Evaluation of Oculocephalic Sympathetic Function in Vascular Headache Syndromes

Part I: Methods of Evaluation


Craig Watson, M.D., Ph.D., Sacramento Headache and Neurology Clinic, 2600 Capitol Avenue, Suite 211, Sacramento, CA 95816.



Patients presenting with a unilateral ptosis and miosis offer a differential diagnostic challenge which ranges from “simple” anisocoria, a benign condition, through a variety of vascular headache syndromes, to life threatening diseases of the peripheral or central nervous system. The resolution of this dilemma often rests with the documentation of clinically questionable findings and the localization of the lesion along the oculocephalic sympathetic pathway.

In the first of our papers, we review simple bedside autonomic tests which can easily be used to document and localize lesions of the oculocephalic sympathetic pathway. We also briefly review the relevant neurotransmitter, neuroanatomical, and neurophysiological information necessary to accurately interpret the results of these tests.