstrates decreased sympathetic responsiveness during the interictal period. Our results suggest hypofunction in the parasympathetic nervous system of migraine patients as attack rate and pain density elevate.

Keywords

• migraine
• autonomic nervous system
• blink reflex
• sympathetic skin response