The Role of Vasomotor and Autonomic Changes in Migraine

Dear Editor, I read with great interest the article recently published in Pain Medicine by Dogru et al. [1], evaluating endothelial and autonomic functions in migraine patients. They found that the increased flow mediated dilation ratios, indicating endothelial dysfunction in migraineurs. Through heart rate variability measurements, they found associations between the presence of aura and increased parasympathetic activity, as well as between the presence of headache and increased sympathetic activity. They put forward a hypothetical suggestion that this autonomic dysregulation might be due to the effect of cortical spreading on depression propagation on the autonomic nervous system (ANS) in migraine patients. However, I would like to add some points that may be taken into consideration. The ANS has also been known to be involved in conduction characteristics because of the rich autonomic innervation of the heart [2]. As migraine symptoms are commonly associated with autonomic accompaniments,...