Mueller Bridget R, Campbell Maya, Grant Jihan, Jean Jasmin, Vinokur Marianna, Kaplan Michael, Clauw Daniel, Robinson-Papp Jessica
Icahn School of Medicine at Mount Sinai.
University of Michigan.
Res Sq. 2025 Jun 16:rs.3.rs-6847469. doi: 10.21203/rs.3.rs-6847469/v1.
We sought to determine: 1.) the relationship between headache frequency and autonomic reflexes, and 2.) mechanisms underlying orthostatic intolerance (OI) in patients with migraine.
Adults with migraine (N = 30) underwent autonomic function tests summarized as the Composite Autonomic Severity Score (CASS) and vagal/adrenergic baroreflex sensitivity (BRS-V/A). Postural Orthostatic Tachycardia Syndrome (POTS) and orthostatic hypotension/hypertension were diagnosed during tilt table testing. A cold pressor test (CPT) evaluated sympathetic vasomotor function. Participants completed the Migraine Disability Assessment (MIDAS), the 2011 Fibromyalgia (FM) Survey Criteria, chronic overlapping pain condition (COPC) screener, and Compass-31.
Monthly headache days correlated with CASS (p = 0.001), BRS-V (p < 0.001), and the systolic blood pressure response to CPT (p = 0.003) in the expected direction with increasing ANS reflex dysfunction correlating to increasing number of headache days. During tilt testing, OI was prevalent (25/30; 83%) and reported by all patients with chronic migraine. An abnormal cardiovascular response to tilt was present in the majority (63%) of which POTS was the most common etiology (56.2%). Patients reporting OI during tilt table testing despite a cardiovascular response (33%) had higher FM scores (15.8 ± 3.6 vs. 7.5 ± 4.6; p < 0.01) and a greater prevalence of non-headache COPCs (88.8% versus 20.0%, p = 0.02), compared to participants who were asymptomatic during tilt.
There are two etiologies of OI in patients with migraine: 1.) an abnormal cardiovascular response to tilt (concordant OI) and, 2.) sensory hypersensitivity (discordant OI).
我们试图确定：1.）头痛频率与自主神经反射之间的关系，以及2.）偏头痛患者体位性不耐受（OI）的潜在机制。
成年偏头痛患者（N = 30）接受了自主神经功能测试，汇总为综合自主神经严重程度评分（CASS）和迷走神经/肾上腺素能压力反射敏感性（BRS-V/A）。在倾斜台测试期间诊断出体位性心动过速综合征（POTS）和体位性低血压/高血压。冷加压试验（CPT）评估交感神经血管运动功能。参与者完成了偏头痛残疾评估（MIDAS）、2011年纤维肌痛（FM）调查标准、慢性重叠疼痛状况（COPC）筛查以及Compass-31。
每月头痛天数与CASS（p = 0.001）、BRS-V（p < 0.001）以及CPT的收缩压反应（p = 0.003）呈预期方向相关，自主神经反射功能障碍增加与头痛天数增加相关。在倾斜测试期间，OI很普遍（25/30；83%），所有慢性偏头痛患者均有报告。大多数患者（63%）对倾斜有异常心血管反应，其中POTS是最常见的病因（56.2%）。与倾斜期间无症状的参与者相比，尽管有心血管反应但在倾斜台测试期间报告有OI的患者FM评分更高（15.8±3.6对7.5±4.6；p < 0.01），非头痛COPC的患病率更高（88.8%对20.0%，p = 0.02）。
偏头痛患者中OI有两种病因：1.）对倾斜的异常心血管反应（一致性OI），以及2.）感觉超敏（不一致性OI）。
