title: Evaluation of interictal autonomic function during attack and remission periods in cluster headaches.
abstract: OBJECTIVE
  To investigate which part of the autonomic system is mainly involved and assess the sensitivity of face sympathetic skin response in cluster headache.
  
  
  METHODS
  The study sample consisted of 19 drug-free cluster headache patients (16 males, three females) and 19 healthy volunteers. Demographic features and pain characteristics were thoroughly identified. Dysautonomic symptoms were evaluated during attack and remission periods of cluster headache patients. Orthostatic hypotension, R-R interval variation and sympathetic skin responses obtained from the face and four extremities were evaluated and the sensitivity of face sympathetic skin responses was assessed in contrast to extremity sympathetic skin responses.
  
  
  RESULTS
  All sympathetic skin responses of face and extremities could be obtained during attack and remission periods. On the symptomatic side, mean latency of face sympathetic skin responses was longer compared to the asymptomatic side and controls (p = 0.02, p = 0.004). There were no differences in latency or amplitude of extremity sympathetic skin responses between symptomatic and asymptomatic sides and controls. No significant relationship was determined between sympathetic skin responses, R-R interval variation, orthostatic hypotension and cluster headache clinical features.
  
  
  CONCLUSIONS
  Sympathetic hypoactivity of the face seems to predominate the pathophysiology of cluster headache. Face sympathetic skin responses might be more sensitive compared to extremity sympathetic skin response in demonstrating dysautonomic symptoms in cluster headache patients.
authors.affiliation: Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Altiokka
authors.affiliation: Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey.
authors.forename: Belgin
authors.initials: B
authors.lastname: Mutluay
authors.affiliation: Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey ayhan.koksal@yahoo.com.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Koksal
authors.affiliation: Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey.
authors.forename: Beyza
authors.initials: B
authors.lastname: Ciftci-Kavaklioglu
authors.affiliation: Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey.
authors.forename: Musa
authors.initials: M
authors.lastname: Ozturk
authors.affiliation: Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey.
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Altunkaynak
authors.affiliation: Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey.
authors.forename: Sevim
authors.initials: S
authors.lastname: Baybas
authors.affiliation: Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Turkey.
authors.forename: Aysun
authors.initials: A
authors.lastname: Soysal
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000502:physiology; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D003027:Cluster Headache / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D005712:Galvanic Skin Response / Q000502:physiology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012074:Remission Induction
keywords: Autonomic involvement; R-R interval variation; cluster headache; primary headache; sympathetic skin response