[Results of autonomic testing in children with migraine with aura, including visual and sensory]

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.