Gergont Aleksandra, Gajda Beata, Wesołowska Ewa
Przegl Lek. 2016;73(3):143-7.
Despite the signs of involvement of autonomic nervous system (ANS) in the pathomechanism of migraine, the significance of its dysfunction was not fully explained. One of parameters serving to establish a balance of both ANS parts is relation of low frequency (LF) to high frequency (HF) heart rate variability (HRV), LF/ HF ratio. HF reflects parasympathetic activity, whereas LF both sympathetic and parasympathetic as well as respiratory rhythm.
The aims of the study was to establish LF and HF ratio in children with migraine with aura, during rest, passive tilting and also during active standing. Prospective research, approved by Bioethical Commission of Jagiellonian University, Nr KBET/188/B/2011.
The examination was performed in 47 children with migraine with aura during headache-free period (within 31 girls and 16 boys, mean age 14 years) and in 32 children without headaches and syncope (19 female and 13 male volunteers), constituting an age-matched control group. HRV was evaluated during rest, during a 10-min 70 degrees head-up passive tilting and during 3-min active standing test, using Task Force Monitor 3030i/3040i.
In all 47 children with migraine with aura head-up tilt test was negative for syncope, however in 4 children (8.5%), postural orthostatic tachycardia syndrome was diagnosed (all of them from a group of 24 children with migraine with sensory aura). In 2 children from the control group head-up tilt-induced syncope (6%), reflecting false positive result (in one of children the second neurocardiogenic syncope occurred). Results of LF/HF ratio did not differ between groups with migraine with aura and controls significantly, whereas they were higher in group of 24 children with migraine with sensory aura during passive tilting. Active standing did not reveal differences of LFIHF ratio between any groups.
Predominance of sympathetic nervous system activity during passive head-up tilt test, as well as more common postural orthostatic tachycardia syndrome in patients with migraine with sensory aura as compared with children with migraine with visual aura and healthy volunteers indicate differential autonomic reactivity. False positive result of passive tilting in healthy children may suggest a higher risk of syncope recurrence. In spite of poor orthostatic tolerance reported by patients with migraine, active standing did not reveal differences between migraine patients and healthy volunteers.
尽管自主神经系统（ANS）参与偏头痛发病机制的迹象明显，但其功能障碍的重要性尚未得到充分解释。用于建立ANS两部分平衡的参数之一是低频（LF）与高频（HF）心率变异性（HRV）的比值，即LF/HF比值。HF反映副交感神经活动，而LF反映交感神经和副交感神经活动以及呼吸节律。
本研究的目的是确定有先兆偏头痛儿童在静息、被动倾斜以及主动站立时的LF和HF比值。前瞻性研究，经雅盖隆大学伦理委员会批准，编号KBET/188/B/2011。
对47名有先兆偏头痛儿童在无头痛期（31名女孩和16名男孩，平均年龄14岁）进行检查，并对32名无头痛和晕厥的儿童（19名女性和13名男性志愿者）进行检查，后者构成年龄匹配的对照组。使用Task Force Monitor 3030i/3040i在静息、10分钟70度头高位被动倾斜以及3分钟主动站立测试期间评估HRV。
在所有47名有先兆偏头痛儿童中，头高位倾斜试验晕厥结果为阴性，然而，4名儿童（8.5%）被诊断为体位性直立性心动过速综合征（他们均来自24名有感觉先兆偏头痛儿童组）。对照组中有2名儿童出现头高位倾斜诱发的晕厥（6%），这是假阳性结果（其中1名儿童发生了第二次神经心源性晕厥）。有先兆偏头痛组与对照组之间的LF/HF比值结果无显著差异，而在24名有感觉先兆偏头痛儿童组中，被动倾斜期间该比值较高。主动站立时，各小组之间的LF/HF比值没有差异。
与有视觉先兆偏头痛儿童及健康志愿者相比，有感觉先兆偏头痛患者在被动头高位倾斜试验期间交感神经系统活动占优势，且体位性直立性心动过速综合征更常见，这表明自主神经反应存在差异。健康儿童被动倾斜的假阳性结果可能表明晕厥复发风险较高。尽管偏头痛患者报告有较差的直立耐受性，但主动站立时偏头痛患者与健康志愿者之间未发现差异。
