Brain Advance Access published online on April 22, 2003
Brain, doi:10.1093/brain/awg158
© 2003 by Guarantors of Brain
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Article
1 Department of Neurology, Rambam Medical Center, Haifa, Israel; Faculty of Medicine, Technion, Haifa, Israel
* Corresponding author. E-mail: davidy{at}tx.technion.ac.il.
Received 22 October 2002
; revised 2 February 2003
; accepted 5 February 2003
Several lines of evidence support involvement of the parasympathetic system in migraine: (i) migraine-associated symptoms, such as exaggerated facial flushing, lacrimation and rhinorrhea; (ii) increased levels of cranial venous vasoactive intestinal peptide in migraineurs during attacks; and (iii) reports of migraine pain alleviation by intranasal instillation of lidocaine, which can block some of the parasympathetic outflow to the cranium. This study assessed cranial parasympathetic function in migraineurs in between attacks, assuming that abnormal function might imply involvement of the parasympathetics in migraine pathogenesis. We tested 39 female migraineurs outside attacks, of whom 11 had bilateral pain, 20 unilateral at a specific side and eight alternating unilateral head pain, and 16 controls. The trigemino-parasympathetic reflex was studied, using soapy and saline eye drops for stimulation of the afferent limb of the reflex arch, and cutaneous vascular response at the forehead for the efferent limb. The latter was recorded by photoplethysmography on both sides of the forehead. We found no difference in vasodilatation between migraineurs as a group and controls (83.7 ± 6.5% and 80.8 ± 7.6%, respectively, not significant). However, when analysing data by the site of pain, we found that those with bilateral pain had the largest vasodilatation response (141.6 ± 16.2%, P < 0.05 versus controls, analysis of varance, post hoc Tukey-Kramer HSD), while those with unilateral pain had the least vasodilatation (45.5 ± 3.3%, P < 0.05). The response of patients with alternating pain (97.2 ± 12.6%) did not differ from controls. It is concluded that cranial parasympathetic function does differ among patients with various migraine types at rest. Based on the understanding of dysfunctional brainstem pain modulation in migraine, we suggest a model of within-brainstem interaction between the two locus coeruleus nuclei, which are involved in control of pain and cranial parasympathetic outflow. The model assumes various levels of inhibitory inter-relationships between these two nuclei; diminution or absence of the normal reciprocal inhibitory relationships between them may underlie the augmented cranial parasympathetic response in bilateral migraineurs, while an excess of reciprocal inhibitory relationship between them may underlie the diminished cranial parasympathetic response in unilateral migraineurs. These findings might help in clarifying inter-relationships between brainstem nuclei in the context of migraine pathogenesis.
Keywords: trigemino-parasympathetic; pain control; locus coeruleus; bilateral, unilateral migraine
Different patterns of parasympathetic activation in uni- and bilateral migraineurs
2 Department of Applied Physics/Electro-optics, Jerusalem College of Technology, Jerusalem, Israel
3 Department of Neurology, Rambam Medical Center, Haifa, Israel
4 Faculty of Medicine, Technion, Haifa, Israel
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  Y. Avnon, M. Nitzan, E. Sprecher, Z. Rogowski, and D. Yarnitsky Autonomic asymmetry in migraine: augmented parasympathetic activation in left unilateral migraineurs Brain, September 1, 2004; 127(9): 2099 - 2108. [Abstract] [Full Text] [PDF]
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