METHODS: Migraineurs seen in a tertiary headache service between 2014 and 2018 (n = 340): cohort one, and a separate cohort of headache patients seen between 2014-May 2021 reporting voice change, or throat swelling, or both, as CAS were selected (n = 64): cohort two. We performed a service evaluation of our records regarding age, sex, diagnosis, headache and CAS frequency and laterality as acquired from the first consultation, during which a detailed headache history is taken by a headache trained physician.
RESULTS: Cohort 1: Mean age 43 (range 14-94, SD 15). The most common diagnosis was chronic migraine (78%). Median monthly headache frequency was 26 days (IQR 15-75). At least one CAS was reported in 74%, with a median of two (IQR 0-3). The most common were nasal congestion (32%), lacrimation (31%) and aural fullness (25%). Most patients reported their most common headache as unilateral (80%) and with it strictly unilateral CAS (64%). There was a positive association between headache and CAS laterality (χ21 = 20.7, P < 0.001), with a positive correlation between baseline headache frequency and number of CAS reported (r = 0.11, P = 0.047). Cohort two: mean age 49 (range 23-83, SD 14). Diagnoses were chronic migraine (50%), chronic cluster headache (11%), undifferentiated continuous lateralised headache (9%), SUNCT/SUNA (8%), hemicrania continua (8%), episodic migraine (8%), episodic cluster headache (3%) and trigeminal neuropathies (3%). Most (89%) described trigeminal distribution pain; 25% involving all three divisions. Throat swelling was reported by 54, voice change by 17, and both by 7. The most common CAS reported were lacrimation (n = 47), facial swelling (n = 45) and rhinorrhoea (n = 37). There was significant agreement between the co-reporting of throat swelling (χ21 = 7.59, P = 0.013) and voice change (χ21 = 6.49, P = 0.02) with aural fullness.
CONCLUSIONS: CAS are common in migraine, are associated with increasing headache frequency and tend to lateralise with headache. Voice change and throat swelling should be recognized as possible parasympathetically-mediated CAS. They may be co-associated and associated with aural fullness, suggesting a broadly somatotopic endophenotype.
方法:2014年至2018年在三级头痛服务中发现的偏头痛患者(n=340):队列1,2014年至2021年5月期间观察到的另一批头痛患者报告语音变化,或者喉咙肿胀,或者两者兼而有之,作为CAS选择(n=64):队列2。我们对我们的年龄记录进行了服务评估,性别,诊断,从第一次咨询中获得的头痛和CAS频率和偏侧性,在此期间,由受过头痛训练的医生进行详细的头痛病史。
结果:队列1:平均年龄43(范围14-94,SD15)。最常见的诊断是慢性偏头痛(78%)。平均每月头痛频率为26天(IQR15-75)。至少有一个CAS报告占74%,中位数为2(IQR0-3)。最常见的是鼻塞(32%),流泪(31%)和听觉丰满(25%)。大多数患者报告其最常见的头痛为单侧(80%),并严格为单侧CAS(64%)。头痛与CAS侧性呈正相关(χ21=20.7,P<0.001),基线头痛频率与报告的CAS数量之间呈正相关(r=0.11,P=0.047)。队列二:平均年龄49(范围23-83,SD14)。诊断为慢性偏头痛(50%),慢性丛集性头痛(11%),未分化的持续性侧方性头痛(9%),SUNCT/SUNA(8%),半乳连续型(8%),发作性偏头痛(8%),阵发性丛集性头痛(3%)和三叉神经病变(3%)。大多数(89%)描述了三叉神经分布疼痛;25%涉及所有三个部门。喉咙肿胀报告为54,声音变化为17,两者均为7。最常见的CAS报告为流泪(n=47),面部肿胀(n=45)和鼻漏(n=37)。咽喉肿胀(χ21=7.59,P=0.013)和语音变化(χ21=6.49,P=0.02)与听觉丰满之间存在显着一致性。
结论:CAS在偏头痛中很常见,与头痛频率增加有关,并倾向于偏侧头痛。语音变化和喉咙肿胀应被认为是可能的副交感神经介导的CAS。它们可能与听觉丰满相关,提示广泛的体位内表型。