title: The phenotype of migraine with unilateral cranial autonomic symptoms documents increased peripheral and central trigeminal sensitization. A case series of 757 patients.
abstract: BACKGROUND
  Migraine with unilateral cranial autonomic symptoms (UAS) is a putative migraine endophenotype with convincing response to trigeminal-targeted treatments that still needs a thorough characterization.
  
  
  OBJECTIVE
  The objective of this article is to carefully investigate the clinical phenotype of migraine with UAS in a large group of patients for more accurate migraine diagnoses, improved clinical management, and better outcome prediction.
  
  
  METHODS
  We studied 757 consecutive episodic and chronic migraineurs in a tertiary headache clinic with face-to-face interviews, detailing in depth their lifestyle, sociodemographic and headache characteristics.
  
  
  RESULTS
  Migraineurs with UAS (37.4%) differed from the general migraine population with respect to longer attack duration (OR = 2.47, p < 0.02, having >72-hour long attacks), more strictly unilateral (OR = 3.18, p < 0.001) and severe headache (OR = 1.72, p = 0.011), more frequent allodynia (OR = 3.03, p < 0.001) and photophobia (OR = 1.87, p = 0.019).
  
  
  CONCLUSIONS
  Migraine patients with UAS are characterized not only by symptoms due to intense peripheral trigeminal activation but also to central sensitization. Our study broadens the knowledge on the clinical and phenotypic characteristics of migraine with UAS, suggests pathophysiological implications, and supports the need for future prospective clinical studies.
authors: Headache and Pain Unit-IRCCS San Raffaele Pisana, Italy piero.barbanti@sanraffaele.it.
authors: P
authors: P
authors: Barbanti
authors: Headache and Pain Unit-IRCCS San Raffaele Pisana, Italy.
authors: C
authors: C
authors: Aurilia
authors: Area of Clinical and Molecular Epidemiology-IRCCS San Raffaele Pisana, Italy.
authors: V
authors: V
authors: Dall'Armi
authors: Headache and Pain Unit-IRCCS San Raffaele Pisana, Italy.
authors: G
authors: G
authors: Egeo
authors: Headache and Pain Unit-IRCCS San Raffaele Pisana, Italy.
authors: L
authors: L
authors: Fofi
authors: Area of Clinical and Molecular Epidemiology-IRCCS San Raffaele Pisana, Italy.
authors: S
authors: S
authors: Bonassi
mesh_terms: D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D003391:Cranial Nerves / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D010641:Phenotype; D014276:Trigeminal Nerve / Q000473:pathology*
keywords: Migraine; cranial autonomic symptoms; disability; pathophysiology; trigemino-autonomic reflex