EVALUATION OF CARDIOVASCULAR AUTONOMIC FUNCTIONS IN MIGRAINE INDIVIDUALS IN TERTIARY CARE HOSPITAL
Authors: Arora Dimple 
Published: March 2020

Introduction: Migraine is a chronic neurological disorder characterized by recurrent disabling attacks of a headache with heterogeneous characterized by headache and hypersensitivity to sensory stimuli. Migraine attacks can depend upon from multitude of causative factors like diet, stress, fatigue, environmental changes and hormonal changes among others. It causes painful condition where individuals suffer from recurrent episodes of headache, which could be very severe. Pain sensations are discerned at various levels of the nervous system. Migraine as one of the top 20 leading neurological causes of disability according to WHO. About 12% of world’s population suffers from migraine and in India about of 1200 million populations there are 150-200 million migraineurs under treatment. About 20% in females and 6% in males has prevalence of migraine. Migraine is define as a heterogeneous disorder where there is variation in attacks in duration, frequency, severity, character and associated with physical and emotional disability. There is anxiety and panic disorder with sympathetic over activity with stress being the most important triggering factor. Migraine is also associated with ischemic stroke. Autonomic nervous system (ANS) plays central role in the cascade of events leading to migraine attack. 

Aim: The main aim of this study is to testing migraine on cardiac autonomic functions and finding the sympathetic or parasympathetic dysfunction in the heart that relates with the pathogenesis of migraine.

Material and methods: This study was carried out in the Dept. of Physiology at Chandulal Chandrakar Memorial Medical College Kachandur, Durg.. In this study total 60 individuals were included from ages 20 to 50 years with 30 in each group. Two groups were included in this study. Migraine fulfilling International Headache Society (IHS) criteria for migraine consists of newly diagnosed cases were included in this study. Participant’s individuals were instructed about various manoeuvres that would be employed and allowed to practice these manoeuvres. ECG was acquired by continuous recording for 5 min (320 s) which is needed for short term ECG analysis. Mean respiratory rate (RR), mean HR, total power, low frequency (LF), high frequency (HF), and LF/HF were estimated as proposed by Wang and Mishra(2006). Both the sympathetic and parasympathetic reactivity of ANS test were done with Orthostatic standing test (OST) as well as deep breathing (DB) which tests the intactness of parasympathetic function were performed after giving enough rest in between the tests. Isometric handgrip (IHG) test and cold pressor (CP) test were also performing for evaluating the sympathetic reactivity. 

Result: Total 30 patients were include in each group with mean age of control group 33.3 ± 5.6 and mean age of case group 30.9 ± 8.6. 24 cases in controls and 26 in cases group there is Female dominant which shown females are more prone to migraine. While compares the resting HR, diastolic blood pressure (DBP) and systolic blood pressure (SBP), between the cases and controls as shown in table no 1. There was not significant between Mean value for HR and mean value of DBP between cases and control. However mean value of SBP showed a P = 0.001 which was highly significant. The mean value of HR, RR interval and total power were also not statistically significant as P > 0.05.

Conclusion: Evaluation of cardiovascular functions in migraine reveals sympathetic hypofunction with an intact parasympathetic activity which as indicated by a significant reduction of sympathetic modulation of RR intervals. Better understanding of the role of sympathetic function and its dysfunction may help to prevent or successfully treat migraine and other headaches.

Keywords: Migraine, Autonomic function, Sympathetic activity, Headache