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Clinical Autonomic Research
Erschienen in: Clinical Autonomic Research 2/2021

10.11.2020 | Research Article

Synergistic but separable sensory changes in postural tachycardia syndrome and chronic migraine

verfasst von: Melissa M. Cortez, Leah Millsap, K. C. Brennan

Erschienen in: Clinical Autonomic Research | Ausgabe 2/2021

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Abstract

Purpose

Up to 90% of patients with postural tachycardia syndrome (PoTS) report headaches, and comorbid migraine headaches are common. Given this, pathophysiological interaction is possible, which may reveal key aspects of disease expression and treatment opportunities. We hypothesized that PoTS subjects—both with and without migraine—would show features of central sensitization, including allodynia and photophobia.

Methods

Eighty participants were evaluated, including 30 PoTS, 30 chronic migraine (CM), and 20 non-headache healthy controls (NH), using tilt table testing, psychophysical assessment of sensory sensitivity thresholds, and an online questionnaire to assess measures of headache burden and associated symptoms. Clinical characteristics and sensory thresholds were compared between disease groups and controls, as well as in a subgroup analysis within the PoTS group, based on headache phenotype.

Results

Sensory sensitivity thresholds were significantly lower and symptom scores were higher in both the PoTS and CM groups compared to controls. However, the patterns of expression differed between PoTS and CM, with pain threshold reductions in the forearm only of PoTS subjects (non-trigeminal sensory sensitization), compared to both periorbital and forearm sites in CM. Unexpectedly, light sensitivity thresholds were significantly lower in PoTS than in both CM and NH.

Conclusions

These findings reveal an underappreciated aspect of disease burden in PoTS, and suggest network sensitization similar to, but separable from, that of migraine. The presence of both photophobia and allodynia in PoTS is reflective of exteroceptive rather than strictly interoceptive disruption, and expands our fundamental understanding of the disorder.
Literatur
1.
Ojha A, Chelimsky TC, Chelimsky G (2011) Comorbidities in pediatric patients with postural orthostatic tachycardia syndrome. J Pediatr 158(1):20–23PubMed
2.
Khurana RK, Eisenberg L (2011) Orthostatic and non-orthostatic headache in postural tachycardia syndrome. Cephalalgia 31(4):409–415PubMed
3.
Heyer GL, Fedak EM, LeGros AL (2013) Symptoms predictive of postural tachycardia syndrome (POTS) in the adolescent headache patient. Headache 53(6):947–953PubMed
4.
Deb A et al (2015) A survey-based analysis of symptoms in patients with postural orthostatic tachycardia syndrome. Proc (Bayl Univ Med Cent) 28(2):157–159
5.
Lipton RB et al (2001) Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache 41(7):646–657PubMed
6.
Mosek A et al (1999) Autonomic dysfunction in migraineurs. Headache 39(2):108–117PubMed
7.
8.
Bigal ME et al (2008) Prevalence and characteristics of allodynia in headache sufferers: a population study. Neurology 70(17):1525–1533PubMedPubMedCentral
9.
Cooke L, Eliasziw M, Becker WJ (2007) Cutaneous allodynia in transformed migraine patients. Headache 47(4):531–539PubMed
10.
Louter MA et al (2013) Cutaneous allodynia as a predictor of migraine chronification. Brain 136(Pt 11):3489–3496PubMed
11.
Cortez MM et al (2017) Altered pupillary light response scales with disease severity in migrainous photophobia. Cephalalgia 37(8):801–811PubMedPubMedCentral
12.
Lovati C et al (2013) Central sensitization in photophobic and non-photophobic migraineurs: possible role of retino nuclear way in the central sensitization process. Neurol Sci 34(Suppl 1):S133–S135PubMed
13.
Noseda R, Burstein R (2013) Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, CSD, sensitization and modulation of pain. Pain 154(Suppl):1
14.
Landy S, Hoagland R, Hoagland NA (2012) Sumatriptan-naproxen migraine efficacy in allodynic patients: early intervention. Headache 52(1):133–139PubMed
15.
Mathew NT (2011) Pathophysiology of chronic migraine and mode of action of preventive medications. Headache 51(Suppl 2):84–92PubMed
16.
Haensch CA et al (2014) Small-fiber neuropathy with cardiac denervation in postural tachycardia syndrome. Muscle Nerve 50(6):956–961PubMed
17.
Mathew PG, Cutrer FM, Garza I (2016) A touchy subject: an assessment of cutaneous allodynia in a chronic migraine population. J Pain Res 9:101–104PubMedPubMedCentral
18.
Lipton RB et al (2016) Improving the detection of chronic migraine: Development and validation of Identify Chronic Migraine (ID-CM). Cephalalgia 36(3):203–215PubMed
19.
Sheldon RS et al (2015) 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm 12(6):e41-63PubMedPubMedCentral
20.
Freeman R et al (2011) Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Auton Neurosci 161(1–2):46–48PubMed
21.
Arnold AC, Ng J, Raj SR (2018) Postural tachycardia syndrome - Diagnosis, physiology, and prognosis. Auton Neurosci 215:3–11PubMedPubMedCentral
22.
Samaan Z et al (2010) Diagnosing migraine in research and clinical settings: the validation of the Structured Migraine Interview (SMI). BMC Neurol 10:7PubMedPubMedCentral
23.
The International Classification of Headache Disorders (2013) 3rd edition (beta version). Cephalalgia 33(9):629–808
24.
Stewart WF et al (2001) Development and testing of the Migraine Disability Assessment (MIDAS) Questionnaire to assess headache-related disability. Neurology 56(6 Suppl 1):S20–S28PubMed
25.
Rendas-Baum R et al (2014) Validation of the Headache Impact Test (HIT-6) in patients with chronic migraine. Health Qual Life Outcomes 12:117PubMedPubMedCentral
26.
Choi JY et al (2009) Usefulness of a photophobia questionnaire in patients with migraine. Cephalalgia 29(9):953–959PubMed
27.
28.
Jakubowski M et al (2005) Can allodynic migraine patients be identified interictally using a questionnaire? Neurology 65(9):1419–1422PubMed
29.
Sletten DM et al (2012) COMPASS 31: a refined and abbreviated composite autonomic symptom score. Mayo Clin Proc 87(12):1196–1201PubMedPubMedCentral
30.
31.
32.
Adams WH et al (2006) The evaluation of light sensitivity in benign essential blepharospasm. Am J Ophthalmol 142(1):82–87PubMed
33.
Burstein R et al (2000) An association between migraine and cutaneous allodynia. Ann Neurol 47(5):614–624PubMed
34.
Burstein R, Cutrer MF, Yarnitsky D (2000) The development of cutaneous allodynia during a migraine attack clinical evidence for the sequential recruitment of spinal and supraspinal nociceptive neurons in migraine. Brain 123(Pt 8):1703–1709PubMed
35.
Low PA (2003) Testing the autonomic nervous system. Semin Neurol 23(4):407–421PubMed
36.
Rea NA, Campbell CL, Cortez MM (2017) Quantitative assessment of autonomic symptom burden in postural tachycardia syndrome (POTS). J Neurol Sci 377:35–41PubMed
37.
Alstadhaug KB (2009) Migraine and the hypothalamus. Cephalalgia 29(8):809–817PubMed
38.
Cortelli P, Pierangeli G (2003) Chronic pain-autonomic interactions. Neurol Sci 24(Suppl 2):S68-70PubMed
39.
40.
Ahn AH, Brennan KC (2013) Unanswered questions in headache: so what is photophobia, anyway? Headache 53(10):1673–1674PubMedPubMedCentral
41.
Cortez MM et al (2020) Craniofacial autonomic dysfunction in migraine: implications for treatment and prognosis. J Neuroophthalmol 40(1):67–73PubMed
42.
Obermann M et al (2007) Prevalence of trigeminal autonomic symptoms in migraine: a population-based study. Cephalalgia 27(6):504–509PubMed
43.
Barbanti P et al (2016) The phenotype of migraine with unilateral cranial autonomic symptoms documents increased peripheral and central trigeminal sensitization A case series of 757 patients. Cephalalgia 36(14):1334–1340PubMed
44.
45.
Cambron M et al (2014) Autonomic function in migraine patients: ictal and interictal pupillometry. Headache 54(4):655–662PubMed
46.
Martín H et al (2011) Photoreactivity of the occipital cortex measured by functional magnetic resonance imaging-blood oxygenation level dependent in migraine patients and healthy volunteers: pathophysiological implications. Headache 51(10):1520–1528PubMed
47.
Brighina F et al (2015) Visual cortex hyperexcitability in migraine in response to sound-induced flash illusions. Neurology 84(20):2057–2061PubMed
48.
Demarquay G, Mauguiere F (2016) Central Nervous System Underpinnings of Sensory Hypersensitivity in Migraine: Insights from Neuroimaging and Electrophysiological Studies. Headache 56(9):1418–1438PubMed
49.
Bendtsen L (2000) Central sensitization in tension-type headache–possible pathophysiological mechanisms. Cephalalgia 20(5):486–508PubMed
50.
Woolf CJ (2011) Central sensitization: implications for the diagnosis and treatment of pain. Pain 152(3 Suppl):S2-15PubMed
51.
Latremoliere A, Woolf CJ (2009) Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain 10(9):895–926PubMedPubMedCentral
52.
Kaufman MR et al (2017) Overactive bladder and autonomic dysfunction: Lower urinary tract symptoms in females with postural tachycardia syndrome. Neurourol Urodyn 36(3):610–613PubMed
53.
Ramos ML et al (2018) Comorbidity between idiopathic overactive bladder and chronic migraine. Cephalalgia 38(3):581–584PubMed
54.
Georgescu D et al (2018) Migraine in young females with irritable bowel syndrome: still a challenge. Neuropsychiatr Dis Treat 14:21–28PubMed
55.
van Hemert S et al (2014) Migraine associated with gastrointestinal disorders: review of the literature and clinical implications. Front Neurol 5:241PubMedPubMedCentral
56.
Khurana RK (2014) Visceral sensitization in postural tachycardia syndrome. Clin Auton Res 24(2):71–76PubMed
57.
Boyer N et al (2017) Propranolol treatment prevents chronic central sensitization induced by repeated dural stimulation. Pain 158(10):2025–2034PubMed
58.
Ayzenberg I et al (2006) Central sensitization of the trigeminal and somatic nociceptive systems in medication overuse headache mainly involves cerebral supraspinal structures. Cephalalgia 26(9):1106–1114PubMed
59.
60.
Sandkuhler J, Gruber-Schoffnegger D (2012) Hyperalgesia by synaptic long-term potentiation (LTP): an update. Curr Opin Pharmacol 12(1):18–27PubMedPubMedCentral
61.
Kuner R, Flor H (2016) Structural plasticity and reorganisation in chronic pain. Nat Rev Neurosci 18(1):20–30PubMed
62.
Kuner R (2010) Central mechanisms of pathological pain. Nat Med 16(11):1258–1266PubMed
Metadaten
Titel
Synergistic but separable sensory changes in postural tachycardia syndrome and chronic migraine
verfasst von
Melissa M. Cortez
Leah Millsap
K. C. Brennan
Publikationsdatum
10.11.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
Clinical Autonomic Research / Ausgabe 2/2021
Print ISSN: 0959-9851
Elektronische ISSN: 1619-1560
DOI
https://doi.org/10.1007/s10286-020-00740-y

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