title: Migraine and autonomic nervous system function: a population-based, case-control study.
abstract: OBJECTIVE
  This study determines if measures of the function of the autonomic nervous system (ANS) differ in a population study of 80 migraine cases vs 85 controls matched for age, race, and sex.
  
  
  BACKGROUND
  The authors sought to confirm clinic-based studies suggesting that migraine is associated with abnormal ANS function.
  
  
  METHODS
  Resting systolic and diastolic blood pressure, Valsalva maneuver, heart rate variability (pulse rate [RR] variation) during deep breathing, and cardiovascular reactivity were measured during headache-free intervals. Migraineurs were subdivided into those with (n = 28) and without (n = 52) disabling headaches.
  
  
  RESULTS
  Resting diastolic, but not systolic, blood pressure was elevated in disabled (73.2 mm) compared with nondisabled cases (71.6 mm; p < 0.10) and controls (69.8 mm; p < 0.096). RR variation also was significantly different among the three groups. Disabled migraine cases (1.19) had significantly lower RR variation compared with nondisabled migraine cases (1.26; p < 0.001) and controls (1.26; p < 0.001). The Valsalva ratio and mean circular resultant were lower in disabled cases compared with other migraine cases and with controls, but the differences were not statistically significant. No differences were found between the three groups when comparing blood pressure response to a psychological stressor.
  
  
  CONCLUSIONS
  Migraineurs with disabling attacks may be prone to ANS hypofunction. These findings may suggest that ANS dysfunction either may be a risk factor for migraine headaches or be a consequence of frequent disabling attacks. Moreover, ANS dysfunction and migraine may share a common neural substrate.
authors.affiliation: Department of Epidemiology, the Johns Hopkins School of Hygiene and Public Health, Baltimore, MD, USA. ashechter@hotmail.com
authors.forename: Aaron
authors.initials: A
authors.lastname: Shechter
authors.forename: Walter F
authors.initials: WF
authors.lastname: Stewart
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Silberstein
authors.forename: Richard B
authors.initials: RB
authors.lastname: Lipton
mesh_terms: D000328:Adult; D017677:Age Distribution; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001794:Blood Pressure; D016022:Case-Control Studies; D004185:Disability Evaluation; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology / Q000503:physiopathology*; D012307:Risk Factors; D017678:Sex Distribution; D014636:Valsalva Maneuver