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Sphenopalatine ganglion stimulation induces changes in cardiac autonomic regulation in cluster headache
Author(s) -
Barloese Mads,
Petersen Anja S.,
Guo Song,
Ashina Messoud,
Mehlsen Jesper,
Jensen Rigmor H.
Publication year - 2018
Publication title -
clinical physiology and functional imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.608
H-Index - 67
eISSN - 1475-097X
pISSN - 1475-0961
DOI - 10.1111/cpf.12484
Subject(s) - medicine , cluster headache , heart rate variability , stimulation , anesthesia , heart rate , ganglion , autonomic nervous system , cardiology , crossover study , blood pressure , anatomy , migraine , alternative medicine , pathology , placebo
Summary Introduction Cluster headache is characterized by attacks of severe unilateral pain accompanied by cranial and systemic autonomic changes. Our knowledge of the latter is imperfect. This study aimed to investigate the effect of low‐frequency sphenopalatine ganglion stimulation on cardiac autonomic regulation. Materials and methods In a double‐blind, randomized, sham‐controlled crossover design, patients received low‐frequency and sham stimulation. RR intervals were recorded, and heart rate variability was analysed (time‐domain, frequency‐domain, nonlinear parameters). Headache characteristics, including cranial autonomic symptoms, were recorded at baseline and every 10 min for 60 min. Results Sixteen patients were included. Changes in heart rate variability from baseline in the analysed parameters differed significantly between low‐frequency and sham stimulation. Initially, during low‐frequency stimulation, there was a greater increase in heart rate compared to sham ( P <0·05) and changes in the frequency, nonlinear and time domain ( P <0·05) reflecting a higher sympathetic tone. These preceded the observed cranial autonomic symptoms. Ten episodes of cluster‐like attacks were reported (six following low‐frequency stimulation, four following sham). During these, parasympathetic tone ( P <0·05) was higher compared to baseline. Conclusions In cluster headache patients subjected to low‐frequency and sham stimulation of the sphenopalatine ganglion, we found changes indicating higher sympathetic tone during low‐frequency stimulation preceding cranial autonomic symptoms or cluster pain. During cluster pain, regardless of stimulation parameters, we saw increased parasympathetic activity, congruent with previous reports. The results indicate involvement of cardiac autonomic regulation before and during cluster headache attacks.