The cold pressor test in interictal migraine patients - different parasympathetic pupillary response indicates dysbalance of the cranial autonomic nervous system

Eren, O. E.; Ruscheweyh, R.; Schankin, Christoph Josef; Schoberl, F.; Straube, A. (2018). The cold pressor test in interictal migraine patients - different parasympathetic pupillary response indicates dysbalance of the cranial autonomic nervous system. BMC neurology, 18(1), p. 41. BioMed Central 10.1186/s12883-018-1043-2

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BACKGROUND: Data on autonomic nervous system (ANS) activations in migraine patients are quite controversial, with previous studies reporting over- and underactivation of the sympathetic as well as parasympathetic nervous system. In the present study, we explicitly aimed to assess the cranial ANS in migraine patients compared to healthy controls by applying the cold pressor test to a cohort of migraine patients in the interictal phase and measuring the pupillary response. METHODS: In this prospective observational study, a strong sympathetic stimulus was applied to 20 patients with episodic migraine in the interictal phase and 20 matched controls without migraine, whereby each participant dipped the left hand into ice-cold (4 degrees C) water for a maximum of 5 min (cold pressor test). At baseline, 2, and 5 min during the cold pressor test, infrared monocular pupillometry was applied to quantify pupil diameter and light reflex parameters. Simultaneously, heart rate and blood pressure were measured by the external brachial RR-method at distinct time intervals to look for at least clinically relevant changes of the cardiovascular ANS. RESULTS: There were no significant differences between the migraine patients and controls at baseline and after 2 min of sympathetic stimulation in all the measured pupillary and cardio-vascular parameters. However, at 5 min, pupillary light reflex (PLR) constriction velocity was significantly higher in migraineurs than in controls (5.59 +/- 0.73 mm/s vs. 5.16 +/- 0.53 mm/s; unpaired t-test p < 0.05), while both cardiovascular parameters and PLR dilatation velocity were similar in both groups at this time point. CONCLUSIONS: Our findings of an increased PLR constriction velocity after sustained sympathetic stimulation in interictal migraine patients suggest an exaggerated parasympathetic response of the cranial ANS. This indicates that brainstem parasympathetic dysregulation might play a significant role in migraine pathophysiology. More dedicated examination of the ANS in migraine patients might be of value for a deeper understanding of its pathophysiology.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Schankin, Christoph Josef


600 Technology > 610 Medicine & health




BioMed Central




Panagiota Milona

Date Deposited:

28 Mar 2019 06:58

Last Modified:

24 Oct 2019 14:07

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Autonomic Nervous System/*physiopathology Blood Pressure/physiology Case-Control Studies Cold Temperature Hand/physiology Heart Rate/physiology Humans Migraine Disorders/*physiopathology Prospective Studies Reflex, Pupillary/*physiology Autonomic nervous system (ANS) Cold pressor test (CPT) Migraine Parasympathetic nervous system (PSNS) Pupillometry Sympathetic nervous system (SNS)




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