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Reconceptualizing autonomic function testing in migraine: a systematic review and meta-analysis
Antun R Pavelić1,2, Karin Zebenholzer3,4, Christian Wöber5,6
1Department of Neurology, University Hospital Tulln, Alter Ziegelweg 10, Tulln, 3430, Austria.
The Journal of Headache and Pain
|April 10, 2024
Summary
Migraine patients exhibit autonomic nervous system (ANS) dysfunction compared to healthy individuals. Evaluating ANS function is crucial, especially with new migraine therapies potentially impacting autonomic function.
Area of Science:
- Neurology
- Autonomic Neuroscience
Background:
- Autonomic nervous system (ANS) testing is vital for diagnosing autonomic dysfunction in migraineurs.
- Previous studies have investigated ANS function in migraine patients versus healthy subjects.
Purpose of the Study:
- To systematically review and meta-analyze existing literature on ANS function in migraine patients.
- To compare ANS test results between migraine patients and healthy controls.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA and MOOSE guidelines.
- Inclusion of seven studies comparing ANS function in migraineurs and controls.
- Analysis of deep breathing, Valsalva maneuver, orthostatic, and isometric challenges.
Main Results:
- Migraine patients (n=424) showed significantly lower interictal autonomic function test results than healthy controls (n=268).
- Specific deficits observed in deep breathing (g=-0.32), orthostatic challenge (g=-0.28), isometric challenge (g=-0.55), and Valsalva ratio (MD=-0.17).
Conclusions:
- Interictal autonomic dysfunction is identifiable in migraine patients compared to controls.
- Routine evaluation of ANS function in migraine patients is recommended.
- Emerging migraine therapies, like anti-CGRP antibodies, may influence ANS function, underscoring the need for monitoring.
