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Updated: Oct 25, 2026
An Alternative to the Traditional Cold Pressor Test: The Cold Pressor Arm Wrap
Published on: January 16, 2014
Combined evaluation of pupillary and cardiovascular responses to cold pressor test in cluster headache patients
C Tassorelli1, G Micieli, V Osipova
1Headache Center and Autonomic Unit, Institute of Neurology IRCCS C. Mondino Foundation, University of Pavia, Italy. tassorel@tin.it
Insights
Cluster headache patients exhibit altered autonomic nervous system responses, including absent pupillary constriction and heightened blood pressure during the cold pressor test. Opioid system modulation may play a role in this sympathetic hyperactivation.
Area of Science:
- Neurology
- Autonomic Neuroscience
- Pain Research
Background:
- The pathophysiology of cluster headache (CH) remains poorly understood.
- Investigating autonomic nervous system (ANS) function offers insights into CH mechanisms.
Purpose of the Study:
- To evaluate oculocephalic and cardiovascular ANS functioning in CH patients.
- To compare responses during active CH phases versus remission.
- To explore the role of opioid neuromodulation.
Main Methods:
- Monitored pupillary and cardiovascular responses to the cold pressor test (CPT).
- Compared CH patients (active and remission phases) with healthy controls.
- Assessed effects of naloxone pretreatment.
Main Results:
- CH patients displayed an absent pupillary miosis response to CPT, unlike controls.
- CH patients showed a more pronounced pressor response to CPT.
- Naloxone pretreatment induced specific alterations in pupillary and cardiovascular responses.
Conclusions:
- Suggests systemic sympathetic hyperactivation in CH patients during CPT.
- Indicates a potential oculocephalic sympathetic hypofunction.
- Highlights altered opioid neuromodulation in cluster headache pathophysiology.
Abstract:
Little is known about the structures and mechanisms involved in the pathophysiology of cluster headache (CH). In this study, pupillary and cardiovascular responses to the cold pressor test (CPT) were monitored in CH patients during either an active phase of disease or a remission period in order to evaluate the oculocephalic and cardiovascular functioning of the autonomic nervous system in this form of idiopathic headache. CH patients showed a specific pattern of pupillary response on both sides during both phases of the disease. This response differed from that of controls because of an absent miosis. The pressor response to CPT was more marked in CH patients than in controls. Naloxone pretreatment caused specific and selective changes in both the pupillary and cardiovascular responses of CH patients. These data suggest a systemic sympathetic hyperactivation in response to CPT in CH patients. An oculocephalic sympathetic hypofunction is possibly associated as well as an altered opioid neuromodulation.
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