title: Prevalence of cranial autonomic parasympathetic symptoms in chronic migraine: Usefulness of a new scale.
abstract: BACKGROUND
  Cranial autonomic symptoms (CAS) seem to appear in around half of migraine patients.
  
  
  OBJECTIVE
  Our aim was to analyse the prevalence and profile of CAS, mainly of cranial autonomic parasympathetic symptoms (CAPS), in a series of patients with chronic migraine (CM) according the new criteria for autonomic symptoms in the current IHS classification.
  
  
  METHODS
  We recruited consecutive CM patients attending our headache clinic. Five CPAS were surveyed: lacrimation, conjunctival injection, eyelid oedema, ear fullness and nasal congestion. They were graded as 0 (absent), 1 (present and mild) and 2 (present and conspicuous); therefore the score in this CAPS scale ranges from 0 to 10 points. As a cranial autonomic sympathetic symptom (CSAS), we also asked about the presence of ptosis.
  
  
  RESULTS
  We interviewed 100 CM patients. Their mean age was 45 years (18-63 years); 93 were females. Eighteen had no CAPS, while 82 reported at least one CAPS. There were only six patients with scores higher than 5, the mean and median CAPS being 2.1 and 2, respectively. Prevalence of CAPS was lacrimation (49%), conjunctival injection (44%), eyelid oedema (39%), ear fullness (30%) and nasal congestion (20%). Ptosis was reported by 42.
  
  
  CONCLUSIONS
  These results, by using for the first time an easy quantitative scale, confirm that (mild) CAPS are not the exception but the rule in CM patients. The score in this CAPS scale could be of help as a further endpoint in clinical trials or to be correlated with potential biomarkers of parasympathetic activation in primary headaches.
authors.affiliation: Neuroscience Area, Service of Neurology, University Hospital Central de Asturias and INEUROPA, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Riesco
authors.affiliation: Neuroscience Area, Service of Neurology, University Hospital Central de Asturias and INEUROPA, Spain.
authors.forename: Angel I
authors.initials: AI
authors.lastname: Pérez-Alvarez
authors.affiliation: Neuroscience Area, Service of Neurology, University Hospital Central de Asturias and INEUROPA, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Verano
authors.affiliation: Neuroscience Area, Service of Neurology, University Hospital Central de Asturias and INEUROPA, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: García-Cabo
authors.affiliation: Neuroscience Area, Service of Neurology, University Hospital Central de Asturias and INEUROPA, Spain.
authors.forename: Juana
authors.initials: J
authors.lastname: Martínez-Ramos
authors.affiliation: Neuroscience Area, Service of Neurology, University Hospital Central de Asturias and INEUROPA, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Sánchez-Lozano
authors.affiliation: Neuroscience Area, Service of Neurology, University Hospital Central de Asturias and INEUROPA, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Cernuda-Morollón
authors.affiliation: Neuroscience Area, Service of Neurology, University Hospital Central de Asturias and INEUROPA, Spain juliopascual@telefonica.net.
authors.forename: Julio
authors.initials: J
authors.lastname: Pascual
mesh_terms: D000293:Adolescent; D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications*; D015995:Prevalence; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Chronic migraine; cranial autonomic symptoms; migraine