Migraine with cranial autonomic features following surgically induced post-ganglionic sympathetic lesion
Article first published online: 8 AUG 2013
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Acta Neurologica Scandinavica
Volume 129, Issue 2, pages e6–e8, February 2014
How to Cite
Migraine with cranial autonomic features following surgically induced post-ganglionic sympathetic lesion. Acta Neurol Scand 2014: 129: e6–e8. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd., .
- Issue published online: 9 JAN 2014
- Article first published online: 8 AUG 2013
- Manuscript Accepted: 15 JUL 2013
- cranial autonomic features;
Although not typically considered as part of the clinical phenotype of migraine, cranial autonomic symptoms, such as lacrimation or conjunctival injection, can certainly occur. Their appearance can lead to the common misdiagnosis of sinus headache in clinical practice.
The patient presented developed post-ganglionic sympathetic denervation at the level of the superior cervical ganglion/carotid plexus. Her subsequent partial Horner's syndrome symptoms intensified during subsequent migraine attacks indicating increasing sympathetic autonomic dysfunction. At the time of the pain, recruitment and activation of the trigeminal autonomic reflex were demonstrated by lacrimation.
The clinical picture suggests peripheral unmasking of the underlying central trigeminal autonomic reflex that is active in migraine. Recognition of cranial autonomic symptoms in migraine is a key to confident differential diagnosis from trigeminal autonomic cephalalgias and from sinus-related headache disorders.