Frequency of Cranial Autonomic Symptoms in Patients with Migraine
DOI:
https://doi.org/10.70749/ijbr.v3i7.2804Keywords:
Cranial Autonomic Symptoms, Lacrimation, Migraine, Nasal Congestion, Prevalence.Abstract
Background: Migraine is characterized by recurring incapacitating headache attacks accompanied by various symptoms, often including aura. Objective: To determine the frequency of cranial autonomic symptoms (CAS) in patients with migraine. Methods: This cross-sectional study was conducted at the Department of Neurology, Lady Reading Hospital, Peshawar, from January 2025 to June 2025. A total of 93 migraine patients aged 18–60 years, diagnosed for ≥1 year as per International Headache Society criteria, were enrolled using non-probability consecutive sampling. Demographic and clinical data were recorded, and CAS were assessed using a structured proforma. CAS were defined as ocular, nasal, facial, or aural autonomic features reported in ≥3 migraine episodes. Data were analyzed using SPSS v26, with p≤0.05 considered significant. Results: Of 93 patients, 64 (68.8%) females, with median age of 30 years (IQR 21.5–38.0). Migraine without aura was present in 72 (77.4%), and with aura in 21 (22.6%) patients. The median duration of migraine was 36.0 months (IQR 12.0–96.0), with a median frequency of 10 attacks per month (IQR 4.0–18.0). CAS were identified in 38 (40.9%) patients. Most frequent symptoms were lacrimation 22 (23.7%), conjunctival injection 20 (21.5%), nasal congestion 13 (14.0%), and aural fullness 11 (11.8%). Ptosis, eyelid edema, and facial sweating were significantly more frequent in older age groups (p=0.044). Conjunctival injection was more common in classical migraine with aura (38.1% vs 16.7%; p=0.035). Conclusion: CAS are frequent in patients with migraine, with lacrimation and conjunctival injection being the most commonly reported.
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1. Ferrari, M. D., Goadsby, P. J., Burstein, R., Kurth, T., Ayata, C., Charles, A., Ashina, M., Van den Maagdenberg, A. M., & Dodick, D. W. (2022). Migraine. Nature Reviews Disease Primers, 8(1).
https://doi.org/10.1038/s41572-021-00328-4
2. Burch, R. C., Buse, D. C., & Lipton, R. B. (2019). Migraine. Neurologic Clinics, 37(4), 631–649.
https://doi.org/10.1016/j.ncl.2019.06.001
3. Safiri, S., Pourfathi, H., Eagan, A., Mansournia, M. A., Khodayari, M. T., Sullman, M. J., Kaufman, J., Collins, G., Dai, H., Bragazzi, N. L., & Kolahi, A. (2021). Global, regional, and national burden of migraine in 204 countries and territories, 1990 to 2019. Pain, 163(2), e293-e309.
https://doi.org/10.1097/j.pain.0000000000002275
4. Nasir, S., Abrar, N., Sher, K., & Shahnaz, S. (2016). Frequency of cranial autonomic symptoms (cas) in migraine patients. Pakistan Journal of Neurological Sciences (PJNS), 11(2), 21-26.
https://ecommons.aku.edu/pjns/vol11/iss2/4/
5. Goadsby, P. J., & Holland, P. R. (2019). Pathophysiology of migraine. Neurologic Clinics, 37(4), 651-671.
https://doi.org/10.1016/j.ncl.2019.07.008
6. Karsan, N., & Goadsby, P. J. (2021). Migraine is more than just headache: Is the link to chronic fatigue and mood disorders simply due to shared biological systems? Frontiers in Human Neuroscience, 15.
https://doi.org/10.3389/fnhum.2021.646692
7. Vicente, B. N., Oliveira, R., Martins, I. P., & Gil-Gouveia, R. (2023). Cranial autonomic symptoms and neck pain in differential diagnosis of migraine. Diagnostics, 13(4), 590.
https://doi.org/10.3390/diagnostics13040590
8. Christensen, C. G., Techlo, T. R., Kogelman, L. J., Wegner Thørner, L., Nissen, J., Sørensen, E., Olesen, J., Hansen, T. F., & Chalmer, M. A. (2022). Population-based prevalence of cranial autonomic symptoms in migraine and proposed diagnostic appendix criteria. Cephalalgia, 42(11-12), 1160-1171.
https://doi.org/10.1177/03331024221094548
9. Tiwari, A., Maurya, P. K., Qavi, A., Kulshreshtha, D., Thacker, A. K., & Singh, A. K. (2022). Cranial autonomic symptoms in migraine. Annals of Indian Academy of Neurology, 25(4), 654-659.
https://doi.org/10.4103/aian.aian_948_21
10. Gelfand, A. A., Reider, A. C., & Goadsby, P. J. (2013). Cranial autonomic symptoms in pediatric migraine are the rule, not the exception. Neurology, 81(5), 431-436.
https://doi.org/10.1212/wnl.0b013e31829d872a
11. Togha, M., Jafari, E., Moosavian, A., Farbod, A., Ariyanfar, S., & Farham, F. (2021). Cranial autonomic symptoms in episodic and chronic migraine: A cross sectional study in Iran. BMC Neurology, 21(1).
https://doi.org/10.1186/s12883-021-02513-0
12. Haytoglu, Z., & Herguner, M. (2019). Cranial autonomic symptoms, neck pain: Challenges in pediatric migraine. Annals of Indian Academy of Neurology, 22(3), 282.
https://doi.org/10.4103/aian.aian_206_18
13. Fatima, M., Asghar, M. S., Ali, A., Kumar, D., Ahmed, J., & Rasheed, U. (2021). Frequency of cranio-autonomic symptoms in the patients of migraine presenting in an outpatient Department of Dow University hospital: A cross-sectional study. Romanian Journal of Neurology, 20(1), 81-87.
https://doi.org/10.37897/rjn.2021.1.11
14. Ray, J. C., Cheema, S., Foster, E., Gunasekera, L., Mehta, D., Corcoran, S. J., Matharu, M. S., & Hutton, E. J. (2022). Autonomic symptoms in migraine: Results of a prospective longitudinal study. Frontiers in Neurology, 13.
https://doi.org/10.3389/fneur.2022.1036798
15. McGinley, J. S., Mangrum, R., Gerstein, M. T., McCarrier, K. P., Houts, C. R., Buse, D. C., Bryant, A. L., Wirth, R. J., & Lipton, R. B. (2024). Symptoms across the phases of the migraine cycle from the patient's perspective: Results of the MiCOAS qualitative study. Headache: The Journal of Head and Face Pain, 65(2), 303-314.
https://doi.org/10.1111/head.14817
16. De Corso, E., Kar, M., Cantone, E., Lucidi, D., Settimi, S., Mele, D., Salvati, A., Bayar Muluk, N., Paludetti, G., & Cingi, C. (2018). Facial pain: Sinus or not? Acta Otorhinolaryngologica Italica, 38(6), 485-496.
https://doi.org/10.14639/0392-100x-1721
17. Danno, D., Wolf, J., Ishizaki, K., Kikui, S., Hirata, K., & Takeshima, T. (2022). Cranial autonomic symptoms in migraine are related to central sensitization: A prospective study of 164 migraine patients at a tertiary headache center. BMC Neurology, 22(1).
https://doi.org/10.1186/s12883-022-02610-8
18. Parashar, R. (2016). Age related changes in autonomic functions. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH.
https://doi.org/10.7860/jcdr/2016/16889.7497
19. Togha, M., Jafari, E., Moosavian, A., Farbod, A., Ariyanfar, S., & Farham, F. (2021). Cranial autonomic symptoms in episodic and chronic migraine: A cross sectional study in Iran. BMC Neurology, 21(1).
https://doi.org/10.1186/s12883-021-02513-0
20. Goadsby, P. (2012). Pathophysiology of migraine. Annals of Indian Academy of Neurology, 15(5), 15.
https://doi.org/10.4103/0972-2327.99993
21. Mungoven, T. J., Henderson, L. A., & Meylakh, N. (2021). Chronic migraine pathophysiology and treatment: A review of current perspectives. Frontiers in Pain Research, 2.
https://doi.org/10.3389/fpain.2021.705276
22. Qavi, A., Maurya, P. K., Jasrotia, R. B., Singh, A. K., Kulshreshtha, D., Ansari, A., & Thacker, A. K. (2021). Cranial autonomic symptoms in episodic migraine: An observational study from headache clinic of a tertiary care center of North India. Nepal Journal of Neuroscience, 18(3), 28-34.
https://doi.org/10.3126/njn.v18i3.35069
23. Rayamajhi, P., Bhattarai, P., Khadka, J., Khanal, S., & Chapagain, S. (2024). Cranial autonomic symptoms in migraine patient presenting in the Department of neurology of a tertiary care center: A descriptive cross-sectional study. Journal of Nepal Medical Association, 62(273), 311-314.
https://doi.org/10.31729/jnma.8576
24. Benoliel, R. (2012). Trigeminal autonomic cephalgias. British Journal of Pain, 6(3), 106-123.
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