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Brain Advance Access published online on July 28, 2004
Brain, doi:10.1093/brain/awh236
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Received February 15, 2004
Revised April 20, 2004
Accepted May 9, 2004

Article

Autonomic asymmetry in migraine: augmented parasympathetic activation in left unilateral migraineurs

Yudith Avnon 1, Meir Nitzan 2, Elliot Sprecher 3, Zeev Rogowski 4, David Yarnitsky 1*

1 Department of Neurology, Rambam Medical Center, Haifa, Israel; Faculty of Medicine, Technion, Haifa, Israel
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

* To whom correspondence should be addressed. E-mail: davidy{at}tx.technion.ac.il.


  Abstract

Summary Brain autonomic control is asymmetrical, the left hemisphere affecting predominantly parasympathetic function and the right hemisphere affecting predominantly sympathetic function. It is not known whether the extent of autonomic activation is altered in migraine, although the fact that some migraineurs express parasympathetic features such as facial flushing, lacrimation and rhinorrhoea might suggest increased parasympathetic activation. We instilled diluted soapy eyedrops and measured (i) the trigemino-parasympathetic reflex by the vasodilator response of forehead skin bilaterally using photoplethysmography; (ii) the somato-sympathetic reflex by vasoconstriction in the index finger; and (iii) heart rate response. We studied 14 left-sided and 15 right-sided unilateral migraineurs outside attacks. We found that left-side migraineurs had significantly higher bilateral parasympathetic vasodilatation, regardless of the stimulation or measurement side (+60.1 ± 6.4%) compared with right-side migraineurs (+41.9 ± 6.4%, P < 0.05). Sympathetic vasoconstriction, however, was similar for the two groups (left, -15.9 ± 4.2%; right, -17.7 ± 4.1%, NS). Bradycardia was significantly more pronounced for the left-side migraineurs (interbeat, RR interval increase of +6.2 ± 1.1% versus +3.1 ± 1.1%, P < 0.04). We conclude that unilateral left-side migraineurs have increased parasympathetic activation in response to pain compared with right-side migraineurs. Sympathetic responses were similar in the two groups and seemed not to be affected by migraine side. Since cranial parasympathetic activity induces cerebral vasodilatation, this augmentation might be an inherent part of the migraine pathophysiology in these patients.

Keywords: migraine; parasympathetic; brain asymmetry; photoplethysmography; trigemino-parasympathetic reflex.
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