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Chuang CH, Li JY, King JT, Chen WT, Chen SP, Wang YF, Liu HY, Hsiao FJ, Pan LLH, Wang SJ, Lai KL. Abnormal heart rate variability and its application in predicting treatment efficacy in patients with chronic migraine: An exploratory study. Cephalalgia 2023; 43:3331024231206781. [PMID: 37851663 DOI: 10.1177/03331024231206781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
AIM This study aimed to investigate the extent of autonomic nervous system dysfunction in patients with chronic migraine using heart rate variability analysis. In addition, we explored the potential association between heart rate variability and treatment outcomes in patients receiving preventive treatment. METHODS In this cross-sectional and prospective study, we compared heart rate variability profiles in 81 preventive-naïve chronic migraine patients and 58 healthy controls. In addition, treatment responses of patients, who received a 12-week treatment with flunarizine, were assessed in relation to baseline heart rate variability. RESULTS We observed that chronic migraine patients had a reduced heart rate variability, signifying autonomic dysfunction in comparison to healthy controls. Furthermore, patients presenting normal heart rate variability, characterized by a standard deviation exceeding 30 milliseconds in normal-to-normal RR intervals, experienced a superior response to flunarizine treatment. This improvement was exemplified by a significantly larger reduction in monthly headache days for patients with higher heart rate variability compared to those with lower heart rate variability: -9.7 (5.9) vs. -6.2 (6.0) days (p = .026). CONCLUSIONS Autonomic dysfunction occurs in chronic migraine as evaluated by heart rate variability. A preserved function is associated with a better treatment outcome to flunarizine.Trial registration: Neurologic Signatures of Chronic Pain Disorders, NCT02747940. Registered 22 April 2016, https://clinicaltrials.gov/ct2/show/NCT02747940.
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Affiliation(s)
- Chun-Hsiang Chuang
- Research Center for Education and Mind Sciences, College of Education, National Tsing Hua University, Hsinchu, Taiwan
- Institute of Information Systems and Applications, College of Electrical Engineering and Computer Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Jhe-Yu Li
- Research Center for Education and Mind Sciences, College of Education, National Tsing Hua University, Hsinchu, Taiwan
- Department of Computer Science and Engineering, National Taiwan Ocean University, Keelung, Taiwan
| | - Jung-Tai King
- College of Hua-Shih College of Education, National Dong Hwa University, Hualien, Taiwan
| | - Wei-Ta Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan
| | - Shih-Pin Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Feng Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hung-Yu Liu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fu-Jung Hsiao
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Ling Hope Pan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuan-Lin Lai
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Henneberg RLG, Vandborg PK, Hansen JK. A Pediatric Case of Benign Episodic Unilateral Mydriasis with Clinical Characteristics Resembling Tadpole Pupil. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1736555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractBenign episodic unilateral mydriasis is an episodic disturbance with dilatation of the entire pupil, often lasting for hours. It occurs most frequently in women aged between 20 and 50 years and is closely associated with migraines. Only a few pediatric cases have been reported. The demographics of benign unilateral mydriasis correspond to another episodic disturbance of the pupil, the tadpole pupil. Also, the clinical similarities between the two conditions are numerous. However, tadpole pupil is an irregular distortion of the pupil lasting from seconds to minutes and occurring in clusters. We present a 16-year-old girl with benign unilateral mydriasis and migraine. Her episodes of mydriasis lasted from seconds to minutes, occurred in clusters, and were thus like episodes of tadpole pupil. Benign unilateral mydriasis presenting this way has not been reported previously. This observation links the phenotypes of benign unilateral mydriasis and tadpole pupil closer together. The given case provides new knowledge as it (i) expands the clinical spectrum of benign episodic unilateral mydriasis, (ii) links the phenotypes of benign unilateral mydriasis and tadpole pupil together, and (iii) in comparison with knowledge about autonomic failure in migraine patients may add to hypotheses on pathophysiology in both pupillary disorders.
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Zhang L, Qiu S, Zhao C, Wang P, Yu S. Heart Rate Variability Analysis in Episodic Migraine: A Cross-Sectional Study. Front Neurol 2021; 12:647092. [PMID: 33833731 PMCID: PMC8021769 DOI: 10.3389/fneur.2021.647092] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/16/2021] [Indexed: 01/24/2023] Open
Abstract
Objective: It has been reported that autonomic nervous dysfunction is more prevalent in migraineurs. Heart rate variability (HRV) is a commonly used method to evaluate the cardiac autonomic nervous function modulation. However, HRV changes in migraine are still contradictory. The main objective of this study was to explore the potential HRV change patterns in episodic migraine (EM) and whether there were differences in HRV between EM ictal period and the interictal period. Patients and Methods: We conducted a cross-sectional study including 18 patients with EM and 18 age- and sex-matched controls. The characteristics of demographics, some lifestyle factors, and psychological conditions were assessed at baseline. HRVs including time-domain analysis and frequency-domain analysis were performed in all participants. HRV analyses in migraine were recorded not only in the interictal period but also in the ictal period. Results: All the HRV parameters showed a decreased trend in migraine than controls. Time-domain parameters standard deviation of all NN intervals in 24 h (SDNN) and triangular index were significantly lower in the migraine ictal period than controls separately (SDNN, 56.94 ± 22.09 ± 7.76 vs. 135.78 ± 35.16, p < 0.001; triangular index, 12.61 ± 3.20 vs. 22.11 ± 6.90, p < 0.001). Frequency-domain parameter low-frequency power was also lower in the migraine ictal period than controls (351.28 ± 206.71 vs. 559.61 ± 281.24, p = 0.02). SDNN was much lower in the migraine ictal period than migraine interictal period (56.94 ± 22.09 vs. 115.94 ± 46.88, p < 0.001). HRV changes during migraine interictal period did not differ from the control group. The correlation analysis revealed a negative correlation between visual analog scale and HRV parameters in the migraine ictal period (p = 0.04). Conclusions: The present cross-sectional study indicates that HRV was significantly decreased in EM population especially during the migraine ictal period, which means unbalance of autonomic system in EM. Perhaps larger prospective cohort studies are wanted to validate these findings.
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Affiliation(s)
- Lvming Zhang
- Department of Neurology, Medical School of Chinese People's Liberation Army, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shi Qiu
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Chunxia Zhao
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Peifu Wang
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Shengyuan Yu
- Department of Neurology, Medical School of Chinese People's Liberation Army, Chinese People's Liberation Army General Hospital, Beijing, China
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Matsuoka R, Muneuchi J, Nagatomo Y, Sugitani Y, Ezaki H, Doi H, Watanabe M. Headache and Left Ventricular Efficiency After Transcatheter Closure of Atrial Septal Defect. Headache 2020; 60:2421-2430. [PMID: 33045096 DOI: 10.1111/head.13990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE/BACKGROUND This study aimed to clarify the relationship between migraine-like headache and ventriculo-arterial coupling after transcatheter closure of the atrial septal defect in children. We hypothesized that migraine headache after defect closure would be related to an abnormal hemodynamic response against an increased left ventricular filling. DESIGN A retrospective cohort study. METHODS We calculated the end-ventricular systolic elastance (Ees), effective arterial elastance (Ea), and ventricular energy efficiency approximated based on echocardiography before and after defect closure, and compared these parameters between the subjects with and without headache after defect closure. RESULTS A total of 167 subjects were studied. Age at the procedure, defect diameter, and pulmonary to systemic blood flow ratio were 11 (9-17) years, 12.8 (9.2-16.0) mm, and 1.8 (1.6-2.3), respectively. We identified 47 (28%) subjects with migraine headache after defect closure. Although there was no significant difference in the Ees, Ea, and ventricular energy efficiency before defect closure between the groups, the Ees (4.0 [3.4-4.9] vs 4.8 [3.7-6.1], P = .014) and ventricular energy efficiency (0.79 [0.76-0.82] vs 0.83 [0.79-0.85], P = .001) after defect closure in subjects with headache were significantly lower than those in subjects without headache. Migraine headache after defect closure was significantly associated with age (odds ratio: 0.97, 95% confidential interval: 0.94-1.00, P = .036) and a decrease in the ventricular energy efficiency after defect closure (odds ratio: 6.42, 95% confidential interval: 2.76-14.90, P < .001). CONCLUSION A loss of ventricular energy efficiency was common in pediatric subjects with migraine-like headache after transcatheter closure of the atrial septal defect, which suggested that the left ventricular function maladaptation was related to headache development after defect closure. We advocate that an impaired ventriculo-arterial coupling may be one of the mechanisms for developing attacks in not only this population but also in other patients with migraine.
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Affiliation(s)
- Ryohei Matsuoka
- Department of Pediatrics, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Japan
| | - Jun Muneuchi
- Department of Pediatrics, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Japan
| | - Yusaku Nagatomo
- Department of Pediatrics, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Japan.,Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichiro Sugitani
- Department of Pediatrics, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Japan
| | - Hiroki Ezaki
- Department of Pediatrics, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Japan
| | - Hirohito Doi
- Department of Pediatrics, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Japan
| | - Mamie Watanabe
- Department of Pediatrics, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Japan
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Druschky K, Lorenz J, Druschky A. Effects of Respiratory Rate on Heart Rate Variability in Neurologic Outpatients with Epilepsies or Migraine: A Preliminary Study. Med Princ Pract 2020; 29:318-325. [PMID: 31698355 PMCID: PMC7445653 DOI: 10.1159/000503710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 10/31/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Variation of spontaneous respiratory rates and influences of spontaneous and paced breathing rates on heart rate variability (HRV) were assessed in patients with epilepsy or migraine, and HRV parameters were compared between the groups. MATERIALS AND METHODS Thirty neurologic outpatients, 16 diagnosed with epilepsies and 14 with migraine, were included. Autonomic testing consisted of short-term HRV, the deep breathing test (DBT), and measurement of HRV at systematically changed breathing rates (paced breathing, 5-18 breaths per minute, bpm). RESULTS Spontaneous respiratory rate during short-term HRV varied from 9 to 23 bpm in the epileptic group and from 5 to 21 bpm in migraine patients and was significantly and negatively correlated with SD of all normal RR intervals (SDNN) and total power (TP) in epileptic patients but not in migraine patients. Paced breathing rate had a significant effect on all HRV parameters assessed in both groups. HRV (SD1, SDNN, TP) and DBT (E-I, SD1, SDNN) parameters were significantly lower in the epileptic group. Group differences were significantly greater during slow compared to fast breathing. CONCLUSIONS An important and new finding is the wide variation of spontaneous respiratory rate in both groups, along with the significant negative correlation with the assessed HRV parameters. The reduction of HRV during slow breathing in epileptic patients may indicate a diminished cardiorespiratory coupling caused by a probable loss of sensitivity within the cardiovagal brainstem circuitry.
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Affiliation(s)
- Katrin Druschky
- Neurologische Gemeinschaftspraxis, PDDr. Katrin Druschky, PDDr. Achim Druschky, Nürnberg, Germany
- Department of Neurology, University of Erlangen-Nuernberg, Erlangen, Germany
- *Katrin Druschky, Neurologische Gemeinschaftspraxis, PDDr. Katrin Druschky, PDDr. Achim Druschky, Am Stadtpark 2, DE–90409 Nürnberg (Germany), E-Mail ;
| | - Jürgen Lorenz
- Faculty of Life Science, Laboratory of Human Biology and Physiology, Applied Science University, Hamburg, Germany
| | - Achim Druschky
- Neurologische Gemeinschaftspraxis, PDDr. Katrin Druschky, PDDr. Achim Druschky, Nürnberg, Germany
- Department of Neurology, University of Erlangen-Nuernberg, Erlangen, Germany
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Huang Q, Yu H, Zhang N, Guo B, Feng C, Wang S, Liang X. Body Mass Index and Primary Headache: A Hospital-Based Study in China. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4630490. [PMID: 31119170 PMCID: PMC6500676 DOI: 10.1155/2019/4630490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/08/2019] [Accepted: 03/31/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Primary headache and obesity are highly prevalent disorders in the general population. Although many studies have reported an association between the two, there is still no overall comprehension about this relationship. To gain a more accurate understanding in this regard, we analyzed data from a 2011 cross-sectional study in Chongqing, China. METHODS Patients with a chief complaint of headache were administered a headache questionnaire and diagnosed by neurology doctors in accordance with the International Classification of Headache Disorders 2nd Edition (ICHD-II) criteria. Patients aged < 18 years or diagnosed with secondary headache were excluded. RESULTS Of 1327 patients who cited headache as the chief complaint, 16 were excluded for missing data, while 396 were diagnosed with chronic headache (177 chronic migraine [CM], 186 chronic tension-type headache [CTTH], and 33 other chronic headache) and 915 with episodic headache (369 episodic migraine [EM], 319 episodic tension-type headache [ETTH], and 227 other episodic headache). Chronic headache patients had a higher number of headache days per month, longer duration of headache history, and greater tendency to overuse analgesics than episodic headache patients. The CM and ETTH patients were more apt to be overweight and had a significantly greater body mass index (BMI; p < 0.05) than the EM and CTTH patients. Overweight (odds ratio [OR] = 3.64; 95% confidence interval (CI), 1.19-8.81) and obesity (OR = 28.63; 95% CI, 2.96-276.6) were independently associated with CM but not with other headaches, and this association was not influenced by other factors such as medication overuse. CONCLUSIONS The relationship between headache and overweight/obesity varies depending on the type of primary headache. CM patients are more likely to have a higher body mass index than EM patients, while ETTH patients are more likely to be overweight/obese than CTTH patients.
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Affiliation(s)
- Qingqing Huang
- Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, China
| | - Huiqing Yu
- Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, China
| | - Ningning Zhang
- Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, China
| | - Bingling Guo
- Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, China
| | - Changyan Feng
- Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, China
| | - Shiqiang Wang
- Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, China
| | - Xiping Liang
- Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, China
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Abstract
Primary headaches are one of the most prevalent neurological disorders and can occur during a wide range of lifespan. Primary headaches, especially migraine, are cyclic disorders with a complex sequence of symptoms within every headache attack. There is no systematic review of whether these symptoms changes during lifespan. Indeed, the clinical presentation of migraine shows an age-dependent change with a significantly shorter duration of the attacks and occurrence of different paroxysmal symptoms, such as vomiting, abdominal pain or vertigo, in childhood and, in contrast, largely an absence of autonomic signs and a more often bilateral headache in the elderly. The age-dependent differences in the clinical presentation are less distinct in cluster headache and, especially, in tension-type headache. The differences in the clinical presentation are in agreement with the idea that the connectivity of hypothalamic areas with different brainstem areas, especially the central parasympathetic areas, is important for the clinical manifestation of migraine, as well as, the change during lifespan.
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Affiliation(s)
- Andreas Straube
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-University, 81377, Munich, Germany.
| | - Anna Andreou
- Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,The Headache Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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