Synergistic but separable sensory changes in postural tachycardia syndrome and chronic migraine
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RESEARCH ARTICLE
Synergistic but separable sensory changes in postural tachycardia syndrome and chronic migraine Melissa M. Cortez1 · Leah Millsap2 · K. C. Brennan1 Received: 11 August 2020 / Accepted: 23 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Up to 90% of patients with postural tachycardia syndrome (PoTS) report headaches, and comorbid migraine headaches are common. Given this, pathophysiological interaction is possible, which may reveal key aspects of disease expression and treatment opportunities. We hypothesized that PoTS subjects—both with and without migraine—would show features of central sensitization, including allodynia and photophobia. Methods Eighty participants were evaluated, including 30 PoTS, 30 chronic migraine (CM), and 20 non-headache healthy controls (NH), using tilt table testing, psychophysical assessment of sensory sensitivity thresholds, and an online questionnaire to assess measures of headache burden and associated symptoms. Clinical characteristics and sensory thresholds were compared between disease groups and controls, as well as in a subgroup analysis within the PoTS group, based on headache phenotype. Results Sensory sensitivity thresholds were significantly lower and symptom scores were higher in both the PoTS and CM groups compared to controls. However, the patterns of expression differed between PoTS and CM, with pain threshold reductions in the forearm only of PoTS subjects (non-trigeminal sensory sensitization), compared to both periorbital and forearm sites in CM. Unexpectedly, light sensitivity thresholds were significantly lower in PoTS than in both CM and NH. Conclusions These findings reveal an underappreciated aspect of disease burden in PoTS, and suggest network sensitization similar to, but separable from, that of migraine. The presence of both photophobia and allodynia in PoTS is reflective of exteroceptive rather than strictly interoceptive disruption, and expands our fundamental understanding of the disorder. Keywords Dysautonomia · Photophobia · Allodynia · Orthostatic headache · Light sensitivity
Introduction Migraine and postural tachycardia syndrome (PoTS) frequently present together in clinical practice [1–3]. Up to 90% of PoTS patients report headaches, with both orthostatic and non-orthostatic manifestations [2, 4]. Migrainous headache is the most widely recognized primary headache in PoTS, though rates vary (28–96%) [1–4]. Even at the lower end of this range, rates of migraine among PoTS patients clearly exceed the estimated prevalence in the population (18% women, 7% men in the United States) [5]. * Melissa M. Cortez [email protected] 1
Department of Neurology, University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84108, USA
School of Medicine, University of Utah, Salt Lake City, UT, USA
2
While migraine is not classically considered an autonomic disorder, autonomic and sensory dysfunction are core features of the migraine attack [6]. Hypersensitivity to benign touch and envi
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