Abstract：
BACKGROUND: Whilst cranial autonomic symptoms (CAS) are typically associated with trigeminal autonomic cephalalgias (TAC\'s), they have also been reported in migraine. Identification and understanding of these symptoms in migraine is important to ensure timely diagnosis and effective management.
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.
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.
摘要：
背景：虽然颅骨自主神经症状（CAS）通常与三叉神经自主性头痛（TAC）有关，他们也有报告在偏头痛。识别和了解偏头痛的这些症状对于确保及时诊断和有效管理很重要。
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。
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。
