Thirteen young women with vascular headaches and unusually large pupils seen at the Mount Sinai Headache Clinic, were investigated for the presence of autonomic dysfunction. Two had had a significant cerebral event: one, a frontal infarct and one, a transient hemisphere deficit.

Measurement of the pupil size by pupillography showed only a small increase in size after Paredrine drops, indicating a partial saturation of iris adrenergic receptors.

Hypertension was present in three, and low blood pressure in five. Red blotching of the face, neck, and thorax was present in seven. Emotional disturbances ranging from neurosis to manic depressive episodes and schizoid features were present in all. Echocardiography performed in nine patients demonstrated a mitral valve prolapse in eight.

The severe headaches, as well as the mood swings and occasional cardiac complaints, responded well to propranolol (Inderal). This syndrome of autonomic dysfunction is thought to be a variant of “hyperdynamic ß adrenergic circulatory state” (1–2) affecting the vessels of the scalp, skin, heart, and iris.

The presence of M.V.P. places these migraine patients in a certain cardiac and neurologic risk category. Young patients with a diagnosis of ophthalmoplegic and hemiplegic migraine, should have a thorough cardiac evaluation in addition to CT Scan.